Subjects -> MEDICAL SCIENCES (Total: 8359 journals)
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ANAESTHESIOLOGY (119 journals)                     

Showing 1 - 119 of 119 Journals sorted alphabetically
Acta Anaesthesiologica Scandinavica     Hybrid Journal   (Followers: 60)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 6)
Acute Pain     Full-text available via subscription   (Followers: 15)
Advances in Anesthesia     Full-text available via subscription   (Followers: 30)
African Journal of Anaesthesia and Intensive Care     Full-text available via subscription   (Followers: 8)
Ain-Shams Journal of Anaesthesiology     Open Access   (Followers: 2)
Ain-Shams Journal of Anesthesiology     Open Access   (Followers: 1)
Ambulatory Anesthesia     Open Access   (Followers: 9)
Anaesthesia     Hybrid Journal   (Followers: 213)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 67)
Anaesthesia and Intensive Care     Full-text available via subscription   (Followers: 59)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 25)
Anaesthesia Reports     Hybrid Journal  
Anaesthesia, Pain & Intensive Care     Open Access  
Anaesthesiology Intensive Therapy     Open Access   (Followers: 9)
Analgesia & Resuscitation : Current Research     Hybrid Journal   (Followers: 6)
Anestesia Analgesia Reanimación     Open Access  
Anestesia en México     Open Access  
Anesthesia & Analgesia     Hybrid Journal   (Followers: 229)
Anesthesia : Essays and Researches     Open Access   (Followers: 10)
Anesthesia Progress     Hybrid Journal   (Followers: 5)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology     Hybrid Journal   (Followers: 212)
Anesthesiology and Pain Medicine     Open Access   (Followers: 23)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 25)
Anesthesiology Research and Practice     Open Access   (Followers: 15)
Angewandte Schmerztherapie und Palliativmedizin     Hybrid Journal  
Annales Françaises d'Anesthésie et de Réanimation     Full-text available via subscription   (Followers: 4)
Annals of Cardiac Anaesthesia     Open Access   (Followers: 14)
BDJ Team     Open Access   (Followers: 1)
Best Practice & Research Clinical Anaesthesiology     Hybrid Journal   (Followers: 16)
BJA : British Journal of Anaesthesia     Hybrid Journal   (Followers: 206)
BJA Education     Hybrid Journal   (Followers: 67)
BMC Anesthesiology     Open Access   (Followers: 17)
BMJ Supportive & Palliative Care     Hybrid Journal   (Followers: 42)
Brazilian Journal of Anesthesiology     Open Access   (Followers: 5)
Brazilian Journal of Anesthesiology (Edicion en espanol)     Open Access  
Brazilian Journal of Anesthesiology (English edition)     Open Access   (Followers: 1)
Brazilian Journal of Pain (BrJP)     Open Access  
British Journal of Pain     Hybrid Journal   (Followers: 26)
Canadian Journal of Anesthesia/Journal canadien d'anesthésie     Hybrid Journal   (Followers: 46)
Case Reports in Anesthesiology     Open Access   (Followers: 11)
Clinical Journal of Pain     Hybrid Journal   (Followers: 16)
Colombian Journal of Anesthesiology : Revista Colombiana de Anestesiología     Hybrid Journal  
Current Anaesthesia & Critical Care     Full-text available via subscription   (Followers: 36)
Current Anesthesiology Reports     Hybrid Journal   (Followers: 4)
Current Opinion in Anaesthesiology     Hybrid Journal   (Followers: 58)
Current Pain and Headache Reports     Hybrid Journal   (Followers: 2)
Der Anaesthesist     Hybrid Journal   (Followers: 8)
Der Schmerz     Hybrid Journal   (Followers: 4)
Der Schmerzpatient     Hybrid Journal  
Douleur et Analgésie     Hybrid Journal  
Egyptian Journal of Anaesthesia     Open Access   (Followers: 2)
Egyptian Journal of Cardiothoracic Anesthesia     Open Access  
EMC - Anestesia-Reanimación     Hybrid Journal  
EMC - Anestesia-Rianimazione     Hybrid Journal  
EMC - Urgenze     Full-text available via subscription  
European Journal of Anaesthesiology     Hybrid Journal   (Followers: 28)
European Journal of Pain     Full-text available via subscription   (Followers: 25)
European Journal of Pain Supplements     Full-text available via subscription   (Followers: 5)
Headache The Journal of Head and Face Pain     Hybrid Journal   (Followers: 5)
Indian Journal of Anaesthesia     Open Access   (Followers: 7)
Indian Journal of Pain     Open Access   (Followers: 2)
Indian Journal of Palliative Care     Open Access   (Followers: 6)
International Anesthesiology Clinics     Hybrid Journal   (Followers: 9)
International Journal of Clinical Anesthesia and Research     Open Access  
Itch & Pain     Open Access   (Followers: 2)
JA Clinical Reports     Open Access  
Journal Club Schmerzmedizin     Hybrid Journal  
Journal of Anesthesia & Clinical Research     Open Access   (Followers: 10)
Journal of Anaesthesiology Clinical Pharmacology     Open Access   (Followers: 8)
Journal of Anesthesia     Hybrid Journal   (Followers: 12)
Journal of Anesthesia History     Full-text available via subscription   (Followers: 1)
Journal of Anesthesiology and Clinical Science     Open Access   (Followers: 1)
Journal of Cellular and Molecular Anesthesia     Open Access  
Journal of Clinical Anesthesia     Hybrid Journal   (Followers: 13)
Journal of Critical Care     Hybrid Journal   (Followers: 40)
Journal of Headache and Pain     Open Access   (Followers: 3)
Journal of Neuroanaesthesiology and Critical Care     Open Access   (Followers: 3)
Journal of Neurosurgical Anesthesiology     Hybrid Journal   (Followers: 8)
Journal of Obstetric Anaesthesia and Critical Care     Open Access   (Followers: 22)
Journal of Pain     Hybrid Journal   (Followers: 18)
Journal of Pain and Symptom Management     Hybrid Journal   (Followers: 39)
Journal of Pain Research     Open Access   (Followers: 10)
Journal of Society of Anesthesiologists of Nepal     Open Access   (Followers: 2)
Journal of the Bangladesh Society of Anaesthesiologists     Open Access  
Jurnal Anestesi Perioperatif     Open Access  
Jurnal Anestesiologi Indonesia     Open Access  
Karnataka Anaesthesia Journal     Open Access   (Followers: 2)
Le Praticien en Anesthésie Réanimation     Full-text available via subscription   (Followers: 2)
Local and Regional Anesthesia     Open Access   (Followers: 8)
Medical Gas Research     Open Access   (Followers: 3)
Medycyna Paliatywna w Praktyce     Open Access   (Followers: 1)
OA Anaesthetics     Open Access   (Followers: 3)
Open Anesthesia Journal     Open Access  
Open Journal of Anesthesiology     Open Access   (Followers: 10)
Pain     Hybrid Journal   (Followers: 55)
Pain Clinic     Hybrid Journal   (Followers: 1)
Pain Management     Hybrid Journal   (Followers: 17)
Pain Medicine     Hybrid Journal   (Followers: 13)
Pain Research and Management     Open Access   (Followers: 8)
Pain Research and Treatment     Open Access   (Followers: 2)
Pain Studies and Treatment     Open Access   (Followers: 2)
Research and Opinion in Anesthesia and Intensive Care     Open Access   (Followers: 3)
Revista Chilena de Anestesia     Open Access   (Followers: 1)
Revista Colombiana de Anestesiología     Open Access   (Followers: 1)
Revista Cubana de Anestesiología y Reanimación     Open Access   (Followers: 1)
Revista da Sociedade Portuguesa de Anestesiologia     Open Access  
Revista Española de Anestesiología y Reanimación     Hybrid Journal  
Revista Española de Anestesiología y Reanimación (English Edition)     Full-text available via subscription   (Followers: 2)
Romanian Journal of Anaesthesia and Intensive Care     Open Access   (Followers: 1)
Saudi Journal of Anaesthesia     Open Access   (Followers: 7)
Scandinavian Journal of Pain     Hybrid Journal   (Followers: 1)
Southern African Journal of Anaesthesia and Analgesia     Open Access   (Followers: 8)
Sri Lankan Journal of Anaesthesiology     Open Access   (Followers: 2)
Survey of Anesthesiology     Full-text available via subscription   (Followers: 12)
Techniques in Regional Anesthesia and Pain Management     Hybrid Journal   (Followers: 11)
Topics in Pain Management     Full-text available via subscription   (Followers: 2)
Trends in Anaesthesia and Critical Care     Full-text available via subscription   (Followers: 23)

           

Similar Journals
Journal Cover
Journal of Critical Care
Journal Prestige (SJR): 1.184
Citation Impact (citeScore): 2
Number of Followers: 40  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0883-9441
Published by Elsevier Homepage  [3161 journals]
  • Myocardial edema in paroxysmal permeability disorders: The paradigm of
           Clarkson's disease
    • Abstract: Publication date: Available online 15 January 2020Source: Journal of Critical CareAuthor(s): Maddalena A. Wu, Emanuele Catena, Chiara Cogliati, Davide Ottolina, Antonio Castelli, Roberto Rech, Tommaso Fossali, Sonia Ippolito, Antonio L. Brucato, Riccardo ColomboAbstractPurposeParoxysmal Permeability Disorders (PPDs) comprise a variety of diseases characterized by recurrent and transitory increase of endothelial permeability. Idiopathic Systemic Capillary Leak Syndrome (ISCLS) is a rare PPD that leads to an abrupt massive shift of fluids and proteins from the intravascular to the interstitial compartment. In some cases, tissue edema may involve the myocardium, but its role in the development of shock has not been elucidated so far.Materials and methodsAssessment of cardiac involvement during ten life-threatening ISCLS episodes admitted to ICU.ResultsTransthoracic echocardiographic examination was performed in eight episodes, whereas a poor acoustic window prevented cardiac ultrasound assessment in two episodes. Myocardial edema was detected by echocardiography in eight episodes and marked pericardial effusion in one-episode. Cardiac magnetic resonance showed diffuse myocardial edema in another episode. In one case, myocardial edema caused fulminant left ventricular dysfunction, which required extracorporeal life support. The mean septum thickness was higher during the shock phase compared to the recovery phase [15.5 mm (13.1–21 mm) vs. 9.9 mm (9–11.3 mm), p = .0003]. Myocardial edema resolved within 72 h.ConclusionsDuring early phases of ISCLS, myocardial edema commonly occurs and can induce transient myocardial dysfunction, potentially contributing to the pathogenesis of shock.
       
  • Impact of the pre-illness lipid profile on sepsis mortality
    • Abstract: Publication date: Available online 14 January 2020Source: Journal of Critical CareAuthor(s): Michael D. Maile, Matthew J. Sigakis, Kathleen A. Stringer, Elizabeth S. Jewell, Milo C. EngorenAbstractPurposeTo determine if baseline lipid levels contribute to the relationship between lipid levels during sepsis and outcomes.Materials and methodsWe conducted a retrospective cohort study at a tertiary-care academic medical center. Multivariable logistic regression models were used to adjust for confounders. Both Systemic Inflammatory Response Syndrome (SIRS) and Sequential Organ Failure Assessment (SOFA) score-based definitions of sepsis were analyzed.Measurements and main resultsAfter adjusting for patient characteristics and severity of illness, baseline values for both low density lipoprotein (LDL) cholesterol and triglycerides were associated with mortality (LDL cholesterol odds ratio [OR] 0.44, 95% confidence interval [CI] 0.23–0.84, p = .013; triglyceride OR 0.54, 95% CI 0.37–0.78, p = .001) using a SIRS based definition of sepsis. An interaction existed between these two variables, which resulted in increased mortality with higher baseline low density lipoprotein (LDL) cholesterol values for individuals with triglycerides below 208 mg/dL and the opposite direction of association above this level (interaction OR 1.48, 95% CI 1.02–2.16, p = .039). When using a SOFA score-based definition, only triglycerides remained associated with the mortality (OR 0.55, 95% CI 0.35–0.86, p = .008).ConclusionsBaseline lipid values, particularly triglyceride concentrations, are associated with hospital mortality in septic patients.
       
  • Sepsis in the new millennium – Are we improving'
    • Abstract: Publication date: Available online 14 January 2020Source: Journal of Critical CareAuthor(s): Graeme J. Duke, John L. Moran, John D. Santamaria, David V. Pilcher
       
  • The evolution of radiographic edema in ARDS and its association with
           clinical outcomes: A prospective cohort study in adult patients
    • Abstract: Publication date: Available online 13 January 2020Source: Journal of Critical CareAuthor(s): Daniel Kotok, Libing Yang, John W. Evankovich, William Bain, Daniel G. Dunlap, Faraaz Shah, Yingze Zhang, Dimitris V. Manatakis, Panayiotis V. Benos, Ian J. Barbash, Sarah F. Rapport, Janet S. Lee, Alison Morris, Bryan J. McVerry, Georgios D. KitsiosAbstractPurposeTo assess the longitudinal evolution of radiographic edema using chest X-rays (CXR) in patients with Acute Respiratory Distress Syndrome (ARDS) and to examine its association with prognostic biomarkers, ARDS subphenotypes and outcomes.Materials and methodsWe quantified radiographic edema on CXRs from patients with ARDS or cardiogenic pulmonary edema (controls) using the Radiographic Assessment of Lung Edema (RALE) score on day of intubation and up to 10 days after. We measured baseline plasma biomarkers and recorded clinical variables.ResultsThe RALE score had good inter-rater agreement (r = 0.83, p 
       
  • Longitudinal comparative trial of antibiotic cycling and mixing on
           emergence of gram negative bacterial resistance in a pediatric medical
           intensive care unit
    • Abstract: Publication date: Available online 13 January 2020Source: Journal of Critical CareAuthor(s): Muralidharan Jayashree, Sunit Singhi, Pallab Ray, Vikas Gautam, Sukhsagar Ratol, Sahul BhartiAbstractPurposeTo compare antibiotic mixing vs. cycling with respect to acquisition of resistance and PICU mortality.Materials and methodsChildren between>1 month to 12 years admitted to a medical PICU were enrolled over three phases (baseline, mixing and cycling) with washout interval of 3 months following each antibiotic strategy. Following a baseline phase, empiric gram negative antibiotic protocol for suspected HCAI, was sequentially subjected to mixing and cycling using Latin Square methodology. Surveillance cultures were taken at admission, 48 h, weekly thereafter and within 2 days of PICU discharge. Acquisition of resistance and PICU mortality were primary and secondary outcomes respectively.Results778 children were enrolled; 99 baseline, 146 mixing, 362 cycling, and 171 during two washout phases. Proportion of children with acquired resistance at baseline (56.6%) was significantly higher than mixing (22.6%) and cycling (18.51%) (p 
       
  • Corrigendum to “Human atrial natriuretic peptide for acute kidney injury
           in adult critically ill patients: A multicenter prospective observational
           study” [Journal of Critical Care 51(2019) 229–235]
    • Abstract: Publication date: Available online 11 January 2020Source: Journal of Critical CareAuthor(s): Tomoko Fujii, Tosiya Sato, Shigehiko Uchino, Kent Doi, Taku Iwami, Takashi Kawamura, JAKID study group
       
  • Can delirium subtypes predict differences in 90-day mortality in the
           intensive care unit'
    • Abstract: Publication date: Available online 10 January 2020Source: Journal of Critical CareAuthor(s): Weiwei Li, Jing Wang
       
  • Bridging INTERMACS 1 patients from VA-ECMO to LVAD via Impella 5.0:
           De-escalate and ambulate
    • Abstract: Publication date: Available online 10 January 2020Source: Journal of Critical CareAuthor(s): Letizia F. Bertoldi, Federico Pappalardo, Edith Lubos, Hanno Grahn, Meike Rybczinski, Markus J. Barten, Luca Bertoglio, Benedikt Schrage, Dirk Westermann, Elisabetta Lapenna, Hermann Reichenspurner, Alexander M. BernhardtAbstractPurposeVeno-arterial extracorporeal membrane oxygenation (VA-ECMO) stabilizes patients in refractory cardiogenic shock. However, ECMO-related complications strongly affect the outcome, especially if a long-term LVAD is needed.Methods and materialsWe describe a new strategy in management of INTERMACS 1 patients consisting in early weaning from VA-ECMO with axillary Impella 5.0 as a bridge to LVAD implantation. Nine patients in two European centres are described.ResultsAll patients were implanted with VA-ECMO for initial hemodynamic and metabolic stabilization. After a median time of 8 days, Impella 5.0 was implanted. Impella support allowed in all patients weaning from inotropes and from VA-ECMO (after a median time of 22 h). No patients had right ventricular failure after ECMO-weaning and most patients were mobilized and orally fed (88.9%) during Impella support. All patient underwent LVAD implantation after a median Impella time of 17 days. Only one patient had right-ventricular failure after LVAD implantation. All patients were discharged from hospital after a median time of 40 days.ConclusionEarly weaning from VA-ECMO with Impella 5.0 as a bridge to LVAD is a safe and effective strategy in management of INTERMACS 1 patients. This approach minimizes ECMO-related complications and allows patient mobilization and right ventricular function optimization before LVAD implantation.
       
  • Can delirium subtypes predict differences in 90-day mortality in the
           intensive care unit' - The authors reply
    • Abstract: Publication date: Available online 10 January 2020Source: Journal of Critical CareAuthor(s): Paul J.T. Rood, Mark van den Boogaard
       
  • Dynamic optic nerve sheath diameter changes upon moderate hyperventilation
           in patients with traumatic brain injury
    • Abstract: Publication date: Available online 9 January 2020Source: Journal of Critical CareAuthor(s): Stephanie Klinzing, Matthias Hilty, Ursina Bechtel-Grosch, Reto Andreas Schuepbach, Philipp Bühler, Giovanna BrandiAbstractBackgroundSonographic assessment of optical nerve sheath diameter (ONSD) has the potential for non-invasive monitoring of intracranial pressure (ICP). Hyperventilation (HV) -induced hypocapnia is used in the management of patients with traumatic brain injury (TBI) to reduce ICP. This study investigates, whether sonography is a reliable tool to detect dynamic changes in ONSD.MethodsThis prospective single center trial included patients with TBI and neuromonitoring within 36 h after injury. Data collection and ONSD measurements were performed at baseline and during moderate HV for 50 min. Patients not suffering from TBI were recruited as control group.ResultsTen patients with TBI (70% males, mean age 35 ± 14 years) with a median of first GCS of 5.9 and ten control patients (40% males, mean age 45 ± 16 years) without presumed intracranial hypertension were included. During HV, ICP decreased significantly (p 
       
  • Automated screening of natural language in electronic health records for
           the diagnosis septic shock is feasible and outperforms an approach based
           on explicit administrative codes
    • Abstract: Publication date: Available online 9 January 2020Source: Journal of Critical CareAuthor(s): Joris Vermassen, Kirsten Colpaert, Liesbet De Bus, Pieter Depuydt, Johan DecruyenaereAbstractPurposeIdentification of patients for epidemiologic research through administrative coding has important limitations. We investigated the feasibility of a search based on natural language processing (NLP) on the text sections of electronic health records for identification of patients with septic shock.Materials and methodsResults of an explicit search strategy (using explicit concept retrieval) and a combined search strategy (using both explicit and implicit concept retrieval) were compared to hospital ICD-9 based administrative coding and to our department's own prospectively compiled infection database.ResultsOf 8911 patients admitted to the medical or surgical ICU, 1023 (11.5%) suffered from septic shock according to the combined search strategy. This was significantly more than those identified by the explicit strategy (518, 5.8%), by hospital administrative coding (549, 5.8%) or by our own prospectively compiled database (609, 6.8%) (p 
       
  • Optic nerve sheath diameter measurement for predicting raised intracranial
           pressure in adult patients with severe traumatic brain injury: A
           meta-analysis
    • Abstract: Publication date: Available online 8 January 2020Source: Journal of Critical CareAuthor(s): Sun Hwa Lee, Hyun Soo Kim, Seong Jong YunAbstractObjectiveTo evaluate and compare the diagnostic feasibility of measuring the optic nerve sheath diameter (ONSD), via brain computed tomography (CT) and ocular ultrasonography (US) for prediction of raised intracranial pressure (ICP) in severe traumatic brain injury (TBI) patients.MethodsThe PubMed and EMBASE databases were searched for studies assessing the diagnostic accuracy of brain CT or ocular US for predicting raised ICP. Bivariate and hierarchical summary receiver operating characteristic modeling were performed to evaluate and compare the diagnostic feasibility of measuring the ONSD in adult patients with severe TBI according to modality (ocular US vs. brain CT).ResultsFive studies (four with ocular US and one with brain CT) were included. The ONSD had a pooled sensitivity of 0.91, pooled specificity of 0.77, and area under the HSROC curve of 0.92 for predicting raised ICP. More importantly, studies using ocular US found an almost equal sensitivity (0.91 vs. 0.90; p = .35) and higher specificity (0.82 vs. 0.58; p = .01) than those using brain CT.ConclusionsMeasurement of the ONSD may be a useful method for predicting raised ICP in adult patients with severe TBI.
       
  • Treating sepsis with vitamin C, thiamine, and hydrocortisone: Exploring
           the quest for the magic elixir
    • Abstract: Publication date: Available online 8 January 2020Source: Journal of Critical CareAuthor(s): J. Obi, S.M. Pastores, L.V. Ramanathan, J. Yang, N.A. HalpernAbstractThe administration of ascorbic acid (vitamin C) alone or in combination with thiamine (vitamin B1) and corticosteroids (VCTS) has recently been hypothesized to improve hemodynamics, end-organ function, and may even increase survival in critically ill patients. There are several clinical studies that have investigated the use of vitamin C alone or VCTS in patients with sepsis and septic shock or are ongoing. Some of these studies have demonstrated its safety and potential benefit in septic patients. However, many questions remain regarding the optimal dosing regimens and plasma concentrations, timing of administration, and adverse effects of vitamin C and thiamine. These questions exist because the bulk of research regarding the efficacy of vitamin C alone or in combination with thiamine and corticosteroids in sepsis is limited to a few randomized controlled trials, retrospective before-and-after studies, and case reports. Thus, although the underlying rationale and mechanistic pathways of vitamin C and thiamine in sepsis have been well described, the clinical impact of the VCTS regimen is complex and remains to be determined. This review aims to explore the current evidence and potential benefits and adverse effects of the VCTS regimen for the treatment of sepsis.
       
  • Development of critical care medicine in India
    • Abstract: Publication date: Available online 8 January 2020Source: Journal of Critical CareAuthor(s): Atul Prabhakar Kulkarni, Kapil Gangadhar Zirpe, Subhal Bhalchandra Dixit, Dhruva Chaudhry, Yatin Mehta, Rajesh Chandra Mishra, Srinivas Samavedam, Manish Munjal, for the Indian Society of Critical Care Medicine
       
  • From a pressure-guided to a perfusion-centered resuscitation strategy in
           septic shock: Critical literature review and illustrative case
    • Abstract: Publication date: Available online 8 January 2020Source: Journal of Critical CareAuthor(s): Raúl J. Gazmuri, Cristina Añez de GomezAbstractPurposeTo support a paradigm shift in the management of septic shock from pressure-guided to perfusion-centered, expected to improve outcome while reducing adverse effects from vasopressor therapy and aggressive fluid resuscitation.Material and methodsCritical review of the literature cited in support of vasopressor use to achieve a predefined mean arterial pressure (MAP) of 65 mmHg and review of pertinent clinical trials and studies enabling deeper understanding of the hemodynamic pathophysiology supportive of a perfusion-centered approach, accompanied by an illustrative case.ResultsReview of the literature cited by the Surviving Sepsis Campaign revealed lack of controlled clinical trials supporting outcome benefits from vasopressors. Additional literature review revealed adverse effects associated with vasopressors and worsened outcome in some studies. Vasopressors increase MAP primarily by peripheral vasoconstriction and in occasions by a modest increase in cardiac output when using norepinephrine. Thus, achieving the recommended MAP of 65 mmHg using vasopressors should not be presumed indicative that organ perfusion has been restored. It may instead create a false sense of hemodynamic stability hampering shock resolution.ConclusionsWe propose focusing the hemodynamic management of septic shock on reversing organ hypoperfusion instead of attaining a predefined MAP target as the key strategy for improving outcome.
       
  • Association of neuronal repair biomarkers with delirium among survivors of
           critical illness
    • Abstract: Publication date: April 2020Source: Journal of Critical Care, Volume 56Author(s): Christina J. Hayhurst, Mayur B. Patel, J. Brennan McNeil, Timothy D. Girard, Nathan E. Brummel, Jennifer L. Thompson, Rameela Chandrasekhar, Lorraine B. Ware, Pratik P. Pandharipande, E. Wesley Ely, Christopher G. HughesAbstractPurposeDelirium is prevalent but with unclear pathogenesis. Neuronal injury repair pathways may be protective. We hypothesized that higher concentrations of neuronal repair biomarkers would be associated with decreased delirium in critically ill patients.Materials and methodsWe performed a nested study of hospital survivors within a prospective cohort that enrolled patients within 72 h of respiratory failure or shock. We measured plasma concentrations of ubiquitin carboxyl-terminal-esterase-L1 (UCHL1) and brain-derived neurotrophic factor (BDNF) from blood collected at enrollment. Delirium was assessed twice daily using the CAM-ICU. Multivariable regression was used to examine the associations between biomarkers and delirium prevalence/duration, adjusting for covariates and interactions with age and IL-6 plasma concentration.ResultsWe included 427 patients with a median age of 59 years (IQR 48–69) and APACHE II score of 25 (IQR 19–30). Higher plasma concentration of UCHL1 on admission was independently associated with lower prevalence of delirium (p = .04) but not associated with duration of delirium (p = .06). BDNF plasma concentration was not associated with prevalence (p = .26) or duration of delirium (p = .36).ConclusionsDuring critical illness, higher UCHL1 plasma concentration is associated with lower prevalence of delirium; BDNF plasma concentration is not associated with delirium.Clinical trial number: NCT00392795; https://clinicaltrials.gov/ct2/show/NCT00392795
       
  • If I die young: Reflections on the social determinants of critical illness
    • Abstract: Publication date: April 2020Source: Journal of Critical Care, Volume 56Author(s): Megan A. Brandeland
       
  • Developing the family support tool: An interactive, web-based tool to help
           families navigate the complexities of surrogate decision making in ICUs
    • Abstract: Publication date: April 2020Source: Journal of Critical Care, Volume 56Author(s): Angela O. Suen, Rachel A. Butler, Robert Arnold, Brad Myers, Holly O. Witteman, Christopher E. Cox, Amanda Argenas, Praewpannanrai Buddadhumaruk, Alexandra Bursic, Natalie C. Ernecoff, Anne-Marie Shields, Dang K. Tran, Douglas B. WhiteAbstractIntroductionAlthough family members of incapacitated, critically ill patients often struggle in the role of surrogate decision maker, there are no low-cost, easily-scaled interventions to address this problem.Aim of the studyTo develop and pilot-test the Family Support Tool, an interactive, web-based tool to help individuals navigate the complexities of surrogate decision making in ICUs.Material and methodsWe used a mixed methods, user-centered process to create the Family Support Tool, including: 1) creation of a preliminary design by an expert panel; 2) engagement of a key stakeholder panel to iteratively refine the preliminary design; 3) user testing of a low-fidelity prototype of the tool by 6 former ICU surrogates; 4) creation of a web-based prototype; and 5) user testing of the web-based prototype with 14 surrogates and ICU physicians, including semi-structured interviews and quantitative measurement of usability, acceptability, and perceived effectiveness.ResultsThe initial design contained a collection of videos and exercises designed to help individuals understand the surrogate's role and think through the patient's values and preferences. Based on family stakeholders' feedback about the emotional overwhelm they experience early in an ICU stay, we redesigned the tool to be viewed in sections, with the first section focused on decreasing surrogates' emotional distress, and later sections focused on helping surrogates prepare for family meetings. Surrogates actively making decisions in the ICU judged the final tool to be highly usable (mean summary score 83.5, correlating to 95th percentile when normalized to devices of its type), acceptable (mean 4.2 +/− 0.5 out of 5), and effective (mean 4.3 +/− 0.6 out of 5). All surrogates reported the tool helped them consider goals of care and all indicated they would recommend the tool to a friend.ConclusionsWe successfully developed a web-based tool to help individuals navigate the complexities of surrogate decision making in ICUs that has high potential for scalability. Surrogates judged the tool to be usable, acceptable, and effective. These data support proceeding to test the tool in a pilot randomized clinical trial.
       
  • French ICU's health care workers have a poor knowledge of the cost of the
           devices they use for patient care: A prospective multicentric study
    • Abstract: Publication date: April 2020Source: Journal of Critical Care, Volume 56Author(s): Paul Gabarre, Pierre-Yves Boelle, Naike Bigé, Muriel Fartoukh, Christophe Guitton, Guillaume Dumas, Jean-Rémi Lavillegrand, Geoffroy Hariri, Jean-Luc Baudel, Daniel Zafimahazo, Hafid Ait-Oufella, Eric MauryAbstractPurposeICU patient's care may require the use of onerous devices, which contributes to make this department one of the most expensive in the hospital. It seemed us relevant to assess healthcare workers' (HCWs) knowledge of the cost of the devices daily used in ICU.Materials and methodsAn anonymous questionnaire was administered on a voluntary basis to HCWs of 3 ICUs.Measurements and main resultsCost estimations were expressed as percentage of the real cost; an estimation was considered correct if it was ±50% of the true price. 107 HCWs (66 physicians and 41 nurses and nurse aids) answered the survey. Only 29% of estimations were within 50% of the real cost. The prices of the cheapest devices were overestimated, while the costs of the most expensive ones were underestimated. In multivariate analysis, cost less than50 euros [OR = 3.2; CI 95%(1.6–6.3)], professional experience
       
  • Muscle degradation, vitamin D and systemic inflammation in hospitalized
           septic patients
    • Abstract: Publication date: April 2020Source: Journal of Critical Care, Volume 56Author(s): Rodrigo Cerqueira Borges, Hermes Vieira Barbeiro, Denise Frediani Barbeiro, Francisco Garcia SorianoAbstractPurposeTo date, the relationship between systemic inflammation and muscle changes observed by ultrasonography in septic patients in clinical studies is not known. Furthermore, the role of vitamin D on muscle changes in these patients needs to be investigated.Materials and methodsForty-five patients admitted to the ICU due to severe sepsis or septic shock. Blood samples were collected to evaluate systemic inflammation (interleukin (IL)-10, IL-1β, IL-1α, IL-6, IL-8 and tumor necrosis factor–α(TNF-α)) and vitamin D. Muscle mass was evaluated by ultrasound during hospitalization. Clinical tests of muscle strength (Medical Research Council (MRC) scale and handgrip) were performed after the awakening of patients.ResultsThere was a reduction in day 2 values to hospital discharge on TNF-alpha, IL-8, IL-6 and IL-10 (p
       
  • Impact of obstructive sleep apnea on the obesity paradox in critically ill
           patients
    • Abstract: Publication date: April 2020Source: Journal of Critical Care, Volume 56Author(s): Sébastien Bailly, Louis-Marie Galerneau, Stéphane Ruckly, Alexandre Seiller, Nicolas Terzi, Carole Schwebel, Claire Dupuis, Renaud Tamisier, Bernard Mourvillier, Jean-Louis Pepin, Jean-François TimsitAbstractObjectivePatients admitted to an intensive care unit (ICU) frequently suffer from multiple chronic diseases, including obstructive sleep apnea (OSA). Until recently OSA was not considered as a key determinant in an ICU patient's prognosis. The objective of this study was to document the impact of OSA on the prognosis of ICU patients.MethodsData were retrospectively collected concerning adult patients admitted to ICU at two university hospitals. In a nested study OSA status was checked using the hospital electronic medical records to identify exposed and unexposed cases. The following outcomes were considered: length of stay in the ICU, ICU mortality, in-hospital mortality, ventilator-associated pneumonia (VAP).ResultsOut of 5146 patients included in the study, 289 had OSA at ICU admission (5.6%). After matching, the overall impact of OSA on length of ICU stay was not significant (p = .24). In a predefined subgroup analysis, there was a significant impact of OSA on the length of ICU stay for patients with BMI over 40 kg/m2 (IRR: 1.56 [1.05; 2.32], p = .03). OSA status had no impact on ICU or hospital mortality and VAP.ConclusionIn general, known OSA did not increase the ICU stay except for patients with both OSA and morbid obesity.
       
  • A meta-analysis of the outcomes following enteral vs parenteral nutrition
           in the open abdomen in trauma patients
    • Abstract: Publication date: April 2020Source: Journal of Critical Care, Volume 56Author(s): En Lin Goh, Swathikan Chidambaram, Ella Segaran, Vanesa Garnelo Rey, Mansoor Ali Khan
       
  • Ketamine sedation in mechanically ventilated patients: A systematic review
           and meta-analysis
    • Abstract: Publication date: April 2020Source: Journal of Critical Care, Volume 56Author(s): A. Travis Manasco, Robert J. Stephens, Lauren H. Yaeger, Brian W. Roberts, Brian M. FullerPurposeKetamine use as a sedative agent in mechanically ventilated patients is increasing. This systematic review and meta-analysis collates existing literature and quantifies the impact of ketamine in mechanically ventilated patients.Materials and methodsEMBASE, MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, conference proceedings, and reference lists were searched. Randomized and nonrandomized studies were included, and two reviewers independently screened abstracts of identified studies for eligibility.ResultsFifteen studies (n = 892 patients) were included. Random effects meta-analytic models revealed that ketamine was associated with a reduction in propofol infusion rate (mean difference in dose, −699 μg/min; 95% CI −1169 to −230, p = .003), but had no impact on fentanyl or midazolam. Ketamine was not associated with mortality, on-target sedation, vasopressor dependence, or hospital length of stay. Cardiovascular complications (e.g. tachycardia and hypertension) were most commonly reported, followed by neurocognitive events, such as agitation and delirium.ConclusionsThe data regarding ketamine use in mechanically ventilated patients is limited in terms of quantity, methodological quality, and demonstrated clinical benefit. Ketamine may play a role as a sedative-sparing agent, but may be associated with harm. High-quality studies are needed before widespread adoption of ketamine earlier in the sedation pathway.
       
  • Management of civilians with penetrating brain injury: A systematic review
    • Abstract: Publication date: April 2020Source: Journal of Critical Care, Volume 56Author(s): Andrea Loggini, Valentina I. Vasenina, Ali Mansour, Paramita Das, Peleg M. Horowitz, Fernando D. Goldenberg, Christopher Kramer, Christos LazaridisAbstractPurposeThere has been a dramatic increase in penetrating gunshot-inflicted civilian penetrating brain injuries (cvPBI). We undertook a systematic review with exclusive focus on the management of cvPBI.MethodsWe explored: (1) cervical spine immobilization, (2) seizure incidence and prophylaxis, (3) infection incidence and antibiotic prophylaxis, (4) coagulopathy (5) vascular complications, and (6) surgical management. We searched PubMed, EMBASE, and Cochrane (1985–2019). The PRISMA guidelines were followed. The Newcastle-Ottawa Scale was employed for qualitative assessment; risk of bias was evaluated based upon the RTI item bank. The full protocol was registered to PROSPERO (CRD42019118877).ResultsThe literature is scant, and of overall low quality and high risk of bias. Incidence of c-spine injury with no direct trauma is low; incidence of seizures does not appear to be different from non-penetrating mechanisms; there is no robust data for prophylactic antibiotics; coagulopathy is prevalent and has been independently associated with outcome; there is a high incidence of vascular injuries with traumatic intracranial aneurysms the most common sequelae; neurosurgical decision-making appears largely influenced by operator's assessment of salvageability. Surgery has been associated with decreased mortality.ConclusionsLimited amount of published work is clinically meaningful; this systematic review identified key knowledge gaps.
       
  • Heterogeneous effect of increasing spinal cord perfusion pressure on
           
    • Abstract: Publication date: April 2020Source: Journal of Critical Care, Volume 56Author(s): Mathew J. Gallagher, David Martín López, Helen V. Sheen, Florence R.A. Hogg, Argyro Zoumprouli, Marios C. Papadopoulos, Samira SaadounAbstractPurposeTo investigate the effect of increasing spinal cord perfusion pressure (SCPP) on sensory evoked potentials (SEPs) and injury site metabolism in patients with severe traumatic spinal cord injury TSCI.Materials and methodsIn 12 TSCI patients we placed a pressure probe, a microdialysis catheter and a strip electrode with 8 contacts on the surface of the injured cord. We monitored SCPP, lactate-to-pyruvate ratio (LPR) and SEPs (after median or posterior tibial nerve stimulation).ResultsIncrease in SCPP by ~20 mmHg produced a heterogeneous response in SEPs and injury site metabolism. In some patients, SEP amplitudes increased and the LPR decreased indicating improved tissue metabolism. In others, SEP amplitudes decreased and the LPR increased indicating more impaired metabolism. Compared with patients who did not improve at follow-up, those who improved had significantly more electrode contacts with SEP amplitude increase in response to increasing SCPP.ConclusionsIncreasing SCPP after acute, severe TSCI may be beneficial (if associated with increase in SEP amplitude) or detrimental (if associated with decrease in SEP amplitude). Our findings support individualized management of patients with acute, severe TSCI guided by monitoring from the injury site rather than applying universal blood pressure targets as is current clinical practice.
       
  • Incidence, risk factors, and outcomes for sepsis-associated delirium in
           patients with mechanical ventilation: A sub-analysis of a multicenter
           randomized controlled trial
    • Abstract: Publication date: April 2020Source: Journal of Critical Care, Volume 56Author(s): Tomonori Yamamoto, Yasumitsu Mizobata, Yu Kawazoe, Kyohei Miyamoto, Yoshinori Ohta, Takeshi Morimoto, Hitoshi YamamuraAbstractPurposeThis study aimed to investigate incidence, risk factors, and outcomes for sepsis-associated delirium (SAD) in mechanically ventilated patients.Materials and methodsWe performed a retrospective post-hoc analysis of the DExmedetomidine for Sepsis in Intensive care unit Randomized Evaluation (DESIRE) trial. Outcomes included 28-day mortality, ventilator-free days, length of ICU stay, self-extubation, and re-intubation. Multivariable analysis was performed to identify variables independently associated with SAD.ResultsWe retrospectively divided the patients into two groups: delirium group (n = 89) and non-delirium group (n = 98). There were no significant differences between the groups in 28-day mortality, self-extubation, and re-intubation. The number of ventilator-free days was significantly less in the delirium vs. non-delirium group (17 vs. 22 days, p = .006), and the length of ICU stay was significantly longer in the delirium group (10 vs. 5 days, p = .04). Multivariable analyses revealed that emergency surgery, more doses of midazolam, and fentanyl were independent predictors for SAD.ConclusionsSAD was associated with a less number of ventilator-free days and longer length of ICU stay. Emergency surgery, more doses of midazolam, and fentanyl may be independent risk factors for SAD in mechanically ventilated patients with sepsis.
       
  • Predicting mortality among critically ill patients with acute kidney
           injury treated with renal replacement therapy: Development and validation
           of new prediction models
    • Abstract: Publication date: April 2020Source: Journal of Critical Care, Volume 56Author(s): Daniel H. Li, Ron Wald, Daniel Blum, Eric McArthur, Matthew T. James, Karen E.A. Burns, Jan O. Friedrich, Neill K.J. Adhikari, Danielle M. Nash, Gerald Lebovic, Andrea K. Harvey, Stephanie N. Dixon, Samuel A. Silver, Sean M. Bagshaw, William Beaubien-SoulignyAbstractPurposeSevere acute kidney injury (AKI) is associated with a significant risk of mortality and persistent renal replacement therapy (RRT) dependence. The objective of this study was to develop prediction models for mortality at 90-day and 1-year following RRT initiation in critically ill patients with AKI.MethodsAll patients who commenced RRT in the intensive care unit for AKI at a tertiary care hospital between 2007 and 2014 constituted the development cohort. We evaluated the external validity of our mortality models using data from the multicentre OPTIMAL-AKI study.ResultsThe development cohort consisted of 594 patients, of whom 320(54%) died and 40 (15% of surviving patients) remained RRT-dependent at 90-day Eleven variables were included in the model to predict 90-day mortality (AUC:0.79, 95%CI:0.76–0.82). The performance of the 90-day mortality model declined upon validation in the OPTIMAL-AKI cohort (AUC:0.61, 95%CI:0.54–0.69) and showed modest calibration. Similar results were obtained for mortality model at 1-year.ConclusionsRoutinely collected variables at the time of RRT initiation have limited ability to predict mortality in critically ill patients with AKI who commence RRT.
       
  • Fluctuations of consciousness after stroke: Associations with the
           confusion assessment method for the intensive care unit (CAM-ICU) and
           potential undetected delirium
    • Abstract: Publication date: April 2020Source: Journal of Critical Care, Volume 56Author(s): Michael E. Reznik, Lori A. Daiello, Bradford B. Thompson, Linda C. Wendell, Ali Mahta, N. Stevenson Potter, Shadi Yaghi, Mitchell M. Levy, Corey R. Fehnel, Karen L. Furie, Richard N. JonesAbstractPurposeTo examine associations between fluctuating consciousness and Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) assessments in stroke patients compared to non-neurological patients.Materials and methodsWe linked all recorded CAM-ICU assessments with corresponding Richmond Agitation Sedation Scale (RASS) measurements in patients with stroke or sepsis from a single-center ICU database. Fluctuating consciousness was defined by RASS variability using standard deviations (SD) over 24-h periods; regression analyses were performed to determine associations with RASS variability and CAM-ICU rating.ResultsWe identified 16,509 paired daily summaries of CAM-ICU and RASS measurements in 546 stroke patients and 1586 sepsis patients. Stroke patients had higher odds of positive (OR 4.2, 95% CI 3.3–5.5) and “unable to assess” (UTA; OR 5.2, 95% CI 4.0–6.8) CAM-ICU ratings compared to sepsis patients, and CAM-ICU-positive and UTA assessment-days had higher RASS variability than CAM-ICU-negative assessment-days, especially in stroke patients. Based on model-implied associations of RASS variability (OR 2.0 per semi-IQR-difference in RASS-SD, 95% CI 1.7–2.2) and stroke diagnosis (OR 2.7, 95% CI 2.0–3.7) with CAM-ICU-positive assessments, over one-third of probable delirium cases among stroke patients were potentially missed by the CAM-ICU.ConclusionsPost-stroke delirium may frequently go undetected by the CAM-ICU, even in the setting of fluctuating consciousness.
       
  • Prevention and early treatment of driveline infections in ventricular
           assist device patients – The DESTINE staging proposal and the first
           standard of care protocol
    • Abstract: Publication date: April 2020Source: Journal of Critical Care, Volume 56Author(s): Alexander M. Bernhardt, Thomas Schlöglhofer, Volker Lauenroth, Florian Mueller, Marcus Mueller, Alexandra Schoede, Christian Klopsch, the Driveline Expert STagINg and carE DESTINE study group, a Ventricular Assist Device Driveline Infection Study GroupAbstractMechanical circulatory support (MCS) using left ventricular assist devices (LVAD) have considerably improved the quality of life and survival rate of patients with end-stage heart failure. Despite substantial technological progress, major challenges with regard to VAD-specific and VAD-related infections have hitherto hindered the broader application of this promising therapy approach. Driveline infections (DLI) range among the main adverse events experienced in LVAD patients. However, many centers still apply their own protocol for driveline exit site (DLES) care and an international standard on prevention, reduction and early treatment of DLI after the perioperative period has not yet been defined. In March 2019, VAD coordinators and cardiac surgeons from Germany and Austria met to develop a standard of care procedure (SOP) as well as a new staging approach with recommended actions for treatment of VAD carriers. In this Driveline Expert STagINg and carE (DESTINE) study group we developed a 10-step SOP for DLES care with emphasis on essentials such as clean and save preparation, sterile dressing change and secure driveline immobilization. An advanced wound staging approach was defined with recommended actions for prevention, early detection and stage-related management of DLI. Broad consensus was reached on the fact that an interdisciplinary approach both in DLES care and DLES healing disorder awareness is required to prolong infect-free survival times on MCS as well as to ensure high patient compliance and quality of life. In conclusion, a new detailed SOP for appropriate DLES care and an advanced wound staging approach for prevention and management of DLI were defined on an expert level applicable for VAD clinicians, practitioners and care givers in Central Europe.
       
  • Pharmacological interventions to reduce edema following cardiopulmonary
           bypass: A systematic review and meta-analysis
    • Abstract: Publication date: April 2020Source: Journal of Critical Care, Volume 56Author(s): Nicole A.M. Dekker, Anoek L.I. van Leeuwen, Peter M. van de Ven, Ralph de Vries, Peter L. Hordijk, Christa Boer, Charissa E. van den BromAbstractPurposeTo compare the effectiveness of different types of pharmacological agents to reduce organ specific edema following cardiopulmonary bypass (CPB).MethodsPubmed, Embase.com and Cochrane were searched for studies administrating a pharmacological agent before CPB. Primary outcome was postoperative edema.ResultsForty-four studies (clinical n = 6, preclinical n = 38) fulfilled eligibility criteria. Steroids were used in most clinical studies (n = 5, 83%) and reduced postoperative edema in 4 studies, however heterogeneity precluded meta-analysis. In preclinical studies, a total of 31 different drugs were tested of which 20 (65%) reduced edema in at least one organ. Particularly neutrophil inhibitors, and modulators of coagulation or endothelial barrier reduced pulmonary edema (SMD −2.77 [−3.93, −1.61]; −1.29 [−2.12, −0.46], −2.33 [−4.69, 0.03], respectively) compared to no treatment. Reducing renal (SMD −0.91 [CI −1.65 to −0.18]), intestinal (SMD −1.98 [CI −3.92 to −0.04]) or myocardial (SMD −1.95 [CI −3.91 to −0.01]) edema following CPB required specific modulators of endothelial barrier.ConclusionOverall, neutrophil inhibitors and direct modulators of endothelial barrier (PAR1, Tie2 signaling) most effectively reduced edema following CPB, in particular pulmonary edema. Future research should focus on a combination of these strategies to reduce edema and assess the effect on organ function and outcome following CPB.
       
  • C-reactive protein as a prognostic factor in intensive care admissions for
           sepsis: A Swedish multicenter study
    • Abstract: Publication date: April 2020Source: Journal of Critical Care, Volume 56Author(s): Hazem Koozi, Maria Lengquist, Attila FrigyesiAbstractPurposeC-reactive protein (CRP) is not included in the major intensive care unit (ICU) prognostic tools such as the Simplified Acute Physiology Score (SAPS). We assessed CRP on ICU admission as a SAPS-3 independent risk marker for short-term mortality and length of stay (LOS) in ICU patients with sepsis.Materials and methodsAdult ICU admissions satisfying the Sepsis-3 criteria to four southern Swedish hospitals were retrospectively identified and divided into a low CRP group (100 mg/L) based on the admission CRP level. The standardized mortality ratio (SMR) was calculated.ResultsA total of 851 admissions were included. The SMR was higher in the high CRP group (0.85 vs. 0.67, P = .001 in the whole sepsis group and 0.85 vs. 0.59, P = .003 in the culture-positive subgroup). The CRP levels also correlated with ICU and hospital LOS in survivors (P 100 mg/L is associated with an increased risk of ICU and 30-day mortality as well as prolonged LOS in survivors, irrespective of morbidity measured with SAPS-3. Thus, CRP may be a simple, early marker for prognosis in ICU admissions for sepsis.
       
  • Pulmonary mucormycosis in a patient with acute liver failure: A case
           report and systematic review of the literature
    • Abstract: Publication date: April 2020Source: Journal of Critical Care, Volume 56Author(s): Yu Qing Huang, Jan-Alexis Tremblay, Hugo Chapdelaine, Me-Linh Luong, François Martin CarrierAbstractPurposePulmonary mucormycosis is a highly lethal invasive fungal infection usually found in immunocompromised patients. We report herein the case of an adult woman who developed pulmonary mucormycosis with possible systemic dissemination after recovering from acute liver failure secondary to acetaminophen overdose.ResultsOur case developed an invasive pulmonary mucormycosis with probable systemic dissemination. She did not suffer from any immunocompromising disease other than severe acute liver failure. She did not survive the disease, although she received appropriate antifungal treatment. We also performed a systematic review of the literature on pulmonary mucormycosis, with or without dissemination, in immunocompetent patients. We found 16 cases of pulmonary or disseminated mucormycosis in immunocompetent patients. Fifty-seven percent of them died and none occurred after an acute liver failure episode.ConclusionThis case report is the first one to present an invasive pulmonary mucormycosis infection after acute liver failure in an adult patient. The clinical course of this disease is highly lethal, even in immunocompetent adults.
       
  • Effects of intraoperative tidal volume on incidence of acute kidney injury
           after cardiovascular surgery: A retrospective cohort study
    • Abstract: Publication date: April 2020Source: Journal of Critical Care, Volume 56Author(s): Kentaro Tojo, Takahiro Mihara, Takahisa GotoAbstractPurposeWe performed a retrospective cohort study to evaluate whether intraoperative low tidal volume ventilation reduces the incidence of acute kidney injury (AKI) after cardiovascular surgery.Materials and methodsRecords of patients who underwent cardiovascular surgery were reviewed. The primary outcome was AKI diagnosed by changes in serum creatinine values. Intraoperative mean tidal volume relative to predicted body weight (PBW) was calculated. The effects of intraoperative mean tidal volumes on AKI incidence were evaluated.ResultsOf 338 examined patients, 105 developed AKI. Among patients who received mean tidal volumes of ≤7,>7 to ≤8,>8 to ≤9, and > 9 mL/kg PBW, the AKI incidence was 12.8% (95% confidence interval [CI]: 6.0–25.1%), 29.9% (95% CI: 22.6–38.4%), 38.7% (95% CI: 30.0–48.2), and 34.5% (95% CI: 23.6–47.3%), respectively. Inverse probability of treatment weighting analysis demonstrated that AKI risk was significantly lower in patients who received ≤7 mL/kg PBW than in those who received>7 mL/kg PBW (odds ratio: 0.14, 95% CI: 0.04–0.46, p = .001).ConclusionsThis study suggests that intraoperative low tidal volume ventilation during cardiovascular surgery is associated with a decreased incidence of postoperative AKI. Lowering tidal volume might be a simple strategy for reducing AKI incidence after cardiovascular surgery.
       
  • The clinical effect of hemostatic resuscitation in traumatic hemorrhage; a
           before-after study
    • Abstract: Publication date: Available online 6 January 2020Source: Journal of Critical CareAuthor(s): Rob L.J. Zwinkels, Henrik Endeman, Sanne E. Hoeks, Moniek P.M. de Maat, Dennis den Hartog, Robert Jan Stolker
       
  • Bedside dynamic calculation of mechanical power: A validation study
    • Abstract: Publication date: Available online 2 January 2020Source: Journal of Critical CareAuthor(s): Sinan Aşar, Özlem Acicbe, Zafer Çukurova, Oya Hergünsel, Emral Canan, Nahit ÇakarAbstractPurposeTo develop an equation to calculate the bedside dynamic mechanical power (MPdyn) for modern ventilators using the Work of Breathing ventilator (WOBv) parameter.Materials and methodsWe developed an equation based on mechanical power values, which is equal to WOBv x minute volume. To measure mechanical power with this equation forty adult patients, hospitalized with the diagnosis of Acute Respiratory Distress Syndrome and underwent invasive mechanical ventilation, were used. To be able compare our results with Gattinoni's standart mechanical power equation (MPstd) the contribution of the PEEP was included in our equation. Then results obtained from MPdyn and MPstd were compared using univariable regression and Bland-Altman analysis. This comparison was performed at different I:E ratios, PEEP levels and tidal volumes.ResultsAnalysis of the results for each condition showed that MPdyn and MPstd equation correlated with R2 ≥ 0.98. Additionally, there was no statistically significant difference between MPdyn and MPstd by comparing analysis for patient power means were 0.04 J/min (p = .42) using Bland-Altman analysis.ConclusionsPhysicians can easily calculate mechanical power by using MPdyn at the bedside of patients on volume control mode.
       
  • A clinical trial of silver-coated and tapered cuff plus supraglottic
           suctioning endotracheal tubes in preventing ventilator-associated
           pneumonia
    • Abstract: Publication date: Available online 28 December 2019Source: Journal of Critical CareAuthor(s): Ata Mahmoodpoor, Sarvin Sanaie, Rukma Parthvi, Kamran Shadvar, Hadi Hamishekar, Afshin Iranpour, Hamidreza Nuri, Sama Rahnemayan, Nader D. NaderAbstractPurposeNovel designs of the endotracheal tube (ETT) are emerged to reduce the risk of ventilator-associated pneumonia (VAP). We evaluated the effect of two different types, namely silver-coated (Bactiguard) and subglottic suctioning (Taperguard) ETTs, on the incidence of VAP in critically-ill patients.MethodsA total of 90 patients, mechanically ventilated for>72 h, were randomly assigned to Bactiguard and Taperguard groups. They otherwise received routine care, including VAP prevention measures during their intensive care unit (ICU) stay. Subglottic suctioning was performed in Taperguard group. Statistical analyses were performed using SPSS 25 for iMacs.ResultsBoth groups had similar demographics and did not differ in the prevalence of comorbidities and the severity of underlying illness. There was no difference in the frequency of reintubation (P = .565), the duration of ventilation, ICU and total hospital length of stay. VAP developed in 31% of the Bactiguard group and 20% of the Taperguard group (P = .227). Nearly twice the number of patients died in the Bactiguard group compared to the Taperguard group. This difference was not significant either (P = .352).ConclusionsThe use of Bactiguard or Taperguard ETTs was not associated with any difference in the incidence of VAP or ICU mortality.
       
  • Effects of propofol on ischemia-reperfusion and traumatic brain injury
    • Abstract: Publication date: Available online 24 December 2019Source: Journal of Critical CareAuthor(s): Melissa A. Hausburg, Kaysie L. Banton, Phillip E. Roman, Fernando Salgado, Peter Baek, Michael J. Waxman, Allen Tanner, Jeffery Yoder, David Bar-OrAbstractOxidative stress exacerbates brain damage following ischemia-reperfusion and traumatic brain injury (TBI). Management of TBI and critically ill patients commonly involves use of propofol, a sedation medication that acts as a general anesthetic with inherent antioxidant properties. Here we review available evidence from animal model systems and clinical studies that propofol protects against ischemia-reperfusion injury. However, evidence of propofol toxicity in humans exists and manifests as a rare complication, “propofol infusion syndrome” (PRIS). Evidence in animal models suggests that brain injury induces expression of the p75 neurotrophin receptor (p75NTR), which is associated with proapoptotic signaling. p75NTR-mediated apoptosis of neurons is further exacerbated by propofol's superinduction of p75NTR and concomitant inhibition of neurotrophin processing. Propofol is toxic to neurons but not astrocytes, a type of glial cell. Evidence suggests that propofol protects astrocytes from oxidative stress and stimulates astroglial-mediated protection of neurons. One may speculate that in brain injury patients under sedation/anesthesia, propofol provides brain-tissue protection or aids in recovery by enhancing astrocyte function. Nevertheless, our understanding of neurologic recovery versus long-term neurological sequelae leading to neurodegeneration is poor, and it is also conceivable that propofol plays a partial as yet unrecognized role in long-term impairment of the injured brain.
       
  • A potential diagnostic problem on the ICU: Euglycaemic diabetic
           Ketoacidosis associated with SGLT2 inhibition
    • Abstract: Publication date: Available online 10 December 2019Source: Journal of Critical CareAuthor(s): Idrisu Sanusi, Alexander Sarnowski, David Russell-Jones, Lui G. ForniAbstractSodium glucose cotransporter 2 (SGLT2) inhibitors are the latest class of oral hypoglycaemic agents approved to treat type II diabetes. Their use is increasing and as such more patients will present to critical care whilst on this treatment. However, there have been several case reports of euglycaemic diabetic ketoacidosis associated with the use of these agents. Under such circumstances the blood glucose is often normal or only moderately elevated and hence the diagnosis may be delayed resulting in inappropriate therapy. In this review we describe a case of SGLT2 mediated ketoacidosis who presented to our intensive care unit, discuss the proposed pathophysiology behind this development of ketoacidosis as well as its potential prevention, management and treatment.
       
  • Double inter-hospital transfer in Sepsis patients presenting to the ED
           does not worsen mortality compared to single inter-hospital transfer
    • Abstract: Publication date: Available online 30 November 2019Source: Journal of Critical CareAuthor(s): Maria D. Arulraja, Morgan B. Swanson, Nicholas M. MohrAbstractPurposeSepsis is a leading cause of hospital deaths. Inter-hospital transfer is frequent in sepsis and is associated with increased mortality. Some sepsis patients undergo two inter-hospital transfers (double transfer). This study assessed the (1) prevalence, (2) associated risk factors, (3) associated mortality, and (4) hospital length-of-stay and costs of double-transfer of sepsis patients.Materials and methodsRetrospective cohort study using 2005–2014 administrative claims data in Iowa. Multivariable generalized estimating equations adjusted for potential confounding variables, with a primary outcome of mortality. Secondary outcomes included hospital length-of-stay and costs. Hospital-specific cost-to-charge ratios estimated hospital costs. Hospitals were categorized into quintiles based on sepsis-volume.ResultsOf 15,182 sepsis subjects, there were 45.2% non-transfers and 2.1% double-transfers. Double-transfers had worse mortality than non-transfers but not single-transfers. Of the non-transfers, 44.9% presented to a top sepsis-volume hospital compared to 22.8% of double-transfers and 25.1% of single-transfers. After transfer from first to second hospital, 93.4% of the single-transfers and 92.2% of the double-transfers were at a top sepsis-volume hospital. Double-transfers had longer length-of-stay and more in total hospital costs than single-transfers.ConclusionsDouble-transfer occurs in 2.1% of Iowa sepsis patients. Double-transfers had similar mortality and increased length of stay and costs compared to single-transfers.
       
  • Muscle wasting associated co-morbidities, rather than sarcopenia are risk
           factors for hospital mortality in critical illness
    • Abstract: Publication date: Available online 26 November 2019Source: Journal of Critical CareAuthor(s): Michelle R. Baggerman, David P.J. van Dijk, Bjorn Winkens, Rob J.J. van Gassel, Martine E. Bol, Ronny M. Schnabel, Frans C. Bakers, Steven W.M. Olde Damink, Marcel C.G. van de PollAbstractBackgroundLow skeletal muscle mass on intensive care unit admission is related to increased mortality. It is however unknown whether this association is influenced by co-morbidities that are associated with skeletal muscle loss. The aim of this study was to investigate whether sarcopenia is an independent risk factor for hospital mortality in critical illness in the presence of co-morbidities associated with muscle wasting.MethodsData of 155 patients with abdominal sepsis were retrospectively analyzed. Skeletal muscle area was assessed using CT-scans at the level of vertebra L3. Demographic and clinical data were retrieved from electronic patient files. Sarcopenia was defined as a muscle area index below the 5th percentile of the general population. Uni- and multivariable analyses were performed to assess the association between sarcopenia and hospital mortality, correcting for age and comorbidities.ResultsThe prevalence of sarcopenia was higher in patients that did not survive until hospital discharge. However, it appeared that this relation was confounded by the presence of chronic renal insufficiency and cancer. These were independent risk factors for hospital mortality, whereas sarcopenia was not.ConclusionIn critically ill patients with abdominal sepsis, muscle wasting associated co-morbidities rather than sarcopenia were risk factors for hospital mortality.
       
  • The effects of hyperoxia on sublingual microcirculation: An unsolved
           puzzle
    • Abstract: Publication date: Available online 20 November 2019Source: Journal of Critical CareAuthor(s): Arnaldo Dubin, Mario Omar Pozo
       
  • Comment on “Effects of short-term hyperoxia on sytemic hemodynamics,
           oxygen transport, and microcirculation: An observational study in patients
           with septic shock and healthy volunteers”
    • Abstract: Publication date: Available online 18 November 2019Source: Journal of Critical CareAuthor(s): Elisa Damiani, Erica Adrario, Andrea Carsetti, Roberta Domizi, Claudia Scorcella, Abele Donati
       
  • Factor XIII activity in patients requiring surgical re-exploration for
           bleeding after elective cardiac surgery – A prospective case control
           study
    • Abstract: Publication date: Available online 18 November 2019Source: Journal of Critical CareAuthor(s): ElisabethH. Adam, Jens Meier, Bernd Klee, Kai Zacharowski, Patrick Meybohm, Christian F. Weber, Andreas PapeAbstractPurposeSurgical re-exploration due to postoperative bleeding is associated with increased morbidity and mortality. The aim of our study was to assess a potential association between the level of postoperative FXIII activity and need for re-exploration due to bleeding in patients undergoing cardiothoracic surgery.Materials and methodsIn our prospective single center observational cohort study, we enrolled patients who underwent elective cardiothoracic surgery. Patients who required re-exploration (RE group) were matched to patients from the study population (non-RE group).ResultsThe study included 64 patients, out of a cohort of 678 patients, of whom 32 required surgical re-exploration due to bleeding within the first 24 h. Between patients of the RE and non-RE group, a significantly reduced FXIII activity was observed postoperatively (59.0 vs 71.1; p = .014). Multivariable analysis revealed reduced FXIII activity (p = .048) as a parameter independently associated with surgical re-exploration. Further, reduced FXIII activity (p = .037) and surgical re-exploration (p = .01) were significantly associated with increased 30 day mortality. In multivariable analysis re-exploration was independently associated with increased risk of 30 day mortality (p = .004, HR 9.68).ConclusionsReduced postoperative FXIII activity may be associated with the need for surgical re-exploration. Postoperative assessment of FXIII activity should therefore be considered in patients undergoing elective cardiothoracic surgery.
       
  • Low serum albumin levels and new-onset atrial fibrillation in the ICU a
           prospective cohort study
    • Abstract: Publication date: Available online 16 November 2019Source: Journal of Critical CareAuthor(s): Dianne E.C. van Beek, Yvette A.M. Kuijpers, Marc H.H. Königs, Iwan C.C. van der Horst, Thomas W.L. ScheerenAbstractPurposeThe aim was to determine if a low serum albumin (SA) level was associated with the occurrence of new onset atrial fibrillation (NOAF) during the first 48 h of intensive care unit (ICU) admission.MethodsOverall, 97 patients admitted to the ICU were included in this prospective study. NOAF during the first 48 h was defined as irregularity and absence of p-waves on the continuous electrocardiogram, lasting longer than 2 min. Association were analysed using logistic regression with correction for confounding variables in multivariable analysis.ResultsThe incidence of NOAF during the first 48 h of ICU admission was 18%. SA levels at ICU admission were significantly associated with NOAF after correction for confounders (odds ratio [OR] 0.86, 95%CI 0.77–0.97, p = .010). SA levels were also significantly associated with the number of episodes of NOAF in multivariate analysis (−0.09 episodes, 95%CI [−0.15/−0.04], p = .001), but not with the presence of sinus rhythm at 48 h (OR 1.05, 95%CI [0.93–1.12], p = .46).ConclusionIn this small hypothesis generating study low levels of SA were associated with the occurrence of NOAF. It remains to be shown if increasing SA levels lowers the incidence of NOAF.
       
  • Corrigendum to “Early target attainment of continuous infusion
           piperacillin/tazobactam and meropenem in critically ill patients: A
           prospective observational study” [Journal of Critical Care 52 (2019)
           75–79]
    • Abstract: Publication date: Available online 15 November 2019Source: Journal of Critical CareAuthor(s): Sofie A.M. Dhaese, Alexander D.J. Thooft, Andras Farkas, Jeffrey Lipman, Alain G. Verstraete, Veronique Stove, Jason A. Roberts, Jan J. De Waele
       
  • Aeration changes induced by high flow nasal cannula are more homogeneous
           than those generated by non-invasive ventilation in healthy subjects:
           Comments and observations
    • Abstract: Publication date: Available online 14 November 2019Source: Journal of Critical CareAuthor(s): Pradipta Bhakta, Habib Md Reazaul Karim, Brian O'Brien, Antonio Esquinas
       
  • Piperacillin-tazobactam should be preferred to third-generation
           cephalosporins to treat wild-type inducible AmpC-producing
           Enterobacterales in critically ill patients with hospital or
           ventilator-acquired pneumonia
    • Abstract: Publication date: Available online 13 November 2019Source: Journal of Critical CareAuthor(s): Cédric Carrié, Guillaume Bardonneau, Laurent Petit, Alexandre Ouattara, Didier Gruson, Bruno Pereira, Matthieu BiaisAbstractPurposeTo compare the rate of therapeutic failure in critically ill patients treated by third-generation cephalosporins (3GCs) or piperacillin-tazobactam (PTZ) for wild-type AmpC-producing Enterobacterales pulmonary infections.MethodsOver a 4-year period, all adult patients treated for a wild-type AmpC-producing Enterobacterales pulmonary infection were retrospectively included. Two groups of patients were compared according to the definitive antibiotic therapy (3GCs or PTZ) considered after
       
  • Neuropsychiatric outcome in subgroups of Intensive Care Unit survivors:
           Implications for after-care
    • Abstract: Publication date: Available online 12 November 2019Source: Journal of Critical CareAuthor(s): Sandra M.A. Dijkstra-Kersten, Lotte Kok, Monika C. Kerckhoffs, Olaf L. Cremer, Dylan W. de Lange, Diederik van Dijk, Dale M. Needham, Arjen J.C. SlooterAbstractPurposePoor neuropsychiatric outcomes are common in survivors of critical illness but it is unclear what patient groups to target for interventions to improve mental health. We compared anxiety, depression, and post-traumatic stress disorder (PTSD) symptoms and health-related quality of life (HrQoL) across different subgroups of Intensive Care Unit (ICU) survivors.Materials and methodsA single-center cohort study was conducted in a mixed-ICU in the Netherlands among survivors of an ICU admission ≥48 h (n = 1730). Survivors received a survey one year after discharge, containing the Hospital Anxiety and Depression Scale (HADS), Impact of Event Scale (IES/IES-R), and EQ-5D (response rate of 67%). Neuropsychiatric symptoms and quality of life were evaluated in a priori defined subgroups, by chi-square tests and Mann-Whitney U tests.ResultsSymptoms of anxiety (HADS anxiety ≥8), depression (HADS depression ≥8), and PTSD (IES ≥35; IES-R ≥ 1.6) were reported by 34%, 33%, and 19% of ICU survivors, with a median HrQoL utility score of 0.81 (IQR:0.65–1.00). These figures were similar for survivors of ARDS, sepsis, severe multiple organ failure (SOFA>11), or ICU stay ≥7 days.ConclusionsThis underlines the importance of prevention and treatment for neuropsychiatric symptoms in ICU survivors in general, not only in specific patient groups.
       
  • Gender differences in mortality and quality of life after septic shock: A
           post-hoc analysis of the ARISE study
    • Abstract: Publication date: Available online 8 November 2019Source: Journal of Critical CareAuthor(s): Nora Luethi, Michael Bailey, Alisa Higgins, Belinda Howe, Sandra Peake, Anthony Delaney, Rinaldo Bellomo, the ARISE investigatorsAbstractPurposeTo assess the impact of gender and pre-menopausal state on short- and long-term outcomes in patients with septic shock.Material and methodsCohort study of the Australasian Resuscitation in Sepsis Evaluation (ARISE) trial, an international randomized controlled trial comparing early goal-directed therapy (EGDT) to usual care in patients with early septic shock, conducted between October 2008 and April 2014. The primary exposure in this analysis was legal gender and the secondary exposure was pre-menopausal state defined by chronological age (≤ 50 years).Results641 (40.3%) of all 1591 ARISE trial participants in the intention-to-treat population were females and overall, 337 (21.2%) (146 females) patients were 50 years of age or younger. After risk-adjustment, we could not identify any survival benefit for female patients at day 90 in the younger (≤50 years) (adjusted Odds Ratio (aOR): 0.91 (0.46–1.89), p = .85) nor in the older (>50 years) age-group (aOR: 1.10 (0.81–1.49), p = .56). Similarly, there was no gender-difference in ICU, hospital, 1-year mortality nor quality of life measures.ConclusionsThis post-hoc analysis of a large multi-center trial in early septic shock has shown no short- or long-term survival effect for women overall as well as in the pre-menopausal age-group.
       
  • Corrigendum to “What do patients rate as most important when cared for
           in the ICU and how is this met' – An empowerment questionnaire
           survey” in Journal of Critical Care 40 (2017) 83–89
    • Abstract: Publication date: Available online 6 November 2019Source: Journal of Critical CareAuthor(s): Ingrid Wåhlin, Peter Samuelsson, Susanna ÅgrenAbstractThis study aimed to explore what patients rate as being of the greatest importance and less important, when being cared for in the intensive care unit (ICU). The aim was also to examine the extent to which these topics are met.In the Patient Empowerment Questionnaire (PEQ-ICU), patients were first asked to rate the importance of 28 items, and then how often those topics were met during their stay in the ICU.Having trust/confidence in staff, Receive visits from next of kin, Staff being positive to visitors, Receive pain relief, Staff showing human warmth, and Staff trying to strengthen my life spirit were the items that most patients evaluated as being of the greatest importance. The items Staff being positive to visitors, Receiving pain relief and Receive visits from next of kin, were the items most frequently c onsidered as “always met”, while the items Have influence and Receive help to look forward were less often met.It was found that there is a potential for improvement in helping the ICU patients to maintain contact with reality, remind them about their importance to someone or something, and what they could look forward to when becoming healthier and returning to ordinary life.
       
  • Population pharmacokinetic model of Vancomycin based on therapeutic drug
           monitoring data in critically ill septic patients
    • Abstract: Publication date: Available online 5 November 2019Source: Journal of Critical CareAuthor(s): Tijana Kovacevic, Branislava Miljkovic, Pedja Kovacevic, Sasa Dragic, Danica Momcicevic, Sanja Avram, Marija Jovanovic, Katarina VucicevicAbstractPurposeThe present study aimed to establish a population pharmacokinetic model of vancomycin, including adult critically ill septic patients, with normal and impaired renal function.Materials and methodsA prospective analysis of 146 concentrations from 73 adult critically ill septic patients treated with 1-h intravenous infusion of vancomycin were included in the study. A nonlinear mixed effects modeling (NONMEM) approach was applied for data analysis and evaluation of the final model. The influence of creatinine clearance calculated by the Cockcroft-Gault equation (CrCl), and other potential covariates on vancomycin clearance (CL) were evaluated.ResultsThe final one-compartment pharmacokinetic model includes the effect of CrCl on CL. Population pharmacokinetic values for a typical subject were estimated at 0.024 l/h for CL dependent on renal function (CLCrCl), 1.93 l/h for residual portion of CL (not dependent on renal function), and 0.511 l/kg for volume of distribution (V). According to the final model, for patients with CrCl = 120 ml/min, the median vancomycin total CL is 4.81 l/h, while CrCl-dependent fraction accounts for approximately 60% of CL.ConclusionsThe developed population vancomycin model may be used in estimating individual CL for adult critically ill septic patients, and could be applied for individualizing dosage regimens taking into account the continuous effect of CrCl.
       
  • Assessment of the current capacity of intensive care units in Uganda; A
           descriptive study
    • Abstract: Publication date: Available online 4 November 2019Source: Journal of Critical CareAuthor(s): Patience Atumanya, Cornelius Sendagire, Agnes Wabule, John Mukisa, Lameck Ssemogerere, Arthur Kwizera, Peter.K. AgabaAbstractPurposeTo describe the organizational characteristics of functional ICUs in Uganda.MethodsA descriptive survey of 12 ICUs in Uganda; ICU organisation, structure, staffing, and support facilities. A functional ICU was defined as one that admitted critically ill patients and had the ability to provide mechanical ventilation. ICUs were selected based on information of their existence. Direct structured interviews were carried out with the ICU directors.ResultsOf the fourteen ICUs reviewed, 12 were functional, and a majority were located in the central region. There were 55 ICU beds making up a ratio of 1.3 ICU beds per million population. The ICU beds comprised 1.5 % of the total bed capacity of studied hospitals. Most of the ICUs [11] were mixed (paediatric-adults), anaesthesia-led (nine) and five operated in a closed model. There were 171 ICU nurses, of whom 13 had formal training in critical care nursing. The majority of the ICUs had a nurse to patient ratio ≥ 1.2; nine during the day and seven at night.ConclusionsThis study shows limited accessibility to critical care services in Uganda. With a high variability in the ICU operational characteristics, there is a need for standardization of ICU care in the country.
       
  • Machine learning to predict 30-day quality-adjusted survival in critically
           ill patients with cancer
    • Abstract: Publication date: Available online 2 November 2019Source: Journal of Critical CareAuthor(s): Hellen Geremias dos Santos, Fernando Godinho Zampieri, Karina Normilio-Silva, Gisela Tunes da Silva, Antonio Carlos Pedroso de Lima, Alexandre Biasi Cavalcanti, Alexandre Dias Porto Chiavegatto FilhoAbstractPurposeTo develop and compare the predictive performance of machine-learning algorithms to estimate the risk of quality-adjusted life year (QALY) lower than or equal to 30 days (30-day QALY).Material and methodsSix machine-learning algorithms were applied to predict 30-day QALY for 777 patients admitted in a prospective cohort study conducted in Intensive Care Units (ICUs) of two public Brazilian hospitals specialized in cancer care. The predictors were 37 characteristics collected at ICU admission. Discrimination was evaluated using the area under the receiver operating characteristic (AUROC) curve. Sensitivity, 1-specificity, true/false positive and negative cases were measured for different estimated probability cutoff points (30%, 20% and 10%). Calibration was evaluated with GiViTI calibration belt and test.ResultsExcept for basic decision trees, the adjusted predictive models were nearly equivalent, presenting good results for discrimination (AUROC curves over 0.80). Artificial neural networks and gradient boosted trees achieved the overall best calibration, implying an accurately predicted probability for 30-day QALY.ConclusionsExcept for basic decision trees, predictive models derived from different machine-learning algorithms discriminated the QALY risk at 30 days well. Regarding calibration, artificial neural network model presented the best ability to estimate 30-day QALY in critically ill oncologic patients admitted to ICUs.
       
  • Acute kidney injury as a risk factor of hyperactive delirium: A case
           control study
    • Abstract: Publication date: Available online 2 November 2019Source: Journal of Critical CareAuthor(s): Wan RYY, McKenzie CA, D. Taylor, L. Camporota, M. OstermannAbstractPurposeDelirium and acute kidney injury (AKI) are common organ dysfunctions during critical illness. Both conditions are associated with serious short- and long-term complications. We investigated whether AKI is a risk factor for hyperactive delirium.MethodsThis was a single-centre case control study conducted in a 30 bedded mixed Intensive Care Unit in the UK. Hyperactive delirium cases were identified by antipsychotic initiation and confirmation of delirium diagnosis through validated chart review. Cases were compared with non-delirium controls matched by Acute Physiology and Chronic Health Evaluation II score and gender. AKI was defined by the KDIGO criteria.Results142 cases and 142 matched controls were identified. AKI stage 3 was independently associated with hyperactive delirium [Odds ratio (OR) 5.40 (95% confidence interval (CI) 2.33–12.51]. Other independent risk factors were mechanical ventilation [OR 2.70 (95% CI 1.40–5.21)], alcohol use disorder [OR 5.80 (95% CI 1.90–17.72)], and dementia [OR 9.76 (95% CI 1.09–87.56)]. Hospital length of stay was significantly longer in delirium cases (29 versus 20 days; p = .004) but hospital mortality was not different.ConclusionsAKI stage 3 is independently associated with hyperactive delirium. Further research is required to explore the factors that contribute to this association.
       
  • Reply to “Aeration changes induced by high flow nasal cannula are more
           homogeneous than those generated by non-invasive ventilation in healthy
           subjects: comments and observations”
    • Abstract: Publication date: Available online 2 November 2019Source: Journal of Critical CareAuthor(s): Purificación Pérez-Teran, Judith Marin-Corral, Irene Dot, Joan Ramon-Masclans
       
  • Comments on “Low-flow time is associated with a favorable neurological
           outcome in out-of-hospital cardiac arrest patients resuscitated with
           extracorporeal cardiopulmonary resuscitation”
    • Abstract: Publication date: Available online 2 November 2019Source: Journal of Critical CareAuthor(s): Fang Lai, Yang Ren, Jiansen Li, Ruifeng Zeng, Banghan Ding
       
  • Composite variables, couplings and distinction of effects
    • Abstract: Publication date: Available online 1 November 2019Source: Journal of Critical CareAuthor(s): Carlo Chiarla, Ivo Giovannini
       
  • The influence of clinical variables on the risk of developing chronic
           conditions in ICU survivors
    • Abstract: Publication date: Available online 31 October 2019Source: Journal of Critical CareAuthor(s): Ilse van Beusekom, Ferishta Bakhshi-Raiez, Marike van der Schaaf, Dave A. Dongelmans, Wim B. Busschers, Nicolette F. de KeizerAbstractPurposeTo assess the association of clinical variables and the development of specified chronic conditions in ICU survivors.Materials and methodsA retrospective cohort study, combining a national health insurance claims database and a national quality registry for ICUs. Claims data from 2012 to 2014 were combined with clinical data of patients admitted to an ICU during 2013. To assess the association of clinical variables (ICU length of stay, mechanical ventilation, acute physiology score, reason for ICU admission, mean arterial pressure score and glucose score) and the development of chronic conditions (i.e. heart diseases, COPD or asthma, Diabetes mellitus type II, depression and kidney diseases), logistic regression was used.Results49,004 ICU patients were included. ICU length of stay was associated with the development of heart diseases, asthma or COPD and depression. The reason for ICU admission was an important risk factor for the development of all chronic conditions with adjusted ORs ranging from 2.05 (CI 1.56; 2.69) for kidney diseases to 5.14 (CI 3.99; 6.62) for depression.ConclusionsClinical variables, especially the reason for ICU admission, are associated with the development of chronic conditions after ICU discharge. Therefore, these clinical variables should be considered when organizing follow-up care for ICU survivors.
       
  • Family ratings of ICU care. Is there concordance within families'
    • Abstract: Publication date: Available online 31 October 2019Source: Journal of Critical CareAuthor(s): Hanne Irene Jensen, Lois Downey, Matty Koopmans, J. Randall Curtis, Ruth A. Engelberg, Rik T. GerritsenAbstractPurposeTo examine heterogeneity of quality-of-care ratings within families and to examine possible predictors of concordance.Materials and methodsWe examined two aspects of agreement within families: response similarity and the amount of exact concordance in responses in a cohort of Danish ICU family members participating in a questionnaire survey (the European Quality Questionnaire: euroQ2).ResultsTwo hundred seventy-four family respondents representing 122 patients were included in the study. Identical ratings between family members occurred in 28%–59% of families, depending upon the specific survey item. In a smaller sample of 28 families whose patients died, between 39% and 86% gave identical responses to items rating end-of-life care. There was more response variance within than between families, yielding low estimates of intrafamily correlation. Statistics correcting for change agreement also suggested modest within-family agreement.ConclusionsThe finding that variance is higher within than between families suggests the value of including multiple participants within a family in order to capture varying points of view.
       
  • The history of critical care in Kenya
    • Abstract: Publication date: Available online 25 October 2019Source: Journal of Critical CareAuthor(s): Wangari Waweru-Siika, Vitalis Mung'ayi, David Misango, Andrea Mogi, Allan Kisia, Zipporah NgumiAbstractCritical care is a young specialty in Kenya. From its humble beginnings in the 1960s to present day Kenya, the bulk of this service has largely been provided by anaesthetists. We provide a detailed account of the growth and development of this specialty in our country, the attempts made by our people to grow this service within our borders and the vital role our international partners have played throughout this process. We also share a selection of our successes over the years, the challenges we have faced and our aspirations as we look to the future.
       
  • Variation in red cell transfusion practice in the intensive care unit –
           An international survey
    • Abstract: Publication date: Available online 23 October 2019Source: Journal of Critical CareAuthor(s): S.A. Willems, F.J. Kranenburg, S. Le Cessie, P.J. Marang- van de Mheen, J. Kesecioglu, J.G. Van der Bom, M.S. ArbousAbstractPurposeUnclear recommendations in transfusion guidelines may possibly lead to inconsistency in treatment of patients admitted to the intensive care unit. This study aimed to uncover variation in red blood cell (RBC) transfusion decisions in the ICU worldwide.MethodsMembers of the European Society of Intensive Care Medicine (ESICM) were requested to complete an online questionnaire which included four different hypothetical clinical scenarios. The scenarios represented patients with acute myocardial infarction (AMI), abdominal sepsis, traumatic brain injury (TBI) and post-surgical complications. Hemoglobin level was 7∙3 g/dL in all scenarios. The questionnaire explored the physicians' transfusion decision in each clinical scenario and identified patient characteristics that were most influential in the transfusion decision.ResultsIn total 211 members participated in the study, of whom 142 (67%) completed the entire survey. Most variation was observed in the clinical scenario of sepsis, in which 49% decided to transfuse and 51% decided not to. In the clinical scenarios of AMI, TBI and post-surgical complications this was respectively; 75/25%, 35/65% and 66/34%.ConclusionsCritical care physicians differed in outcome of RBC transfusion decisions and weighed patient characteristics differently. These findings indicate that variation in transfusion practice amongst critical care physicians exists.
       
  • Fluid resuscitation in patients with end-stage renal disease on
           hemodialysis presenting with severe sepsis or septic shock: A case control
           study
    • Abstract: Publication date: Available online 23 October 2019Source: Journal of Critical CareAuthor(s): Kartikeya Rajdev, Lazer Leifer, Gurkirat Sandhu, Benjamin Mann, Sami Pervaiz, Saad Habib, Abdul Hasan Siddiqui, Bino Joseph, Seleshi Demissie, Suzanne El-SayeghAbstractDue to the potential risk of volume overload, physicians are hesitant to aggressively fluid-resuscitate septic patients with end-stage renal disease (ESRD) on hemodialysis (HD). Primary objective: To calculate the percentage of ESRD patients on HD (Case) who received ≥30 mL/Kg fluid resuscitation within the first 6 h compared to non-ESRD patients (Control) that presented with severe sepsis (SeS) or septic shock (SS). Secondary objectives: Effect of fluid resuscitation on intubation rate, need for urgent dialysis, hospital length of stay (LOS), intensive care unit (ICU) admission and LOS, need for vasopressors, and hospital mortality. Medical records of 715 patients with sepsis, SeS, SS, and ESRD were reviewed. We identified 104 Case and 111 Control patients. In the Case group, 23% of patients received ≥30 mL/Kg fluids compared to 60% in the Control group (p 
       
  • Cost-effectiveness of second-line vasopressors for the treatment of septic
           shock
    • Abstract: Publication date: Available online 23 October 2019Source: Journal of Critical CareAuthor(s): Simon W. Lam, Erin F. Barreto, Rachael Scott, Kianoush B. Kashani, Ashish K. Khanna, Seth R. BauerAbstractPurposeTo determine the cost-effectiveness of escalating doses of norepinephrine or norepinephrine plus the adjunctive use of vasopressin or angiotensin II as a second-line vasopressor for septic shock.Materials and methodsDecision tree analysis was performed to compare costs and outcomes associated with norepinephrine monotherapy or the two adjunctive second-line vasopressors. Short- and long-term outcomes modeled included ICU survival and lifetime quality-adjusted-life-years (QALY) gained. Costs were modeled from a payer's perspective, with a willingness-to-pay threshold set at $100,000/unit gained. One-way (tornado diagrams) and probabilistic sensitivity analyses were performed.ResultsAdjunctive vasopressin was the most cost-effective therapy, and dominated both norepinephrine monotherapy and adjunctive angiotensin II by producing higher ICU survival at less cost. For the lifetime horizon, while norepinephrine monotherapy was least expensive, adjunctive vasopressin was the most cost-effective with an incremental cost-effectiveness ratio of $19,762 / QALY gained. Although adjunctive angiotensin II produced more QALYs compared to norepinephrine monotherapy, it was dominated in the long-term evaluation by second-line vasopressin. Sensitivity analyses demonstrated model robustness and medication costs were not significant drivers of model results.ConclusionsVasopressin is the most cost-effective second-line vasopressor in both the short- and long-term evaluations. Vasopressor price is a minor contributor to overall cost.
       
  • An international perspective on the frequency, perception of utility, and
           quality of interprofessional rounds practices in intensive care units
    • Abstract: Publication date: Available online 22 October 2019Source: Journal of Critical CareAuthor(s): Andre C.K.B. Amaral, Jean-Louis Vincent, Louise Rose, Mark E. Mikkelsen, Steve Webb, Grazielle Viana Ramos, Ruxandra Pinto, Jorge SalluhAbstractPurposeTo describe international variation in interprofessional rounds in intensive care units (ICUs).Materials and methodsSurvey of ICU clinicians on their practices and perceptions of rounds using societal mailing lists and social media.ResultsOut of 2402 respondents, 1752 (72.8%) use rounds. Teams are mostly composed of intensivists, nurses and medical trainees. The majority of rounds (57.5%) last>2 h, and North Americans report the highest rates of rounds allowing family attendance (92.4%). Shorter rounds (1–2 h, OR 0.67, 0.52–0.86, p 
       
  • Gas exchange, specific lung elastance and mechanical power in the early
           and persistent ARDS
    • Abstract: Publication date: Available online 22 October 2019Source: Journal of Critical CareAuthor(s): Davide Chiumello, Sara Froio, Giovanni Mistraletti, Paolo Formenti, Luca Bolgiaghi, Antonio Cammaroto, Michele Umbrello, Silvia CoppolaAbstractPurposeAim of this study was to evaluate the effect of acute respiratory distress syndrome (ARDS) duration on gas-exchange, respiratory mechanics, specific lung elastance and mechanical power.Materials and methodsIn a single center prospective study 28 ARDS patients (66.4 ± 10.0 years, BMI 23.6[21.3–28.8] kg/m2, PaO2/FiO2 148.9[99.6–173.5]) who still presented ARDS criteria after 7-days of mechanical ventilation were studied in early and persistent phase of the disease (day-1 and after 7-days). Each patient underwent PEEP trial at 5–15 cmH2O in both phases.ResultsAt both PEEP levels the PaO2 was similar in both phases (early: 70.7[65.1–84.4] vs 102.0[85.5–131.8] mmHg; persistent 70.7[63.0–76.2] vs 97.4[86.5–117.1] mmHg, 5–15 cmH2O respectively), the PaCO2 was significantly higher in the persistent phase at both PEEP levels (early 50.6 ± 10.2 vs 52.1 ± 10.5 mmHg; persistent 57.7 ± 13.4 vs 56.9 ± 12.8 mmHg). Specific lung elastance was not different in the early compared to the persistent phase 12.5 ± 3.1 vs 12.2 ± 3.8 cmH2O. The mechanical power normalized for the functional residual capacity increased with PEEP and was similar in both phases (early 23.4[12.8–32.8] vs 34.3[25.3–47.9], persistent 16.3[10.9–24.1] vs 26.7[19.9–46.0] J/min/L, 5–15 cmH2O respectively).ConclusionsThe persistent phase of ARDS for 7-days did not affect the respiratory mechanics while significantly impaired the PaCO2 exchange.
       
  • Machine learning for prediction of septic shock at initial triage in
           emergency department
    • Abstract: Publication date: Available online 22 October 2019Source: Journal of Critical CareAuthor(s): Joonghee Kim, HyungLan Chang, Doyun Kim, Dong-Hyun Jang, Inwon Park, Kyuseok KimAbstractBackgroundWe hypothesized utilizing machine learning (ML) algorithms for screening septic shock in ED would provide better accuracy than qSOFA or MEWS.MethodsThe study population was adult (≥20 years) patients visiting ED for suspected infection. Target event was septic shock within 24 h after arrival. Demographics, vital signs, level of consciousness, chief complaints (CC) and initial blood test results were used as predictors. CC were embedded into 16-dimensional vector space using singular value decomposition. Six base learners including support vector machine, gradient-boosting machine, random forest, multivariate adaptive regression splines and least absolute shrinkage and selection operator and ridge regression and their ensembles were tested. We also trained and tested MLP networks with various setting.ResultsA total of 49,560 patients were included and 4817 (9.7%) had septic shock within 24 h. All ML classifiers significantly outperformed qSOFA score, MEWS and their age-sex adjusted versions with their AUROC ranging from 0.883 to 0.929. The ensembles of the base classifiers showed the best performance and addition of CC embedding was associated with statistically significant increases in performance.ConclusionsML classifiers significantly outperforms clinical scores in screening septic shock at ED triage.
       
  • Association of negative fluid balance during the de-escalation phase of
           sepsis management on mortality: A cohort study
    • Abstract: Publication date: Available online 22 October 2019Source: Journal of Critical CareAuthor(s): Tsering Dhondup, Jong-Chie Claudia Tien, Alberto Marquez, Cassie C. Kennedy, Ognjen Gajic, Kianoush B. KashaniAbstractPurposeWe aimed to evaluate the impact of negative fluid balance during the fluid de-escalation phase of sepsis management.Material and methodsThis is a historical cohort study of adult intensive care units (ICU) patients with septic shock and severe sepsis in a quaternary medical center, from January 2007 through December 2009. We used regression modeling to assess the impact of negative volume balance on mortality after adjustments for age, comorbidities, and illness severity.ResultsAmong 633 enrolled patients, 387 patients reached negative fluid balance who in comparison with others had a lower 90-day mortality rate (36% vs. 44%; P = .048), despite higher severity of illness. Each 1-L negative daily fluid balance was associated with reduced ICU, hospital, 90-day and 1-year mortality (hazard ratio [HR] 0.39[95%CI, 0.28–0.57], 0.76[95%CI, 0.63–0.94], 0.69[95%CI, 0.59–0.81], 0.67 [0.58–0.78], respectively; P 
       
  • Evidence summary resources may influence clinical decision making: A
           case-based scenario evaluation of an evidence summary tool
    • Abstract: Publication date: Available online 19 October 2019Source: Journal of Critical CareAuthor(s): Philippa T. Heighes, Gordon S. DoigAbstractPurpose:Evidence summary resources are popular with clinicians but it is unknown whether they can influence clinical decision making. We evaluated whether an extremely condensed and explicit evidence summary tool could influence clinical decision making.Materials and methodsAn evidence summary tool was developed using a formal mapping exercise and graphic design principles. An invitation to participate was sent to subscribers of a critical care e-mail discussion list. Participants received a study package (evidence summary tool précising prone positioning in severe ARDS; case-based scenario describing a patient with severe ARDS plus evaluation questionnaire). Influence on clinical decisions was captured regarding six competing interventions, with Belief in benefit measured before and after reading the summary tool.ResultsAmong 93 participants, 87% were male with a mean age of 49.6(SD9.3) years. Mean ICU experience was 20.0(SD9.9) years.The evidence summary tool significantly influenced clinical decision making: belief in benefit of prone positioning increased (P 
       
  • From monitoring to individualized settings during nasal high flow: ROX
           index to optimize flow rate'
    • Abstract: Publication date: Available online 18 October 2019Source: Journal of Critical CareAuthor(s): Elena Spinelli, Tommaso Mauri
       
  • The importance of hospital length of stay in patients with acute brain
           injury: Reply
    • Abstract: Publication date: Available online 18 October 2019Source: Journal of Critical CareAuthor(s): Rajat N. Moman, Andrew C. Hanson, Darrell R. Schroeder, Matthew A. Warner
       
  • Acute increase in nasal high flow support and ROX index stability: Our
           insights in response to Mauri T et al.
    • Abstract: Publication date: Available online 18 October 2019Source: Journal of Critical CareAuthor(s): Habib Md Reazaul Karim, Marco Zaccagnini, Antonio M. Esquinas
       
  • Intensive care unit occupancy and premature discharge rates: A cohort
           study assessing the reporting of quality indicators
    • Abstract: Publication date: Available online 9 October 2019Source: Journal of Critical CareAuthor(s): M.C. Blayney, L. Donaldson, P. Smith, C. Wallis, S. Cole, N.I. Lone, on behalf of the Scottish Intensive Care Society Audit GroupAbstractPurposeICU occupancy fluctuates. High levels may disadvantage patients. Currently, occupancy is benchmarked annually which may inaccurately reflect strained units. Outcomes potentially sensitive to occupancy include premature (early) ICU discharge and non-clinical transfer (NCT). This study assesses the association between daily occupancy and these outcomes, and evaluates benchmarking care across Scotland using daily occupancy.Materials and methodsPopulation: all Scottish ICU patients, 2006–2014. Exposure: bed occupancy per unit-day; Outcomes: proportion of early discharges and NCTs. Design: Retrospective cohort study. Outcome rates were calculated above various occupancy thresholds. Polynomial regression visualised associations, and inflection points between occupancy and outcomes. Spearman's rho correlations between occupancy measures and outcomes were reported.Results65,472 discharges occurred over 57,812 unit-days. 1954(3.0%) discharges were early; 429 (0.7%) were NCTs. Early discharge rates above 70%, 80% and 90% occupancy were 3.9%, 5.0% and 7.5% respectively. Occupancies at which outcome rates greatly increased were near 80% for early discharge, and 90% for NCT. Mean annual occupancy was not correlated with outcomes; annual proportion of days ≥90% occupancy correlated most strongly (early discharge rho = 0.46,p 
       
  • Performance of a quick sofa-65 score as a rapid sepsis screening tool
           during initial emergency department assessment: A propensity score
           matching study
    • Abstract: Publication date: Available online 9 October 2019Source: Journal of Critical CareAuthor(s): Jonghoo Lee, Jae-Uk SongAbstractPurposeWe sought to elucidate the performance of a Quick Sequential Organ Function Assessment-65 (qSOFA-65) score in recognizing sepsis and to compare the qSOFA-65 score to systemic inflammatory response syndrome (SIRS) and qSOFA scores.MethodsWe performed a matched case-control study using propensity score matching. The number of patients meeting qSOFA-65, qSOFA, and SIRS positive criteria were calculated between the sepsis and non-sepsis groups. We compared the diagnostic performance of the three scoring systems in predicting sepsis.ResultsA total of 2441 patients were included in the study. In propensity matched cohorts, the percentage of patients who met qSOFA-65, qSOFA, and SIRS positive criteria were 46.7%, 14.3%, and 55.6%, respectively. The sensitivity and specificity scores for the qSOFA-65, qSOFA, and SIRS positive criteria for sepsis were 0.66 and 0.73, 0.28 and 0.97, and 0.66 and 0.55, respectively. The AUC value of qSOFA-65 positive criteria in predicting sepsis was significantly higher than that of qSOFA and SIRS positive criteria (adjusted AUC 0.688 vs. 0.630 vs. 0.596, respectively).ConclusionsWe found that qSOFA-65 was more likely to identify patients with sepsis on the initial ED visit relative to qSOFA or SIRS. This may have quality improvement implications in predicting sepsis.
       
 
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