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RANDOMIZED CONTROLLED TRIAL
Philippe Wibart, Thomas Réginault, Margarita Garcia-Fontan, Bérangère Barbrel, Clement Bader, Antoine Benard, Verônica Franco Parreira, Daniel Gonzalez-Antón, Nam H Bui, Didier Gruson, Gilles Hilbert, Roberto Martinez-Alejos, Frédéric Vargas
OBJECTIVE: We hypothesized that the use of mechanical insufflation-exsufflation can reduce the incidence of acute respiratory failure within the 48-hour post-extubation period in intensive care unit-acquired weakness patients. METHODS: This was a prospective randomized controlled open-label trial. Patients diagnosed with intensive care unit-acquired weakness were consecutively enrolled based on a Medical Research Council score ≤ 48/60. The patients randomly received two daily sessions; in the control group, conventional chest physiotherapy was performed, while in the intervention group, chest physiotherapy was associated with mechanical insufflation-exsufflation...
2023: Crit Care Sci
#22
JOURNAL ARTICLE
Jose F Díez-Concha, Diego Mauricio Gómez-García, Julián Alberto Agudelo, Edwin Alexander Lizarazo Herrera
BACKGROUND: There is evidence that early admission to the palliative care (PC) program in adult cancer patients improves symptoms management, reduces unplanned hospital admissions, minimizes aggressive cancer treatments, and enables patients to make decisions about their end-of-life (EOL) care. OBJECTIVES: This retrospective cohort study aimed to determine whether late admission to a PC program is associated with aggressive treatment at the EOL in adult patients with oncological diseases from their admission until death...
2023: Palliative care and social practice
#23
Fabian Massaga, Leonard A Washington, Isidor H Ngayomela, Amri Salim Mwami, Ahmed Shabhay
INTRODUCTION AND IMPORTANCE: Poly-trauma is among the top ten leading causes of mortality and morbidity in developing countries. Road traffic injuries are the major cause of mortality in the overall burden of deaths related to injuries. The aim of this publication is to show how important are the principles of management in saving life even in austere limited resource settings. CASE PRESENTATION: We herein present a case of a 17-year-old male who presented to our emergency department about an hour after being involved in motor traffic accident in a semiconscious state, in hypovolemic shock and sustained multiple injuries...
September 2023: International Journal of Surgery Case Reports
#24
REVIEW
Tobias Liebregts, Catherina Lueck, Annemarie Mohring, Joachim Riße, Asterios Tzalavras
A growing number of patients are living with cancer or have a history of cancer leading to increasing adverse effects of treatment or disease necessitating emergency department (ED) consultation. Long-term cancer survivors are at higher risk of comorbidities causing a substantial increase in health care resource utilization. The most frequent reasons for cancer-related ED visits are dyspnea, fever, pain, gastrointestinal or neurological symptoms leading to high hospital and intensive care unit admission rates...
September 2, 2023: Medizinische Klinik, Intensivmedizin und Notfallmedizin
#25
REVIEW
A-C Toffart, F Gonzalez, R Hamidfar-Roy, M Darrason
In medicine, each decision is the result of a trade-off between medical scientific data, the rights of individuals (protection of persons, information, consent), individual desires, collective values and norms, and the economic constraints that guide our society. Whether or not to admit a cancer patient to an intensive care unit is very often an ethical dilemma. It is necessary to distinguish patients who would benefit from admission to an intensive care unit (ICU) from those for whom it would be futile. In this review, we will discuss the appropriateness of ICU admission and the concept of unreasonable admission, along with the different levels of intensity of ICU care and the alternatives to intensive care...
August 31, 2023: Revue des Maladies Respiratoires
#26
REVIEW
Giovanni Perricone, Thierry Artzner, Eleonora De Martin, Rajiv Jalan, Julia Wendon, Marco Carbone
Acute-on-chronic liver failure (ACLF) is a clinical syndrome defined by an acute deterioration of the liver function associated with extrahepatic organ failures requiring intensive care support and associated with a high short-term mortality. ACLF has emerged as a major cause of mortality in patients with cirrhosis and chronic liver disease. ACLF has a unique pathophysiology in which systemic inflammation plays a key role; this provides the basis of novel therapies, several of which are now in clinical trials...
August 2023: Intensive Care Medicine
#27
JOURNAL ARTICLE
Sebastian Loesaus, Peter Konrad Zahn, Matthias Bechtel, Justus Thomas Strauch, Dirk Buchwald, Andreas Baumann, Dinah Maria Berres
BACKGROUND: The presence of Nucleated Red Blood Cells (NRBCs) in critically ill patients is associated with higher mortality and poor prognosis. Although patients on extracorporeal support such as veno-venous or veno-arterial extracorporeal membrane oxygenation (VV/VA-ECMO) are severely ill, NRBCs have rarely been investigated regarding their predictive value so far. METHODS: As part of a retrospective study, we examined all cardiothoracic surgery patients from July 2019 to September 2020 who received ECMO treatment during their inpatient stay...
August 7, 2023: European Journal of Medical Research
#28
JOURNAL ARTICLE
U V Jaganath, K de Vasconcellos, D L Skinner, P D Gopalan
BACKGROUND: With a shortage of intensive care unit (ICU) beds and rising healthcare costs in resource-limited settings, clinicians need to appropriately triage admissions into ICU to avoid wasteful expenditure and unnecessary bed utilisation. OBJECTIVES: To assess the nature, appropriateness and outcome of referrals to a tertiary centre ICU. METHODS: A retrospective review of ICU consults from September 2016 to February 2017 at King Edward VIII Hospital was performed...
2023: The Southern African journal of critical care: the official journal of the Critical Care Society
#29
REVIEW
Jun Takeshita, Yasufumi Nakajima, Kazuya Tachibana, Muneyuki Takeuchi, Nobuaki Shime
An updated systematic review with meta-analysis comparing perioperative prophylactic administration of corticosteroids with placebo in pediatric cardiac surgeries using cardiopulmonary bypass was conducted. The Cochrane Central Register of Controlled Trials and MEDLINE (via PubMed) were searched for relevant randomized controlled trials published between January 1, 2000, and February 14, 2023. The primary outcome was postoperative in-hospital mortality. Secondary outcomes were duration of mechanical ventilation, length of intensive care unit and hospital stay, postoperative low cardiac output syndrome, and adverse events...
July 25, 2023: Anaesthesia, Critical Care & Pain Medicine
#30
JOURNAL ARTICLE
John M VanBuren, Mark Hall, Athena F Zuppa, Peter M Mourani, Joseph Carcillo, J Michael Dean, Kevin Watt, Richard Holubkov
OBJECTIVES: Describe the statistical design of the Personalized Immunomodulation in Sepsis-induced Multiple Organ Dysfunction Syndrome (MODS) (PRECISE) study. DESIGN: Children with sepsis-induced MODS undergo real-time immune testing followed by assignment to an immunophenotype-specific study cohort. Interventional cohorts include the granulocyte macrophage-colony stimulating factor (GM-CSF) for the Reversal of Immunoparalysis in Pediatric Sepsis-induced MODS (GRACE)-2 trial, which uses the drug GM-CSF (or placebo) to reverse immunoparalysis; and the Targeted Reversal of Inflammation in Pediatric Sepsis-induced MODS (TRIPS) trial, which uses the drug anakinra (or placebo) to reverse systemic inflammation...
July 27, 2023: Pediatric Critical Care Medicine
#31
JOURNAL ARTICLE
Janneke Horn, Marjolein Admiraal, Jeannette Hofmeijer
No abstract text is available yet for this article.
August 24, 2023: European Heart Journal. Acute Cardiovascular Care
#32
JOURNAL ARTICLE
Thomas Hays, Rebecca Hernan, Michele Disco, Emily L Griffin, Nimrod Goldshtrom, Diana Vargas, Ganga Krishnamurthy, Miles Bomback, Atteeq U Rehman, Amanda T Wilson, Saurav Guha, Shruti Phadke, Volkan Okur, Dino Robinson, Vanessa Felice, Avinash Abhyankar, Vaidehi Jobanputra, Wendy K Chung
BACKGROUND: Rapid genome sequencing (rGS) has been shown to improve care of critically ill infants. Congenital heart disease (CHD) is a leading cause of infant mortality and is often caused by genetic disorders, yet the utility of rGS has not been prospectively studied in this population. METHODS: We conducted a prospective evaluation of rGS to improve the care of infants with complex CHD in our cardiac neonatal intensive care unit. RESULTS: In a cohort of 48 infants with complex CHD, rGS diagnosed 14 genetic disorders in 13 (27%) individuals and led to changes in clinical management in 8 (62%) cases with diagnostic results...
July 7, 2023: Circulation. Genomic and Precision Medicine
#33
JOURNAL ARTICLE
Renea L Beckstrand, Janelle L B Macintosh, Jeanette Drake, Con Newman, Ryan Rasmussen, Karlen E Luthy
BACKGROUND: Critical care nurses working in urban settings have reported obstacles in caring for dying patients. However, the perceptions of such obstacles by nurses working in critical access hospitals (CAHs), which are located in rural areas, are unknown. OBJECTIVE: To study stories and experiences related to obstacles in providing end-of-life care reported by CAH nurses. METHODS: This exploratory, cross-sectional study presents the qualitative stories and experiences of nurses working in CAHs as reported on a questionnaire...
July 1, 2023: American Journal of Critical Care
#34
MULTICENTER STUDY
Hiromichi Naito, Masaaki Sakuraya, Takashi Hongo, Hiroaki Takada, Tetsuya Yumoto, Takashi Yorifuji, Toru Hifumi, Akihiko Inoue, Tetsuya Sakamoto, Yasuhiro Kuroda, Atsunori Nakao
BACKGROUND: Extracorporeal cardiopulmonary resuscitation (ECPR) is rapidly becoming a common treatment strategy for patients with refractory cardiac arrest. Despite its benefits, ECPR raises a variety of ethical concerns when the treatment is discontinued. There is little information about the decision to withhold/withdraw life-sustaining therapy (WLST) for out-of-hospital cardiac arrest (OHCA) patients after ECPR. METHODS: We conducted a secondary analysis of data from the SAVE-J II study, a retrospective, multicenter study of ECPR in Japan...
June 27, 2023: Critical Care: the Official Journal of the Critical Care Forum
#35
REVIEW
Enric Reverter, David Toapanta, Octavi Bassegoda, Juliana Zapatero, Javier Fernandez
Intensive care unit (ICU) admission is frequently required in patients with decompensated cirrhosis for organ support. This entity, known as acute-on-chronic liver failure (ACLF), is associated with high short-term mortality. ICU management of ACLF is complex, as these patients are prone to develop new organ failures and infectious or bleeding complications. Poor nutritional status, lack of effective liver support systems, and shortage of liver donors are also factors that contribute to increase their mortality...
May 2023: Seminars in Liver Disease
#36
JOURNAL ARTICLE
(no author information available yet)
Acute-on-chronic liver failure (ACLF), which was described relatively recently (2013), is a severe form of acutely decompensated cirrhosis characterised by the existence of organ system failure(s) and a high risk of short-term mortality. ACLF is caused by an excessive systemic inflammatory response triggered by precipitants that are clinically apparent (e.g., proven microbial infection with sepsis, severe alcohol-related hepatitis) or not. Since the description of ACLF, some important studies have suggested that patients with ACLF may benefit from liver transplantation and because of this, should be urgently stabilised for transplantation by receiving appropriate treatment of identified precipitants, and full general management, including support of organ systems in the intensive care unit (ICU)...
August 2023: Journal of Hepatology
#37
JOURNAL ARTICLE
Nathan S Bryan, Janos Molnar, John Somberg
BACKGROUND: The study was initiated in 2020 to test the efficacy of a nitric oxide generating lozenge (NOL) in outpatients with newly diagnosed COVID-19 to mitigate disease severity. The study enrolled high risk patients, African American and Latino. METHODS: This was a randomized, double blinded, prospective, placebo controlled trial. The primary endpoint was hospitalization, ICU admission, intubation, dialysis and death. The secondary endpoints were time to symptom resolution and the effect on oxygen saturation...
June 24, 2023: American Journal of Medicine
#38
RANDOMIZED CONTROLLED TRIAL
Samuel M Brown, Christina E Barkauskas, Birgit Grund, Shweta Sharma, Andrew N Phillips, Lindsay Leither, Ithan D Peltan, Michael Lanspa, Daniel L Gilstrap, Ahmad Mourad, Kathleen Lane, Jeremy R Beitler, Alexis L Serra, Ivan Garcia, Eyad Almasri, Mohamed Fayed, Kinsley Hubel, Estelle S Harris, Elizabeth A Middleton, Macy A G Barrios, Kusum S Mathews, Neha N Goel, Samuel Acquah, Jarrod Mosier, Cameron Hypes, Elizabeth Salvagio Campbell, Akram Khan, Catherine L Hough, Jennifer G Wilson, Joseph E Levitt, Abhijit Duggal, Siddharth Dugar, Andrew J Goodwin, Charles Terry, Peter Chen, Sam Torbati, Nithya Iyer, Uriel S Sandkovsky, Nicholas J Johnson, Bryce R H Robinson, Michael A Matthay, Neil R Aggarwal, Ivor S Douglas, Jonathan D Casey, Manuel Hache-Marliere, J Georges Youssef, William Nkemdirim, Brad Leshnower, Omar Awan, Sonal Pannu, Darragh Shane O'Mahony, Prasad Manian, J W Awori Hayanga, Glenn W Wortmann, Bruno M Tomazini, Robert F Miller, Jens-Ulrik Jensen, Daniel D Murray, Nina A Bickell, Jigna Zatakia, Sarah Burris, Elizabeth S Higgs, Ven Natarajan, Robin L Dewar, Adam Schechner, Nayon Kang, Alejandro Arenas-Pinto, Fleur Hudson, Adit A Ginde, Wesley H Self, Angela J Rogers, Cathryn F Oldmixon, Haley Morin, Adriana Sanchez, Amy C Weintrob, Alexandre Biasi Cavalcanti, Anne Davis-Karim, Nicole Engen, Eileen Denning, B Taylor Thompson, Annetine C Gelijns, Virginia Kan, Victoria J Davey, Jens D Lundgren, Abdel G Babiker, James D Neaton, H Clifford Lane
BACKGROUND: There is a clinical need for therapeutics for COVID-19 patients with acute hypoxemic respiratory failure whose 60-day mortality remains at 30-50%. Aviptadil, a lung-protective neuropeptide, and remdesivir, a nucleotide prodrug of an adenosine analog, were compared with placebo among patients with COVID-19 acute hypoxaemic respiratory failure. METHODS: TESICO was a randomised trial of aviptadil and remdesivir versus placebo at 28 sites in the USA. Hospitalised adult patients were eligible for the study if they had acute hypoxaemic respiratory failure due to confirmed SARS-CoV-2 infection and were within 4 days of the onset of respiratory failure...
September 2023: Lancet Respiratory Medicine
#39
JOURNAL ARTICLE
Nicole M Fierro, Navpreet K Dhillon, Greigory Park, John Stupinski, Peter Drevets, Dennis J Zheng, Areti Tillou, Chaiss Ugarte, Morgan Schellenberg, Erika Tay-Lasso, Jeffry Nahmias, Paige Parker, Eric J Ley
BACKGROUND: The desire to deliver appropriate care after trauma creates challenges when deciding to proceed if care appears futile. This study aimed to analyze survival rates for trauma patients who undergo closed chest compressions by decade of life. METHODS: A multi-center retrospective review of trauma patients with an injury severity score (ISS) ≥16 who underwent closed chest compressions from 2015-2020 at four large, urban, academic Level I trauma centers was conducted...
June 15, 2023: Journal of Trauma and Acute Care Surgery
#40
RANDOMIZED CONTROLLED TRIAL
Mina F Nordness, Amelia W Maiga, Laura D Wilson, Tatsuki Koyama, Erika L Rivera, Shayan Rakhit, Michael de Riesthal, Cari L Motuzas, Madison R Cook, Deepak K Gupta, James C Jackson, Shawniqua Williams Roberson, William J Meurer, Roger J Lewis, Geoffrey T Manley, Pratik P Pandharipande, Mayur B Patel
OBJECTIVE: To evaluate the safety, feasibility, and efficacy of combined adrenergic blockade with propranolol and clonidine in patients with severe traumatic brain injury (TBI). BACKGROUND: Administration of adrenergic blockade after severe TBI is common. To date, no prospective trial has rigorously evaluated this common therapy for benefit. METHODS: This phase II, single-center, double-blinded, pilot randomized placebo-controlled trial included patients aged 16-64 years with severe TBI (intracranial hemorrhage and Glasgow Coma Scale score ≤ 8) within 24 h of ICU admission...
June 9, 2023: Critical Care: the Official Journal of the Critical Care Forum
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