Fernando G Zampieri, Lucas P Damiani, Jan Bakker, Gustavo A Ospina-Tascón, Ricardo Castro, Alexandre B Cavalcanti, Glenn Hernandez
Rationale: A recent randomized controlled trial showed that a peripheral perfusion-guided resuscitation strategy was associated with lower mortality and less organ dysfunction when compared with lactate-guided resuscitation strategy in patients with septic shock, but the difference in the primary outcome, 28-day mortality, did not reach the proposed statistical significance threshold ( P  = 0.06). We tested different analytic methods to aid in the interpretation of these results. Objectives: To reassess the results of the ANDROMEDA-SHOCK trial using both Bayesian and frequentist frameworks...
February 15, 2020: American Journal of Respiratory and Critical Care Medicine
Martin J Tobin
No abstract text is available yet for this article.
June 29, 2021: American Journal of Respiratory and Critical Care Medicine
Victor P Gazivoda, Mudathir Ibrahim, Aaron Kangas-Dick, Arony Sun, Michael Silver, Ory Wiesel
BACKGROUND: Pneumomediastinum and pneumothorax are complications which may be associated with barotrauma in mechanically ventilated patients. The current literature demonstrates unclear outcomes regarding barotrauma in critically ill patients with severe COVID-19. The purpose of this study was to examine the incidence of barotrauma in patients with severe COVID-19 pneumonia and its influence on survival. STUDY DESIGN AND METHODS: A retrospective cohort study was performed from March 18, 2020 to May 5, 2020, with follow-up through June 18, 2020, encompassing critically ill intubated patients admitted for COVID-19 pneumonia at an academic tertiary care hospital in Brooklyn, New York...
June 21, 2021: Journal of Intensive Care Medicine
Andrew Bryant, Theresa A Lawrie, Therese Dowswell, Edmund J Fordham, Scott Mitchell, Sarah R Hill, Tony C Tham
BACKGROUND: Repurposed medicines may have a role against the SARS-CoV-2 virus. The antiparasitic ivermectin, with antiviral and anti-inflammatory properties, has now been tested in numerous clinical trials. AREAS OF UNCERTAINTY: We assessed the efficacy of ivermectin treatment in reducing mortality, in secondary outcomes, and in chemoprophylaxis, among people with, or at high risk of, COVID-19 infection. DATA SOURCES: We searched bibliographic databases up to April 25, 2021...
June 17, 2021: American Journal of Therapeutics
Anuj B Mehta, Allan J Walkey, Douglas Curran-Everett, Ivor S Douglas
OBJECTIVES: Tracheostomy utilization has dramatically increased recently. Large gaps exist between expected and actual outcomes resulting in significant decisional conflict and regret. We determined 1-year patient outcomes and healthcare utilization following tracheostomy to aid in decision-making and resource allocation. DESIGN: Retrospective cohort study. SETTING: All California hospital discharges from 2012 to 2013 with follow-up through 2014...
November 2019: Critical Care Medicine
Shannon S Carson, Jeremy M Kahn, Catherine L Hough, Eric J Seeley, Douglas B White, Ivor S Douglas, Christopher E Cox, Ellen Caldwell, Shrikant I Bangdiwala, Joanne M Garrett, Gordon D Rubenfeld
OBJECTIVE: Significant deficiencies exist in the communication of prognosis for patients requiring prolonged mechanical ventilation after acute illness, in part because of clinician uncertainty about long-term outcomes. We sought to refine a mortality prediction model for patients requiring prolonged ventilation using a multicentered study design. DESIGN: Cohort study. SETTING: Five geographically diverse tertiary care medical centers in the United States (California, Colorado, North Carolina, Pennsylvania, and Washington)...
April 2012: Critical Care Medicine
Chengliang Yang, Mingyao Liu
No abstract text is available yet for this article.
April 5, 2021: JAMA Internal Medicine
Suchitra Ranjit, Rajeswari Natraj, Niranjan Kissoon, Ravi Thiagarajan, Balasubramaniam Ramakrishnan, M Ignacio Monge Garcia
Objectives: Fluid boluses are commonly administered to improve the cardiac output and tissue oxygen delivery in pediatric septic shock. The objective of this study is to evaluate the effect of an early fluid bolus administered to children with septic shock on the cardiac index and mean arterial pressure, as well as on the hemodynamic response and its relationship with outcome. Design, Setting, Patients, and Interventions: We prospectively collected hemodynamic data from children with septic shock presenting to the emergency department or the PICU who received a fluid bolus (10 mL/kg of Ringers Lactate over 30 min)...
March 15, 2021: Pediatric Critical Care Medicine
Timothy D Henry, Matthew I Tomey, Jacqueline E Tamis-Holland, Holger Thiele, Sunil V Rao, Venu Menon, Deborah G Klein, Yoshifumi Naka, Ileana L Piña, Navin K Kapur, George D Dangas
Cardiogenic shock (CS) remains the most common cause of mortality in patients with acute myocardial infarction. The SHOCK trial (Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock) demonstrated a survival benefit with early revascularization in patients with CS complicating acute myocardial infarction (AMICS) 20 years ago. After an initial improvement in mortality related to revascularization, mortality rates have plateaued. A recent Society of Coronary Angiography and Interventions classification scheme was developed to address the wide range of CS presentations...
March 4, 2021: Circulation
Ishaq Lat, Craig M Coopersmith, Daniel De Backer, Craig M Coopersmith
OBJECTIVE: To expand upon the priorities of fluid resuscitation and vasopressor therapy research priorities identified by a group of experts assigned by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. DATA SOURCES: Original paper and literature search. STUDY SELECTION: Several members of the original task force with expertise specific to the area of fluid resuscitation and vasopressor therapy. DATA EXTRACTION: None...
March 1, 2021: Intensive Care Medicine Experimental
Charles-Edouard Luyt, Lila Bouadma, Andrew Conway Morris, Jayesh A Dhanani, Marin Kollef, Jeffrey Lipman, Ignacio Martin-Loeches, Saad Nseir, Otavio T Ranzani, Antoine Roquilly, Matthieu Schmidt, Antoni Torres, Jean-François Timsit
Pulmonary infection is one of the main complications occurring in patients suffering from acute respiratory distress syndrome (ARDS). Besides traditional risk factors, dysregulation of lung immune defenses and microbiota may play an important role in ARDS patients. Prone positioning does not seem to be associated with a higher risk of pulmonary infection. Although bacteria associated with ventilator-associated pneumonia (VAP) in ARDS patients are similar to those in patients without ARDS, atypical pathogens (Aspergillus, herpes simplex virus and cytomegalovirus) may also be responsible for infection in ARDS patients...
November 11, 2020: Intensive Care Medicine
Ken Kuljit S Parhar, Danny J Zuege, Karen Shariff, Gwen Knight, Sean M Bagshaw
Many patients with coronavirus disease (COVID-19) will develop acute respiratory distress syndrome (ARDS). Prone positioning is an important non-pharmacologic strategy that should be considered for all invasively ventilated patients with moderate to severe ARDS (including those with COVID-19). Prone positioning offers several physiologic and clinical benefits, including improving hypoxemia, matching ventilation with perfusion, reducing regional hyperinflation, and improving survival. To safely offer prone positioning, appropriate training, simulation, and health system planning should be undertaken...
December 24, 2020: Canadian Journal of Anaesthesia
Elisabeth A J de Vos, Peter H J van der Voort
PURPOSE: ICU acquired hypernatremia (IAH) is associated with increased morbidity and mortality, however treatment remains controversial. This study aims to determine the effect of enteral free water suppletion in patients with IAH. MATERIALS AND METHODS: Retrospective single center study in a tertiary ICU. INCLUSION CRITERIA: patients with IAH and treatment with enteral free water. EXCLUSION CRITERIA: patients with renal replacement therapy, diabetic ketoacidosis or hyperosmolar hyperglycaemic state...
April 2021: Journal of Critical Care
Ned Hartfiel, Girendra Sadera, Victoria Treadway, Catherine Lawrence, Rhiannon Tudor Edwards
BACKGROUND: Timely information provided by clinical librarians can contribute to outcomes such as improved patient care and time savings for hospital staff. What is unknown is the return on investment (ROI) of a clinical librarian on a critical care unit. OBJECTIVE: The aim of this study was to assess the ROI, from the employer perspective, of placing a clinical librarian in a critical care unit in a large UK acute hospital. METHODS: Using a mixed methods approach, ROI was estimated by comparing the total costs with the total monetised benefits of implementing the clinical librarian intervention...
November 16, 2020: Health Information and Libraries Journal
Ketan K Dhatariya, Nicole S Glaser, Ethel Codner, Guillermo E Umpierrez
Diabetic ketoacidosis (DKA) is the most common acute hyperglycaemic emergency in people with diabetes mellitus. A diagnosis of DKA is confirmed when all of the three criteria are present - 'D', either elevated blood glucose levels or a family history of diabetes mellitus; 'K', the presence of high urinary or blood ketoacids; and 'A', a high anion gap metabolic acidosis. Early diagnosis and management are paramount to improve patient outcomes. The mainstays of treatment include restoration of circulating volume, insulin therapy, electrolyte replacement and treatment of any underlying precipitating event...
May 14, 2020: Nature Reviews. Disease Primers
John A Harvin, Lillian S Kao
PURPOSE OF REVIEW: Acute pain management in the surgical ICU is imperative. Effective acute pain management hastens a patient's return to normal function and avoid the negative sequelae of untreated acute pain. Traditionally, opioids have been the mainstay of acute pain management strategies in the surgical ICU, but alternative medications and management strategies are increasingly being utilized. RECENT FINDINGS: Extrapolating from lessons learned from enhanced recovery after surgery protocols, surgical intensivists are increasingly utilizing multimodal pain regimens (MMPRs) in critically ill surgical patients recovering from major surgical procedures and injuries...
December 2020: Current Opinion in Critical Care
Olivier Hermine, Xavier Mariette, Pierre-Louis Tharaux, Matthieu Resche-Rigon, Raphaël Porcher, Philippe Ravaud
Importance: Severe pneumonia with hyperinflammation and elevated interleukin-6 is a common presentation of coronavirus disease 2019 (COVID-19). Objective: To determine whether tocilizumab (TCZ) improves outcomes of patients hospitalized with moderate-to-severe COVID-19 pneumonia. Design, Setting, and Particpants: This cohort-embedded, investigator-initiated, multicenter, open-label, bayesian randomized clinical trial investigating patients with COVID-19 and moderate or severe pneumonia requiring at least 3 L/min of oxygen but without ventilation or admission to the intensive care unit was conducted between March 31, 2020, to April 18, 2020, with follow-up through 28 days...
January 1, 2021: JAMA Internal Medicine
Klaus Stahl, Rolf Bikker, Benjamin Seeliger, Julius J Schmidt, Heiko Schenk, Bernhard M W Schmidt, Tobias Welte, Hermann Haller, Marius M Hoeper, Korbinian Brand, Sascha David
BACKGROUND: Deficiency of immunoglobulins of the classes IgG, IgG1, IgA and IgM is associated with severity of disease and mortality in sepsis and septic shock. Therapeutic plasma exchange (TPE) with fresh frozen plasma (FFP) has recently gained attention as an adjunctive therapeutic option in early septic shock. We hypothesized that TPE might modulate immunoglobulin deficiencies besides sole elimination of circulating injurious molecules. METHODS: We conducted a prospective single center study with TPE in 33 patients with early septic shock (onset < 12 h) requiring high doses of norepinephrine (NE > 0...
October 16, 2020: Journal of Intensive Care Medicine
James E Tisdale, Mina K Chung, Kristen B Campbell, Muhammad Hammadah, Jose A Joglar, Jacinthe Leclerc, Bharath Rajagopalan
Many widely used medications may cause or exacerbate a variety of arrhythmias. Numerous antiarrhythmic agents, antimicrobial drugs, psychotropic medications, and methadone, as well as a growing list of drugs from other therapeutic classes (neurological drugs, anticancer agents, and many others), can prolong the QT interval and provoke torsades de pointes. Perhaps less familiar to clinicians is the fact that drugs can also trigger other arrhythmias, including bradyarrhythmias, atrial fibrillation/atrial flutter, atrial tachycardia, atrioventricular nodal reentrant tachycardia, monomorphic ventricular tachycardia, and Brugada syndrome...
September 15, 2020: Circulation
Xiaoying Gu, Fei Zhou, Yeming Wang, Guohui Fan, Bin Cao
According to the Third International Consensus Definition for Sepsis and Septic Shock, sepsis is a life-threatening organ dysfunction resulting from dysregulated host responses to infection. Epidemiological data about sepsis from the 2017 Global Burden of Diseases, Injuries and Risk Factor Study showed that the global burden of sepsis was greater than previously estimated. Bacteria have been shown to be the predominant pathogen of sepsis among patients with pathogens detected, while sepsis caused by viruses is underdiagnosed worldwide...
September 30, 2020: European Respiratory Review: An Official Journal of the European Respiratory Society
2020-10-30 11:35:05
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