A Saade, G Moratelli, E Azoulay, M Darmon
OBJECTIVE: We assessed herpesvirus reactivation in severe SARS-CoV-2 infection. METHODS: Retrospective study including consecutive patients admitted to an onco-hematology intensive care unit (ICU) for severe COVID-19. Replication of EBV, CMV, and HSV was evaluated. Competing risk analyses were used to assess the cumulative risk of viral reactivation, and time-dependent Cox and Fine and Gray models to assess risk factors for viral reactivation. RESULTS: Among 100 patients, 38 were immunocompromised...
July 28, 2021: Infectious diseases now
Woon Yong Kwon, Yoon Sun Jung, Gil Joon Suh, Taekyun Kim, Hyeongkyu Kwak, Taekwon Kim, Jeong Yeon Kim, Min Sung Lee, Kyung Su Kim, Jonghwan Shin, Hui Jai Lee, Kyung Min You
AIM: of study To investigate whether regional cerebral oxygen saturation (rSO2 ) differs in out-of-hospital cardiac arrest (OHCA) survivors undergoing targeted temperature management (TTM) 36℃ versus 33℃. METHODS: A randomized clinical trial was conducted at intensive care units in two referral hospitals. Fifty-seven comatose OHCA survivors were randomized into either a 36℃ or 33℃ group. Patients were cooled and maintained at an oesophageal temperature of either 36℃ or 33℃ for 24 hours, rewarmed at a rate of 0...
July 28, 2021: Resuscitation
Amirah H Daher, Iyad Al-Ammouri, Nour Ghanem, Mahmood Abu Zahra, Enas Zayadneh, Montaha Al-Iede
BACKGROUND: The aim of this study is to describe the main causes of admission to a general Pediatric Intensive Care Unit (PICU), as well as main causes of mortality in this population. In addition, we describe the percentage of patients who died following a failed cardiopulmonary resuscitation (CPR) vs. Do Not Resuscitate (DNR) orders METHODS: This is a retrospective cohort study with chart review of admissions and mortality cases that occurred in the pediatric intensive care unit. Mortality rates in the pediatric admissions are reported with description of demographics, diagnosis, length of stay, use of mechanical ventilation, use of vasoactive agents, preexisting comorbidities, the presence of a DNR order, and final cause of mortality...
July 31, 2021: Pediatrics International: Official Journal of the Japan Pediatric Society
Lisa-Maria Steurer, Gerald Schlager, Kambis Sadeghi, Johann Golej, Dominik Wiedemann, Michael Hermon
BACKGROUND: Hemadsorption via the cytokine-adsorber CytoSorb® has successfully been used as an adjunctive method in adults, mainly for the purpose of immunomodulation under acute inflammatory conditions such as sepsis and cardiac surgery. In recent years, there has been growing interest in its use in pediatric intensive care to improve outcomes in patients with multiple organ failure following inflammatory illness. Literature on the application of CytoSorb® in neonatal and pediatric patients is scarce, though the implication is that it could be an effective last-resort treatment option in critically ill pediatric patients...
July 31, 2021: Artificial Organs
Diana MacKay, Natasha Freeman, Jacqueline A Boyle, Sandra Campbell, Anna McLean, David Peiris, Sumaria Corpus, Christine Connors, Elizabeth Moore, Mark Wenitong, Bronwyn Silver, H David McIntyre, Jonathan E Shaw, Alex Brown, Renae Kirkham, Louise Maple-Brown
OBJECTIVE: To identify successes to date and opportunities for improvement in the implementation of a complex health systems intervention aiming to improve antenatal and postpartum care and health outcomes for women with hyperglycemia in pregnancy in regional and remote Australia. METHODS: A qualitative evaluation, underpinned by the RE-AIM framework (reach, effectiveness, adoption, implementation, maintenance), was conducted mid-intervention. Semi-structured interviews were conducted with 45 participants, including clinicians; regional policymakers and managers; and study implementation staff...
July 31, 2021: International Journal of Gynaecology and Obstetrics
Dominique D Benoit, Esther N van der Zee, Michael Darmon, An K L Reyners, Victoria Metaxa, Djamel Mokart, Alexander Wilmer, Pieter Depuydt, Andreas Hvarfner, Katerina Rusinova, Jan G Zijlstra, François Vincent, Dimitrios Lathyris, Anne-Pascale Meert, Jacques Devriendt, Emma Uyttersprot, Erwin J O Kompanje, Ruth Piers, Elie Azoulay
BACKGROUND: Whether Intensive Care Unit (ICU) clinicians display unconscious bias towards cancer patients is unknown. The aim of this study was to compare the outcomes of critically ill patients with and without perceptions of excessive care (PECs) by ICU clinicians in patients with and without cancer. METHODS: This study is a sub-analysis of the large multicentre DISPROPRICUS study. Clinicians of 56 ICUs in Europe and the United States completed a daily questionnaire about the appropriateness of care during a 28-day period...
July 31, 2021: Annals of Intensive Care
Xiaoyang Zhou, Weihao Pan, Bixin Chen, Zhaojun Xu, Jianneng Pan
BACKGROUND: Dynamic arterial elastance (Eadyn ) has been extensively considered as a functional parameter of arterial load. However, conflicting evidence has been obtained on the ability of Eadyn to predict mean arterial pressure (MAP) changes after fluid expansion. This meta-analysis sought to assess the predictive performance of Eadyn for the MAP response to fluid expansion in mechanically ventilated hypotensive patients. METHODS: We systematically searched electronic databases through November 28, 2020, to retrieve studies that evaluated the association between Eadyn and fluid expansion-induced MAP increases in mechanically ventilated hypotensive adults...
July 31, 2021: Annals of Intensive Care
Nitin Arora
No abstract text is available yet for this article.
July 31, 2021: Intensive Care Medicine
Gengxin Cai, Xiunong Zhang, Qitian Ou, Yuan Zhou, Linqiang Huang, Shenglong Chen, Hongke Zeng, Wenqiang Jiang, Miaoyun Wen
BACKGROUND: It is generally believed that hypercapnia and hypocapnia will cause secondary injury to patients with craniocerebral diseases, but a small number of studies have shown that they may have potential benefits. We assessed the impact of partial pressure of arterial carbon dioxide (PaCO2 ) on in-hospital mortality of patients with craniocerebral diseases. The hypothesis of this research was that there is a nonlinear correlation between PaCO2 and in-hospital mortality in patients with craniocerebral diseases and that mortality rate is the lowest when PaCO2 is in a normal range...
July 30, 2021: Neurocritical Care
Simon Poignant, Bernard Vigué, Patricia Balram, Mathieu Biais, Romain Carillon, Vincent Cottenceau, Claire Dahyot-Fizelier, Vincent Degos, Thomas Geeraerts, Patrick Jeanjean, Emmanuel Vega, Sigismond Lasocki, Fabien Espitalier, Marc Laffon
BACKGROUND: Sedation/analgesia is a daily challenge faced by intensivists managing patients with brain injury (BI) in intensive care units (ICUs). The optimization of sedation in patients with BI presents particular challenges. A choice must be made between the potential benefit of a rapid clinical evaluation and the potential exacerbation of intracranial hypertension in patients with impaired cerebral compliance. In the ICU, a pragmatic approach to the use of sedation/analgesia, including the optimal titration, management of multiple drugs, and use of any type of brain monitor, is needed...
July 30, 2021: Neurocritical Care
Jaakko Heikkinen, Janne Nurminen, Jarno Velhonoja, Heikki Irjala, Tatu Happonen, Tero Soukka, Kimmo Mattila, Jussi Hirvonen
OBJECTIVES: Due to its superior soft-tissue contrast and ability to delineate abscesses, MRI has high diagnostic accuracy in neck infections. Whether MRI findings can predict the clinical course in these patients is unknown. The purpose of this study was to determine the clinical and prognostic significance of various MRI findings in emergency patients with acute neck infections. MATERIALS AND METHODS: We retrospectively reviewed the 3-T MRI findings of 371 patients with acute neck infections from a 5-year period in a single tertiary emergency radiology department...
July 30, 2021: European Radiology
Rajit K Basu, Erica C Bjornstad, Katja M Gist, Michelle Starr, Paras Khandhar, Rahul Chanchlani, Kelli A Krallman, Michael Zappitelli, David Askenazi, Stuart L Goldstein
BACKGROUND: We aimed to study the association of suspected versus confirmed infection with the novel SARS-CoV2 virus with the prevalence of acute kidney injury (AKI) in critically ill children. METHODS: Sequential point-prevalence study of children and young adults aged 7 days to 25 years admitted to intensive care units under investigation for SARS-CoV2 infection. AKI was staged in the first 14 days of enrollment using KDIGO creatinine-based staging. SARS-CoV2 positive (CONFIRMED) were compared to SUSPECTED (negative or unknown)...
July 30, 2021: Pediatric Research
Jill R Demirci, Jessica Davis, Melissa Glasser, Beverly Brozanski
OBJECTIVE: To describe the prevalence and patterns of gestational parent's own milk (GPOM) feedings among infants undergoing major surgery during their neonatal intensive care unit (NICU) admission. STUDY DESIGN: We analyzed de-identified electronic medical records of all infants admitted to a regional NICU 2014-2015 who underwent surgery for a gastrointestinal, cardiac, or other major organ system defect(s). RESULTS: Of 79 infants, 85% received any GPOM during the NICU hospitalization...
July 30, 2021: Journal of Perinatology: Official Journal of the California Perinatal Association
Yuan Hou, Yadi Zhou, Michaela U Gack, Justin D Lathia, Asha Kallianpur, Reena Mehra, Timothy A Chan, Jae U Jung, Lara Jehi, Charis Eng, Feixiong Cheng
Sex differences in the susceptibility of SARS-CoV-2 infection and severity have been controversial, and the underlying mechanisms of COVID-19 in a sex-specific manner remain understudied. Here we inspected sex differences in SARS-CoV-2 infection, hospitalization, admission to the intensive care unit (ICU), sera inflammatory biomarker profiling, and single-cell RNA-sequencing (scRNA-seq) profiles across nasal, bronchoalveolar lavage fluid (BALF), and peripheral blood mononuclear cells (PBMCs) from COVID-19 patients with varying degrees of disease severities...
July 30, 2021: Signal Transduction and Targeted Therapy
Daniel I McIsaac, Robert Talarico, Angela Jerath, Duminda N Wijeysundera
BACKGROUND: Days alive and at home (DAH) is a patient centered outcome measureable in routinely collected health data. The validity and minimally important difference (MID) in hip fracture have not been evaluated. OBJECTIVE: We assessed construct and predictive validity and estimated a MID for the patient-centred outcome of DAH after hip fracture admission. METHODS: This is a cross-sectional observational study using linked health administrative data in Ontario, Canada...
July 30, 2021: BMJ Quality & Safety
Christopher McPherson
Chronic pain and agitation can complicate the clinical course of critically ill infants. Randomized controlled trials of analgesia and sedation in neonatal intensive care have focused on relatively short durations of exposure. To date, clinicians have few options to treat chronic visceral pain and hyperalgesia. Gabapentin has emerged as a common therapy for a diverse group of pain syndromes and neurologic conditions in adults. In neonates, case reports and series describe the successful treatment of visceral hyperalgesia arising from gastrointestinal insults with or without concomitant neurologic morbidities...
July 1, 2021: Neonatal Network: NN
Kacy L Minot, Katelin P Kramer, Colleen Butler, Michele Foster, Courtney Gregory, Kathryn Haynes, Czarina Lagon, Amber Mason, Samantha Wynn, Elizabeth E Rogers, Melissa C Liebowitz
BACKGROUND: Early skin-to-skin care (SSC) has been shown to improve outcomes after preterm birth, including improved clinical stability and establishment of breastfeeding. Recent evidence suggests the most unstable infants get the most benefit, yet these infants are not consistently offered opportunities for SSC because of safety concerns and discomfort of the care team. PURPOSE: To identify barriers and implement a multidimensional approach to increase SSC within the first 72 hours of life among infants born less than 28 weeks' gestation and less than 1,000 g in a Level IV university-based regional intensive care nursery...
July 1, 2021: Neonatal Network: NN
Safia Akhlaq, Taymmia Ejaz, Adil Aziz, Arslan Ahmed
A young man presented in emergency department with shortness of breath and cough after accidental inhalation of chlorine gas. Initial presentation was unremarkable; therefore, he was kept under observation for 8 hours and was later discharged. After 5 hours, the patient presented again in emergency department with sudden-onset shortness of breath and chest discomfort. On examination, subcutaneous crepitation around the neck and chest was found. Chest and neck X-ray revealed subcutaneous emphysema and pneumomediastinum...
July 30, 2021: BMJ Case Reports
Hazarathamma Makam, Farah Siddiqui, Asmita Patwardhan, Anil Darbar
Ehlers-Danlos syndrome (EDS) is an uncommon heterogenous autosomal dominant multisystemic connective tissue disorder, which may potentially present with life-threatening emergencies. The prevalence of EDS of all subtypes is from 1 in 10 000 to 1 in 20 000. Pregnancy in women with type IV EDS poses significant challenges, necessitating the care of multidisciplinary team. Potential complications of type IV EDS include arterial dissection, arterial aneurysm, visceral rupture, excessive bleeding, tissue fragility and delayed wound healing...
July 30, 2021: BMJ Case Reports
Chon In Kuok, Winnie Kwai Yu Chan, Anthony Wai Leung Kwok
BACKGROUND: Understanding trauma epidemiology is essential in formulating region-specific strategies for injury prevention. Our study aimed to evaluate the characteristics and clinical outcomes of critical pediatric trauma requiring intensive care in Hong Kong. METHODS: A retrospective analysis was performed on pediatric patients who were injured and admitted to the pediatric intensive care unit (PICU), Queen Elizabeth Hospital, Hong Kong between 2014 and 2018. Clinical features of patients who sustained injuries before and after 2 years old were compared...
July 13, 2021: Pediatrics and Neonatology
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