Jun Nakata, Takeshi Yamamoto, Keita Saku, Yuki Ikeda, Takashi Unoki, Kuniya Asai
Cardiogenic shock is a complex and diverse pathological condition characterized by reduced myocardial contractility. The goal of treatment of cardiogenic shock is to improve abnormal hemodynamics and maintain adequate tissue perfusion in organs. If hypotension and insufficient tissue perfusion persist despite initial therapy, temporary mechanical circulatory support (t-MCS) should be initiated. This decade sees the beginning of a new era of cardiogenic shock management using t-MCS through the accumulated experience with use of intra-aortic balloon pump (IABP) and venoarterial extracorporeal membrane oxygenation (VA-ECMO), as well as new revolutionary devices or systems such as transvalvular axial flow pump (Impella) and a combination of VA-ECMO and Impella (ECPELLA) based on the knowledge of circulatory physiology...
December 19, 2023: Journal of Intensive Care
Mark M G Mulder, Joep Schellens, Jan-Willem E M Sels, Frank van Rosmalen, Anne-Marije Hulshof, Femke de Vries, Ruud Segers, Casper Mihl, Walther N K A van Mook, Aalt Bast, Henri M H Spronk, Yvonne M C Henskens, Iwan C C van der Horst, Hugo Ten Cate, Leon J Schurgers, Marjolein Drent, Bas C T van Bussel
BACKGROUND: Extra-hepatic vitamin K-status, measured by dephosphorylated uncarboxylated matrix Gla protein (dp-ucMGP), maintains vascular health, with high levels reflecting poor vitamin K status. The occurrence of extra-hepatic vitamin K deficiency throughout the disease of COVID-19 and possible associations with pulmonary embolism (PE), and mortality in intensive care unit (ICU) patients has not been studied. The aim of this study was to investigated the association between dp-ucMGP, at endotracheal intubation (ETI) and both ICU and six months mortality...
December 18, 2023: Journal of Intensive Care
Tuğce Dinç Dogan, Vera Guttenthaler, Alexa Zimmermann, Andrea Kunsorg, Merve Özlem Dinç, Niko Knuelle, Jens-Christian Schewe, Maria Wittmann
BACKGROUND: Postoperative delirium is a common complication in patients after cardiac surgery, especially in older patients, and can manifest as a disturbance of attention and consciousness. It can lead to increased postoperative morbidity, prolonged need for care, and mortality. The presented study investigates whether the occurrence of postoperative delirium after cardiac surgery can be prevented by a multisensory stimulation. It was conducted as a prospective, randomized, controlled, non-pharmacological intervention study in the years 2021 and 2022 at the University Hospital Bonn in Germany...
December 13, 2023: Journal of Intensive Care
Keibun Liu, Mohan Gurjar, Ricardo Kenji Nawa, Chi Ryang Chung, Kensuke Nakamura
No abstract text is available yet for this article.
December 7, 2023: Journal of Intensive Care
Saori Ikumi, Takuya Shiga, Takuya Ueda, Eichi Takaya, Yudai Iwasaki, Yu Kaiho, Kunio Tarasawa, Kiyohide Fushimi, Yukiko Ito, Kenji Fujimori, Masanori Yamauchi
BACKGROUND: Japan has four types of intensive care units (ICUs) that are divided into two categories according to the management fee charged per day: ICU management fees 1 and 2 (ICU1/2) (equivalent to high-intensity staffing) and 3 and 4 (ICU3/4) (equivalent to low-intensity staffing). Although ICU1/2 charges a higher rate than ICU3/4, no cost-effectiveness analysis has been performed for ICU1/2. This study evaluated the clinical outcomes and cost-effectiveness of ICU1/2 compared with those of ICU3/4...
December 4, 2023: Journal of Intensive Care
Han Chen, Zhi-Zhong Chen, Shu-Rong Gong, Rong-Guo Yu
BACKGROUND: Limiting driving pressure and mechanical power is associated with reduced mortality risk in both patients with and without acute respiratory distress syndrome. However, it is still poorly understood how the intensity of mechanical ventilation and its corresponding duration impact the risk of mortality. METHODS: Critically ill patients who received mechanical ventilation were identified from the Medical Information Mart for Intensive Care (MIMIC)-IV database...
November 29, 2023: Journal of Intensive Care
Xiawei Shi, Yangyang Shi, Liming Fan, Jia Yang, Hao Chen, Kaiwen Ni, Junchao Yang
BACKGROUND: Heterogeneity among critically ill patients undergoing invasive mechanical ventilation (IMV) treatment could result in high mortality rates. Currently, there are no well-established indicators to help identify patients with a poor prognosis in advance, which limits physicians' ability to provide personalized treatment. This study aimed to investigate the association of oxygen saturation index (OSI) trajectory phenotypes with intensive care unit (ICU) mortality and ventilation-free days (VFDs) from a dynamic and longitudinal perspective...
November 29, 2023: Journal of Intensive Care
Lauren T Thornton, John J Marini
The effort to minimize VILI risk must be multi-pronged. The need to adequately ventilate, a key determinant of hazardous power, is reduced by judicious permissive hypercapnia, reduction of innate oxygen demand, and by prone body positioning that promotes both efficient pulmonary gas exchange and homogenous distributions of local stress. Modifiable ventilator-related determinants of lung protection include reductions of tidal volume, plateau pressure, driving pressure, PEEP, inspiratory flow amplitude and profile (using longer inspiration to expiration ratios), and ventilation frequency...
November 20, 2023: Journal of Intensive Care
Marco Lorenz, Kristina Fuest, Bernhard Ulm, Julius J Grunow, Linus Warner, Annika Bald, Vanessa Arsene, Michael Verfuß, Nils Daum, Manfred Blobner, Stefan J Schaller
BACKGROUND: This study aimed to assess the impact of duration of early mobilisation on survivors of critical illness. The hypothesis was that interventions lasting over 40 min, as per the German guideline, positively affect the functional status at ICU discharge. METHODS: Prospective single-centre cohort study conducted in two ICUs in Germany. In 684 critically ill patients surviving an ICU stay > 24 h, out-of-bed mobilisation of more than 40 min was evaluated...
November 20, 2023: Journal of Intensive Care
Chun Lin, Wen-Cheng Chao, Kai-Chih Pai, Tsung-Ying Yang, Chieh-Liang Wu, Ming-Cheng Chan
BACKGROUND: Neuromuscular blockade agents (NMBAs) can be used to facilitate mechanical ventilation in critically ill patients. Accumulating evidence has shown that NMBAs may be associated with intensive care unit (ICU)-acquired weakness and poor outcomes. However, the long-term impact of NMBAs on mortality is still unclear. METHODS: We conducted a retrospective analysis using the 2015-2019 critical care databases at Taichung Veterans General Hospital, a referral center in central Taiwan, as well as the Taiwan nationwide death registry profile...
November 17, 2023: Journal of Intensive Care
Tomoyo Saito, Mineji Hayakawa, Osamu Kumano, Yoshinori Honma, Mone Murashita, Jun Kato, Syouki Fukui, Masaki Takahashi, Yuki Takahashi, Takumi Tsuchida, Asumi Mizugaki, Shuhei Takauji, Mariko Hayamizu, Tomonao Yoshida, Kenichi Katabami, Takeshi Wada, Kunihiko Maekawa
BACKGROUND: Unfractionated heparin (UFH) is primarily monitored using activated partial thromboplastin time (APTT). However, the recent introduction of anti-activated factor X (anti-Xa) activity testing has provided a direct evaluation of Xa inhibition by anticoagulants. This study aimed to investigate discrepancies between APTT and anti-Xa activity during UFH monitoring in critically ill patients and explore their underlying causes. METHODS: This study analyzed 271 pairs of laboratory test results from blood samples of 99 critically ill patients receiving continuous intravenous UFH...
November 16, 2023: Journal of Intensive Care
Sira M Baumann, Natalie J Kruse, Paulina S C Kliem, Simon A Amacher, Sabina Hunziker, Tolga D Dittrich, Fabienne Renetseder, Pascale Grzonka, Raoul Sutter
OBJECTIVES: This review examined studies regarding the implementation and translation of patients' advance directives (AD) in intensive care units (ICUs), focusing on practical difficulties and obstacles. METHODS: The digital PubMed and Medline databases were screened using predefined keywords to identify relevant prospective and retrospective studies published until 2022. RESULTS: Seventeen studies from the United States, Europe, and South Africa (including 149,413 patients and 1210 healthcare professionals) were identified...
November 15, 2023: Journal of Intensive Care
Harri Hemilä, Elizabeth Chalker
No abstract text is available yet for this article.
November 13, 2023: Journal of Intensive Care
Matsuyuki Doi, Naoki Takahashi, Rumi Nojiri, Takehiko Hiraoka, Yusuke Kishimoto, Shinichi Inoue, Nobuyo Oya
BACKGROUND: The aims of this study were to evaluate the efficacy, safety, and pharmacokinetics (PK) of continuous intravenous administration of remifentanil in mechanically ventilated patients in the intensive care unit (ICU). METHODS: This was a multicenter, randomized, double-blinded, fentanyl-controlled, non-inferiority phase 3 study. Patients aged ≥ 20 years requiring 6 h to 10 days mechanical ventilation in an ICU and requiring pain relief were randomly assigned in a 1:1 ratio to receive either remifentanil (n = 98) or fentanyl (n = 98)...
November 13, 2023: Journal of Intensive Care
Weerachai Chaijamorn, Sathian Phunpon, Thanompong Sathienluckana, Taniya Charoensareerat, Sutthiporn Pattharachayakul, Dhakrit Rungkitwattanakul, Nattachai Srisawat
BACKGROUND: Lacosamide is one of the anticonvulsants used in critically ill patients. This study aimed to suggest appropriate lacosamide dosing regimens in critically ill patients receiving continuous renal replacement therapy (CRRT) via Monte Carlo simulations. METHODS: Mathematical models were created using published demographic and pharmacokinetics in adult critically ill patients. CRRT modalities with different effluent rates were added into the models. Lacosamide regimens were evaluated on the probability of target attainment (PTA) using pharmacodynamic targets of trough concentrations and area under the curve within a range of 5-10 mg/L and 80...
November 9, 2023: Journal of Intensive Care
Yaxi Wang, Gang Wang, Yuxiao Zhao, Cheng Wang, Chen Chen, Yaoyao Ding, Jing Lin, Jingjing You, Silong Gao, Xufeng Pang
BACKGROUND: This study aimed to apply the backpropagation neural network (BPNN) to develop a model for predicting multidrug-resistant organism (MDRO) infection in critically ill patients. METHODS: This study collected patient information admitted to the intensive care unit (ICU) of the Affiliated Hospital of Qingdao University from August 2021 to January 2022. All patients enrolled were divided randomly into a training set (80%) and a test set (20%). The least absolute shrinkage and selection operator and stepwise regression analysis were used to determine the independent risk factors for MDRO infection...
November 9, 2023: Journal of Intensive Care
Nozomi Takahashi, Yutaka Kondo, Kenji Kubo, Moritoki Egi, Ken-Ichi Kano, Yoshiyasu Ohshima, Taka-Aki Nakada
BACKGROUND: The efficacy of therapeutic drug monitoring (TDM)-based antimicrobial dosing optimization strategies on pharmacokinetics/pharmacodynamics and specific drug properties for critically ill patients is unclear. Here, we conducted a systematic review and meta-analysis of randomized controlled trials to evaluate the effectiveness of TDM-based regimen in these patients. METHODS: Articles from three databases were systematically retrieved to identify relevant randomized control studies...
November 8, 2023: Journal of Intensive Care
Takeshi Unoki, Kei Hayashida, Yusuke Kawai, Shunsuke Taito, Morihide Ando, Yuki Iida, Fumihito Kasai, Tatsuya Kawasaki, Ryo Kozu, Yutaka Kondo, Masakazu Saitoh, Hideaki Sakuramoto, Nobuyuki Sasaki, Ryuichi Saura, Kensuke Nakamura, Akira Ouchi, Saiko Okamoto, Masatsugu Okamura, Tomoki Kuribara, Akira Kuriyama, Yujiro Matsuishi, Norimasa Yamamoto, Shodai Yoshihiro, Taisuke Yasaka, Ryo Abe, Takahito Iitsuka, Hiroyasu Inoue, Yuki Uchiyama, Satoshi Endo, Kazuki Okura, Kohei Ota, Takahisa Otsuka, Daisuke Okada, Kengo Obata, Yukiko Katayama, Naoki Kaneda, Mio Kitayama, Shunsuke Kina, Ryuichi Kusaba, Masanari Kuwabara, Naoki Sasanuma, Masahiro Takahashi, Chihiro Takayama, Naonori Tashiro, Junko Tatsuno, Takahiko Tamura, Mitsuhiro Tamoto, Asuka Tsuchiya, Yusuke Tsutsumi, Tadashi Nagato, Chihiro Narita, Tomohiro Nawa, Tadayoshi Nonoyama, Masatoshi Hanada, Kotaro Hirakawa, Akiko Makino, Hirotaka Masaki, Ryosuke Matsuki, Shinya Matsushima, Wataru Matsuda, Saori Miyagishima, Masaru Moromizato, Naoya Yanagi, Kota Yamauchi, Yuhei Yamashita, Natsuhiro Yamamoto, Keibun Liu, Yuki Wakabayashi, Shinichi Watanabe, Hiroshi Yonekura, Nobuto Nakanishi, Tetsuya Takahashi, Osamu Nishida
Providing standardized, high-quality rehabilitation for critically ill patients is a crucial issue. In 2017, the Japanese Society of Intensive Care Medicine (JSICM) promulgated the "Evidence-Based Expert Consensus for Early Rehabilitation in the Intensive Care Unit" to advocate for the early initiation of rehabilitations in Japanese intensive care settings. Building upon this seminal work, JSICM has recently conducted a rigorous systematic review utilizing the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology...
November 7, 2023: Journal of Intensive Care
Hiroyuki Ohbe, Takashi Tagami, Akira Endo, Shigeki Miyata, Hiroki Matsui, Kiyohide Fushimi, Shigeki Kushimoto, Hideo Yasunaga
BACKGROUND: Previous studies have reported conflicting results regarding fresh frozen plasma (FFP)-to-red blood cell (RBC) ratio and platelet-to-RBC ratio on outcomes for massive transfusion for trauma. Moreover, nationwide data on massive transfusion practices for trauma in the real-world clinical setting are scarce. This study aimed to examine the nationwide practice patterns and trends in massive transfusion for trauma in Japan using a national administrative, inpatient database. METHOD: We identified patients who underwent emergency hospitalization for trauma and received massive transfusion, defined as administration of at least 20 units of RBC within the first 2 days of admission, using the nationwide inpatient database, which covers approximately 90% of all tertiary emergency hospitals in Japan, between 2011 and 2020...
October 18, 2023: Journal of Intensive Care
Nobuyasu Awano, Taisuke Jo, Takehiro Izumo, Minoru Inomata, Yu Ito, Kojiro Morita, Hiroki Matsui, Kiyohide Fushimi, Hirokazu Urushiyama, Takahide Nagase, Hideo Yasunaga
BACKGROUND: The prognosis for acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) is poor, and there is no established treatment. Hence, we aimed to investigate the effectiveness of a polymyxin B-immobilised fibre column (PMX) for the treatment of AE-IPF. METHODS: Data were retrospectively collected from the Japanese Diagnosis Procedure Combination database from 1 July 2010 to 31 March 2018. We identified adult patients with idiopathic pulmonary fibrosis who received high-dose methylprednisolone (mPSL) therapy and mechanical ventilation upon admission...
October 11, 2023: Journal of Intensive Care
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