Fiona Coyer, Michelle Barakat-Johnson, Jill Campbell, Jennifer Palmer, Rachael L Parke, Naomi E Hammond, Serena Knowles, Anna Doubrovsky
BACKGROUND: Device-related pressure injuries (DRPIs) are an ongoing iatrogenic problem evident in intensive care unit (ICU) settings. Critically ill patients are at high risk of developing pressure injuries caused by devices. OBJECTIVE: The aim of the study was to determine the prevalence of DRPI in critically ill patients in intensive care and the location, stage, and attributable device of DRPI and describe the products and processes of care used to prevent these injuries...
February 20, 2021: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
Brian L Erstad, Jeffrey F Barletta
Medications used for supportive care or prophylaxis constitute a significant portion of drug utilization in the intensive care unit. Evidence-based guidelines are available for many aspects of supportive care but drug doses listed are typically for patients with normal body habitus and not morbid obesity. Failure to account for the pharmacokinetic changes that occur with obesity can lead to an incorrect dose and treatment failure or toxicity. This paper is intended to help clinicians design initial dosing regimens in critically ill obese patients for medications commonly used for hemodynamic support or prophylaxis...
February 23, 2021: Critical Care: the Official Journal of the Critical Care Forum
Damien Contou, Radj Cally, Florence Sarfati, Paul Desaint, Megan Fraissé, Gaëtan Plantefève
No abstract text is available yet for this article.
February 23, 2021: Critical Care: the Official Journal of the Critical Care Forum
Tao Zhou, Nan Zheng, Xiang Li, Dongmei Zhu, Yi Han
BACKGROUND: Neutrophil-lymphocyte count ratio (NLCR) has been reported as better indicator of bacteremia than procalcitonin (PCT), and more precise predictor of mortality than C-reactive protein (CRP) under various medical conditions. However, large controversy remains upon this topic. To address the discrepancy, our group has compared the efficiency of NLCR with conventional inflammatory markers in predicting the prognosis of critical illness. METHODS: We performed a multi-center retrospective cohort study involving 536 ICU patients with outcomes of survival, 28- and 7-day mortality...
February 23, 2021: BMC Emergency Medicine
E H J Mestrom, J A van der Stam, M E Te Pas, J G van der Hoeven, N A W van Riel, A J G H Bindels, A Boer, V Scharnhorst
PURPOSE: To provide more in-depth insight in the development of early ICU-acquired hypernatremia in critically ill patients based on detailed, longitudinal and quantitative data. MATERIALS AND METHODS: A comparative analysis was performed using prospectively collected data of ICU patients. All patients requiring ICU admission for more than 48 h between April and December 2018 were included. For this study, urine samples were collected daily and analyzed for electrolytes and osmolality...
February 10, 2021: Journal of Critical Care
Arianna J Vidger, Quinn A Czosnowski
PURPOSE: Describe the characteristics, hospital course, and outcomes of adult ICU patients receiving extremely high dose insulin infusions compared to those with lower insulin requirements. MATERIALS AND METHODS: Retrospective observational study of 128 adult ICU patients receiving IV insulin infusions at a large academic medical center. Extremely high dose insulin infusions were defined as maximum rate ≥ 35 units/h. The primary endpoint was rate of hypoglycemia (BG < 70 mg/dL) and time to glucose control...
February 9, 2021: Journal of Critical Care
Maaike Versyck, Wafa Zarrougui, Fabien Lambiotte, Nabil Elbeki, Piehr Saint-Leger
INTRODUCTION: Coronavirus disease 2019 or COVID-19 is a new infectious disease responsible for potentially severe respiratory impairment associated with initial immunosuppression. Similarly to influenza, several authors have described a higher risk of fungal infection after COVID-19, in particular for invasive pulmonary aspergillosis. The main objective here is to define the prevalence of invasive pulmonary aspergillosis (IPA) in a cohort of COVID-19 patients with moderate to severe acute respiratory disease syndrome (ARDS)...
February 16, 2021: Journal de Mycologie Médicale
P Barlow, A M Thow
Unhealthy diets are increasing contributors to poor health and mortality in low- and middle-income countries (LMICs). Government interventions targeting the structural drivers of unhealthy diets are needed to prevent these illnesses, including nutrition labelling regulations that create healthier food environments. Yet, implementation remains slow and uneven. One explanation for slow implementation highlights the role of politics, including powerful ideological discourse and its strategic deployment by economically powerful actors...
February 11, 2021: Social Science & Medicine
Chao Yan, Xinmeng Zhang, Cheng Gao, Erin Wilfon, Jonathan Casey, Danniel France, Yang Gong, Mayur Patel, Bradley Malin, You Chen
BACKGROUND: Few ICU staffing studies examine collaboration structures among healthcare workers. Knowledge about how healthcare workers (HWs) are connected to care for critically ill COVID-19 (C19) patients provides evidence for characterizing the relationship between team structures, care quality, and patient safety. OBJECTIVE: To discover the distinctions of teamwork structures in C19 critical care by comparing HW collaboration associated with the management of critically ill patients with and without C19...
February 22, 2021: JMIR Human Factors
Kai E Swenson, Stephen J Ruoss, Erik R Swenson
The ongoing COVID-19 pandemic has been unprecedented on many levels, not least of which are the challenges in understanding the pathophysiology of these new critically ill patients. One widely-reported phenomenon is that of a profoundly hypoxemic patient with minimal to no dyspnea out of proportion to the extent of radiographic abnormalities and changes in lung compliance. This apparently unique presentation, sometimes called "happy hypoxemia or hypoxia" but better described as "silent hypoxemia", has led to the speculation of underlying pathophysiologic differences between COVID-19 lung injury and ARDS from other causes...
February 23, 2021: Annals of the American Thoracic Society
Christophe Vandenbriele, Tim Balthazar, James Wilson, Tom Adriaenssens, Simon Davies, Walter Droogne, Christophe Dubois, Ana Francisca Caetano, Kaatje Goetschalckx, Steven Jacobs, Stefan Janssens, Stephane Ledot, Bart Meyns, Hatem Soliman-Aboumarie, Peter Verbrugghe, Susanna Price
AIMS: Patients presenting with cardiogenic shock (CS) related to acute, severe mitral regurgitation (MR) are often considered too ill for immediate surgical intervention. Therefore, other less invasive techniques for haemodynamic stabilization should be explored. The purpose of this exploratory study was to investigate the feasibility and outcomes in patients with CS due to severe MR by using a novel approach combining haemodynamic stabilization with left Impella-support plus MR-reduction using MitraClip®...
December 2, 2020: European Heart Journal. Acute Cardiovascular Care
Sarah K Adie, Nicholas Farina, Ahmad A Abdul-Aziz, Ran Lee, Michael P Thomas, Matthew C Konerman
AIMS: Dexmedetomidine is one of the sedative agents recommended by the Society of Critical Care Medicine as a preferred option over benzodiazepines in critically ill, mechanically ventilated patients. Little data exists describing sedation in the cardiac intensive care unit (CICU). The purpose of this study was to determine the prevalence of adverse events in CICU patients treated with dexmedetomidine. METHODS AND RESULTS: This was a retrospective cohort analysis of patients >18 years old admitted to the University of Michigan CICU from June 2014 to October 2019 who received dexmedetomidine therapy...
August 28, 2020: European Heart Journal. Acute Cardiovascular Care
Jonathan E Sevransky, Richard E Rothman, David N Hager, Gordon R Bernard, Samuel M Brown, Timothy G Buchman, Laurence W Busse, Craig M Coopersmith, Christine DeWilde, E Wesley Ely, Lindsay M Eyzaguirre, Alpha A Fowler, David F Gaieski, Michelle N Gong, Alex Hall, Jeremiah S Hinson, Michael H Hooper, Gabor D Kelen, Akram Khan, Mark A Levine, Roger J Lewis, Chris J Lindsell, Jessica S Marlin, Anna McGlothlin, Brooks L Moore, Katherine L Nugent, Samuel Nwosu, Carmen C Polito, Todd W Rice, Erin P Ricketts, Caroline C Rudolph, Fred Sanfilippo, Kert Viele, Greg S Martin, David W Wright
Importance: Sepsis is a common syndrome with substantial morbidity and mortality. A combination of vitamin C, thiamine, and corticosteroids has been proposed as a potential treatment for patients with sepsis. Objective: To determine whether a combination of vitamin C, thiamine, and hydrocortisone every 6 hours increases ventilator- and vasopressor-free days compared with placebo in patients with sepsis. Design, Setting, and Participants: Multicenter, randomized, double-blind, adaptive-sample-size, placebo-controlled trial conducted in adult patients with sepsis-induced respiratory and/or cardiovascular dysfunction...
February 23, 2021: JAMA
Ben Kim, Miranda Hunt, John Muscedere, David M Maslove, Joon Lee
BACKGROUND: Critical illness has been suggested as a sentinel event for frailty development in at-risk older adults. Frail critical illness survivors are affected by increased adverse health outcomes, but monitoring the recovery after intensive care unit (ICU) discharge is challenging. Clinicians and funders of health care systems envision an increased role of wearable devices in monitoring clinically relevant measures, as sensor technology is advancing rapidly. The use of wearable devices has also generated great interest among older patients, and they are the fastest growing group of consumer-grade wearable device users...
February 23, 2021: JMIR aging
Samet Karahan, Kemal Erol, Recep Civan Yuksel, Cem Artan, Ilhami Celik
OBJECTIVES: Antiphospholipid antibodies (APAs) increase the risk of excessive blood clotting, but their role in COVID-19 remains unclear. We aimed to investigate the presence of conventional APAs used in the classification of antiphospholipid antibody syndrome in patients with severe lung infection with SARS-CoV-2 and to compare these results with non-COVID-19 critically ill patients. METHODS: Thirty-one COVID-19 patients (COVID group) and 28 non-COVID-19 critically ill patients (non-COVID group), were included in the study...
February 23, 2021: Modern Rheumatology
Jeffrey M Sturek, Tania A Thomas, James D Gorham, Chelsea A Sheppard, Allison E Raymond, Kristen Petros De Guex, William B Harrington, Andrew J Barros, Gregory R Madden, Yosra M Alkabab, David Lu, Qin Liu, Melinda D Poulter, Amy J Mathers, Archana Thakur, Ewa M Kubicka, Lawrence G Lum, Scott K Heysell
Rationale: The COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an unprecedented event requiring rapid adaptation to changing clinical circumstances. Convalescent immune plasma (CIP) is a promising treatment that can be mobilized rapidly in a pandemic setting. Objectives: We tested whether administration of SARS-CoV-2 CIP at hospital admission could reduce the rate of ICU transfer or 28 day mortality. Methods: In a single-arm phase II study, patients >18 years-old with respiratory symptoms documented with COVID-19 infection who were admitted to a non-ICU bed were administered two units of CIP within 72 hours of admission...
February 19, 2021: medRxiv: the preprint server for health sciences
Geidy E Serrano, Jessica E Walker, Richard Arce, Michael J Glass, Daisy Vargas, Lucia I Sue, Anthony J Intorcia, Courtney M Nelson, Javon Oliver, Jaclyn Papa, Aryck Russell, Katsuko E Suszczewicz, Claryssa I Borja, Christine Belden, Danielle Goldfarb, David Shprecher, Alireza Atri, Charles H Adler, Holly A Shill, Erika Driver-Dunckley, Shyamal H Mehta, Benjamin Readhead, Matthew J Huentelman, Joseph L Peters, Ellie Alevritis, Christian Bimi, Joseph P Mizgerd, Eric M Reiman, Thomas J Montine, Marc Desforges, James L Zehnder, Malaya K Sahoo, Haiyu Zhang, Daniel Solis, Benjamin A Pinsky, Michael Deture, Dennis W Dickson, Thomas G Beach
The coronavirus SARS-CoV-2 (SCV2) causes acute respiratory distress, termed COVID-19 disease, with substantial morbidity and mortality. As SCV2 is related to previously-studied coronaviruses that have been shown to have the capability for brain invasion, it seems likely that SCV2 may be able to do so as well. To date, although there have been many clinical and autopsy-based reports that describe a broad range of SCV2-associated neurological conditions, it is unclear what fraction of these have been due to direct CNS invasion versus indirect effects caused by systemic reactions to critical illness...
February 18, 2021: medRxiv: the preprint server for health sciences
Carly G K Ziegler, Vincent N Miao, Anna H Owings, Andrew W Navia, Ying Tang, Joshua D Bromley, Peter Lotfy, Meredith Sloan, Hannah Laird, Haley B Williams, Micayla George, Riley S Drake, Taylor Christian, Adam Parker, Campbell B Sindel, Molly W Burger, Yilianys Pride, Mohammad Hasan, George E Abraham, Michal Senitko, Tanya O Robinson, Alex K Shalek, Sarah C Glover, Bruce H Horwitz, Jose Ordovas-Montanes
Infection with SARS-CoV-2, the virus that causes COVID-19, can lead to severe lower respiratory illness including pneumonia and acute respiratory distress syndrome, which can result in profound morbidity and mortality. However, many infected individuals are either asymptomatic or have isolated upper respiratory symptoms, which suggests that the upper airways represent the initial site of viral infection, and that some individuals are able to largely constrain viral pathology to the nasal and oropharyngeal tissues...
February 20, 2021: the Preprint Server for Biology
Yong Wang, Xiao-Yu Yin, Xue He, Chen-Mao Zhou, Jin-Chun Shen, Jian-Hua Tong
Postintensive care syndrome (PICS) is defined as a new or worsening impairment in cognition, mental health, and physical function after critical illness and persisting beyond hospitalization, which is associated with reduced quality of life and increased mortality. Recently, we have developed a clinically relevant animal model of PICS based on two-hit hypothesis. However, the underlying mechanism remains unclear. Accumulating evidence has demonstrated that hippocampal GABAergic interneuron dysfunction is implicated in various mood disorders induced by stress...
February 22, 2021: Aging
Michelle A Lopez, Xian Yu, Annette Walder, Marc A Kowalkowski, Jeffrey D Colvin, Jean L Raphael
BACKGROUND: Children's hospitals (CHs) deliver care to underserved, critically ill, and medically complex patients. However, non-CHs care for the majority of children with frequently occurring conditions. In this study, we aimed to examine resource use across hospitals where children receive care for frequent inpatient conditions. METHODS: This was a cross-sectional, observational analysis of pediatric hospitalizations for 8 frequent inpatient conditions (pneumonia, asthma, bronchiolitis, mood disorders, appendicitis, epilepsy, skin and soft tissue infections, and fluid and electrolyte disorders) in the 2016 Kids' Inpatient Database...
February 22, 2021: Hospital Pediatrics
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