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Critical Care Medicine
Journal Prestige (SJR): 3.116  Citation Impact (citeScore): 3 Number of Followers: 320  Hybrid journal (It can contain Open Access articles)ISSN (Print) 0090-3493 - ISSN (Online) 1530-0293 Published by LWW Wolters Kluwer  [330 journals]
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- Practice Standards for the Use of Multimodality Neuromonitoring: A Delphi
Consensus Process*-
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Authors: Foreman; Brandon; Kapinos, Gregory; Wainwright, Mark S.; Ngwenya, Laura B.; O’Phelan, Kristine H.; LaRovere, Kerri L.; Kirschen, Matthew P.; Appavu, Brian; Lazaridis, Christos; Alkhachroum, Ayham; Maciel, Carolina B.; Amorim, Edilberto; Chang, Jason J.; Gilmore, Emily J.; Rosenthal, Eric S.; Park, Soojin
Abstract:
OBJECTIVES: To address areas in which there is no consensus for the technologies, effort, and training necessary to integrate and interpret information from multimodality neuromonitoring (MNM).DESIGN: A three-round Delphi consensus process.SETTING: Electronic surveys and virtual meeting.SUBJECTS: Participants with broad MNM expertise from adult and pediatric intensive care backgrounds.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: Two rounds of surveys were completed followed by a virtual meeting to resolve areas without consensus and a final survey to conclude the Delphi process. With 35 participants consensus was achieved on 49% statements concerning MNM. Neurologic impairment and the potential for MNM to guide management were important clinical considerations. Experts reached consensus for the use of MNM—both invasive and noninvasive—for patients in coma with traumatic brain injury, aneurysmal subarachnoid hemorrhage, and intracranial hemorrhage. There was consensus that effort to integrate and interpret MNM requires time independent of daily clinical duties, along with specific skills and expertise. Consensus was reached that training and educational platforms are necessary to develop this expertise and to provide clinical correlation.CONCLUSIONS: We provide expert consensus in the clinical considerations, minimum necessary technologies, implementation, and training/education to provide practice standards for the use of MNM to individualize clinical care.
PubDate: Thu, 16 Nov 2023 00:00:00 GMT-
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- Measuring Strain in the ICU*
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Authors: Maves; Ryan C.
Abstract: No abstract available
PubDate: Thu, 16 Nov 2023 00:00:00 GMT-
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- POSTCARDS from a SIESTA: Crossing the Translational and Generalizability
Gap for Predictive Models of Acute Respiratory Distress Syndrome-Related
Mortality*-
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Authors: Wong; An-Kwok Ian; Kamaleswaran, Rishikesan
Abstract: No abstract available
PubDate: Thu, 16 Nov 2023 00:00:00 GMT-
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- Buprenorphine: Its Emerging Role as a Strategy to Reduce Full Opioid
Agonist Use in the ICU*-
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Authors: Devlin; John W.
Abstract: No abstract available
PubDate: Thu, 16 Nov 2023 00:00:00 GMT-
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- Does CytoSorb Pose Unique Challenges to Pooled Estimates in
Meta-Analysis'*-
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Authors: Wieruszewski; Patrick M.; Murad, M. Hassan
Abstract:
No abstract available
PubDate: Thu, 16 Nov 2023 00:00:00 GMT-
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- Is It Time to Reconsider the Concept of “Salvage Therapy” in
Refractory Shock'*-
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Authors: Wieruszewski; Patrick M.; Sevransky, Jonathan E.; Roberts, Russel J.
Abstract:
No abstract available
PubDate: Thu, 16 Nov 2023 00:00:00 GMT-
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- Measuring Bundle Implementation Work Requires a Calibrated Scale*
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Authors: Anderson; Brian J.; Schweickert, William D.
Abstract: No abstract available
PubDate: Thu, 16 Nov 2023 00:00:00 GMT-
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- Are We Ready for Biomarker-Guided Immune Modulation in Critical Care'*
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Authors: Leligdowicz; Aleksandra
Abstract: No abstract available
PubDate: Thu, 16 Nov 2023 00:00:00 GMT-
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- Climbing the Evidence Pyramid: Developing an Evidence-Based Approach to
the Provision of Venovenous Extracorporeal Membrane Oxygenation*-
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Authors: Gannon; Whitney D.; Teijeiro-Paradis, Ricardo; Prekker, Matthew E.; Pratt, Elias H.; Tucker, William D.; Casey, Jonathan D.
Abstract:
No abstract available
PubDate: Thu, 16 Nov 2023 00:00:00 GMT-
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- Trajectory After Tracheostomy: Sobering Data for Decision Makers*
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Authors: Savel; Richard H.; Shiloh, Ariel L.
Abstract: No abstract available
PubDate: Thu, 16 Nov 2023 00:00:00 GMT-
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- Is Expertise Evidence' Insights From A New Guideline*
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Authors: Nunnally; Mark E.
Abstract: No abstract available
PubDate: Thu, 16 Nov 2023 00:00:00 GMT-
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- Seizures After Acute Subdural Hemorrhage: Call for More Monitoring*
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Authors: Vespa; Paul
Abstract: No abstract available
PubDate: Thu, 16 Nov 2023 00:00:00 GMT-
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- Physiology-Based Indications to Improve Outcome of Awake Extracorporeal
Membrane Oxygenation*-
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Authors: Mauri; Tommaso; Furfaro, David; Kassis, Elias Baedorf
Abstract:
No abstract available
PubDate: Thu, 16 Nov 2023 00:00:00 GMT-
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- Harmonizing ICU Admission, Discharge, and Transfer Criteria to Improve
Critical Care Capability-
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Authors: McCurdy; Michael T.; Tabatabai, Ali
Abstract: No abstract available
PubDate: Thu, 16 Nov 2023 00:00:00 GMT-
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Authors: Nates; Joseph L.; Pastores, Stephen M.; Oropello, John M.
Abstract: No abstract available
PubDate: Thu, 16 Nov 2023 00:00:00 GMT-
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- Hedge Language Is Also Used Because We Clinicians Are Asked the Unknowable
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Authors: Hassaballa; Hesham A.
Abstract: No abstract available
PubDate: Thu, 16 Nov 2023 00:00:00 GMT-
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Authors: Hakes; Nicholas A.; Mittal, Vaishali; Magnus, David C.; Batten, Jason N.
Abstract: No abstract available
PubDate: Thu, 16 Nov 2023 00:00:00 GMT-
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- Immediate Fluid Bolus or Norepinephrine in Endotoxic Shock
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Authors: Jha; Ajay Kumar
Abstract: No abstract available
PubDate: Thu, 16 Nov 2023 00:00:00 GMT-
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Authors: Ospina-Tascón; Gustavo A.; Aldana, José L.; García Marín, Alberto F.
Abstract: No abstract available
PubDate: Thu, 16 Nov 2023 00:00:00 GMT-
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- Apples and Oranges—All ‘Vitamin C’ May Not Be Created
Equal-
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Authors: Plummer; Mark P.; Lankadeva, Yugeesh R.; Bellomo, Rinaldo
Abstract: No abstract available
PubDate: Thu, 16 Nov 2023 00:00:00 GMT-
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Authors: Angriman; Federico; Muttalib, Fiona; Lamontagne, François; Adhikari, Neill K. J.; LOVIT Investigators
Abstract: No abstract available
PubDate: Thu, 16 Nov 2023 00:00:00 GMT-
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- The International Cardiac Arrest Research Consortium
Electroencephalography Database-
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Authors: Amorim; Edilberto; Zheng, Wei-Long; Ghassemi, Mohammad M.; Aghaeeaval, Mahsa; Kandhare, Pravinkumar; Karukonda, Vishnu; Lee, Jong Woo; Herman, Susan T.; Sivaraju, Adithya; Gaspard, Nicolas; Hofmeijer, Jeannette; van Putten, Michel J. A. M.; Sameni, Reza; Reyna, Matthew A.; Clifford, Gari D.; Westover, M. Brandon
Abstract:
OBJECTIVES: To develop the International Cardiac Arrest Research (I-CARE), a harmonized multicenter clinical and electroencephalography database for acute hypoxic-ischemic brain injury research involving patients with cardiac arrest.DESIGN: Multicenter cohort, partly prospective and partly retrospective.SETTING: Seven academic or teaching hospitals from the United States and Europe.PATIENTS: Individuals 16 years old or older who were comatose after return of spontaneous circulation following a cardiac arrest who had continuous electroencephalography monitoring were included.INTERVENTIONS: Not applicable.MEASUREMENTS AND MAIN RESULTS: Clinical and electroencephalography data were harmonized and stored in a common Waveform Database-compatible format. Automated spike frequency, background continuity, and artifact detection on electroencephalography were calculated with 10-second resolution and summarized hourly. Neurologic outcome was determined at 3–6 months using the best Cerebral Performance Category (CPC) scale. This database includes clinical data and 56,676 hours (3.9 terabytes) of continuous electroencephalography data for 1,020 patients. Most patients died (n = 603, 59%), 48 (5%) had severe neurologic disability (CPC 3 or 4), and 369 (36%) had good functional recovery (CPC 1–2). There is significant variability in mean electroencephalography recording duration depending on the neurologic outcome (range, 53–102 hr for CPC 1 and CPC 4, respectively). Epileptiform activity averaging 1 Hz or more in frequency for at least 1 hour was seen in 258 patients (25%) (19% for CPC 1–2 and 29% for CPC 3–5). Burst suppression was observed for at least 1 hour in 207 (56%) and 635 (97%) patients with CPC 1–2 and CPC 3–5, respectively.CONCLUSIONS: The I-CARE consortium electroencephalography database provides a comprehensive real-world clinical and electroencephalography dataset for neurophysiology research of comatose patients after cardiac arrest. This dataset covers the spectrum of abnormal electroencephalography patterns after cardiac arrest, including epileptiform patterns and those in the ictal-interictal continuum.
PubDate: Thu, 19 Oct 2023 00:00:00 GMT-
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- Elevated Plasma Interleukin-18 Identifies High-Risk Acute Respiratory
Distress Syndrome Patients not Distinguished by Prior Latent Class
Analyses Using Traditional Inflammatory Cytokines: A Retrospective
Analysis of Two Randomized Clinical Trials-
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Authors: Moore; Andrew R.; Pienkos, Shaun M.; Sinha, Pratik; Guan, Jiazhen; O’Kane, Cecilia M.; Levitt, Joseph E.; Wilson, Jennifer G.; Shankar-Hari, Manu; Matthay, Michael A.; Calfee, Carolyn S.; Baron, Rebecca M.; McAuley, Daniel F.; Rogers, Angela J.
Abstract:
OBJECTIVES: Interleukin-18 (IL-18) plasma level and latent class analysis (LCA) have separately been shown to predict prognosis and treatment response in acute respiratory distress syndrome (ARDS). IL-18 is a measure of inflammasome activation, a pathway potentially distinct from inflammation captured by biomarkers defining previously published LCA classes. We hypothesized that elevated IL-18 would identify distinct “high-risk” patients not captured by prior LCA classifications.DESIGN: Statins for acutely injured lungs from sepsis (SAILS) and hydroxymethylglutaryl-CoA reductase inhibition with simvastatin in acute lung injury to reduce pulmonary dysfunction trial (HARP-2) are two large randomized, controlled trials in ARDS in which both LCA assignments and IL-18 levels were shown to predict mortality. We first evaluated the overlap between high IL-18 levels (≥ 800 pg/mL) with prior LCA class assignments using McNemar’s test and then tested the correlation between IL-18 and LCA biomarkers using Pearson’s exact test on log-2 transformed values. Our primary analysis was the association of IL-18 level with 60-day mortality in the hypoinflammatory LCA class, which was assessed using the Fisher exact test and Cox proportional hazards modeling adjusting for age, Acute Physiology and Chronic Health Evaluation score, and gender. Secondary analyses included the association of IL-18 and LCA with mortality within each IL-18/LCA subgroup.SETTING: Secondary analysis of two multicenter, randomized controlled clinical trials of ARDS patients.SUBJECTS: Six hundred eighty-three patients in SAILS and 511 patients in HARP-2.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: We found that 33% of patients in SAILS and HARP-2 were discordant by IL-18 level and LCA class. We further found that IL-18 level was only modestly correlated (0.17–0.47) with cytokines used in the LCA assignment. A substantial subset of individuals classified as hypoinflammatory by LCA (14% of SAILS and 43% of HARP-2) were classified as high risk by elevated IL-18. These individuals were at high risk for mortality in both SAILS (42% 60-d mortality, odds ratio [OR] 3.3; 95% CI, 1.8–6.1; p < 0.001) and HARP-2 (27% 60-d mortality, OR 2.1; 95% CI, 1.2–3.8; p = 0.009).CONCLUSIONS: Plasma IL-18 level provides important additional prognostic information to LCA subphenotypes defined largely by traditional inflammatory biomarkers in two large ARDS cohorts.
PubDate: Mon, 11 Sep 2023 00:00:00 GMT-
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- Identification of Clinically Significant Cytokine Signature Clusters in
Patients With Septic Shock-
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Authors: Zhao; Jack O.; Patel, Bhakti K.; Krishack, Paulette; Stutz, Matthew R.; Pearson, Steven D.; Lin, Julie; Lecompte-Osorio, Paola A.; Dugan, Karen C.; Kim, Seoyoen; Gras, Nicole; Pohlman, Anne; Kress, John P.; Hall, Jesse B.; Sperling, Anne I.; Adegunsoye, Ayodeji; Verhoef, Philip A.; Wolfe, Krysta S.
Abstract:
OBJECTIVES: To identify cytokine signature clusters in patients with septic shock.DESIGN: Prospective observational cohort study.SETTING: Single academic center in the United States.PATIENTS: Adult (≥ 18 yr old) patients admitted to the medical ICU with septic shock requiring vasoactive medication support.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: One hundred fourteen patients with septic shock completed cytokine measurement at time of enrollment (t1) and 24 hours later (t2). Unsupervised random forest analysis of the change in cytokines over time, defined as delta (t2–t1), identified three clusters with distinct cytokine profiles. Patients in cluster 1 had the lowest initial levels of circulating cytokines that decreased over time. Patients in cluster 2 and cluster 3 had higher initial levels that decreased over time in cluster 2 and increased in cluster 3. Patients in clusters 2 and 3 had higher mortality compared with cluster 1 (clusters 1–3: 11% vs 31%; odds ratio [OR], 3.56 [1.10–14.23] vs 54% OR, 9.23 [2.89–37.22]). Cluster 3 was independently associated with in-hospital mortality (hazard ratio, 5.24; p = 0.005) in multivariable analysis. There were no significant differences in initial clinical severity scoring or steroid use between the clusters. Analysis of either t1 or t2 cytokine measurements alone or in combination did not reveal clusters with clear clinical significance.CONCLUSIONS: Longitudinal measurement of cytokine profiles at initiation of vasoactive medications and 24 hours later revealed three distinct cytokine signature clusters that correlated with clinical outcomes.
PubDate: Tue, 05 Sep 2023 00:00:00 GMT-
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- Predicting ICU Mortality in Acute Respiratory Distress Syndrome Patients
Using Machine Learning: The Predicting Outcome and STratifiCation of
severity in ARDS (POSTCARDS) Study*-
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Authors: Villar; Jesús; González-Martín, Jesús M.; Hernández-González, Jerónimo; Armengol, Miguel A.; Fernández, Cristina; Martín-Rodríguez, Carmen; Mosteiro, Fernando; Martínez, Domingo; Sánchez-Ballesteros, Jesús; Ferrando, Carlos; Domínguez-Berrot, Ana M.; Añón, José M.; Parra, Laura; Montiel, Raquel; Solano, Rosario; Robaglia, Denis; Rodríguez-Suárez, Pedro; Gómez-Bentolila, Estrella; Fernández, Rosa L.; Szakmany, Tamas; Steyerberg, Ewout W.; Slutsky, Arthur S.; for the Predicting Outcome STratifiCation of severity in ARDS (POSTCARDS Network
Abstract:
OBJECTIVES: To assess the value of machine learning approaches in the development of a multivariable model for early prediction of ICU death in patients with acute respiratory distress syndrome (ARDS).DESIGN: A development, testing, and external validation study using clinical data from four prospective, multicenter, observational cohorts.SETTING: A network of multidisciplinary ICUs.PATIENTS: A total of 1,303 patients with moderate-to-severe ARDS managed with lung-protective ventilation.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: We developed and tested prediction models in 1,000 ARDS patients. We performed logistic regression analysis following variable selection by a genetic algorithm, random forest and extreme gradient boosting machine learning techniques. Potential predictors included demographics, comorbidities, ventilatory and oxygenation descriptors, and extrapulmonary organ failures. Risk modeling identified some major prognostic factors for ICU mortality, including age, cancer, immunosuppression, Pao2/Fio2, inspiratory plateau pressure, and number of extrapulmonary organ failures. Together, these characteristics contained most of the prognostic information in the first 24 hours to predict ICU mortality. Performance with machine learning methods was similar to logistic regression (area under the receiver operating characteristic curve [AUC], 0.87; 95% CI, 0.82–0.91). External validation in an independent cohort of 303 ARDS patients confirmed that the performance of the model was similar to a logistic regression model (AUC, 0.91; 95% CI, 0.87–0.94).CONCLUSIONS: Both machine learning and traditional methods lead to promising models to predict ICU death in moderate/severe ARDS patients. More research is needed to identify markers for severity beyond clinical determinants, such as demographics, comorbidities, lung mechanics, oxygenation, and extrapulmonary organ failure to guide patient management.
PubDate: Thu, 31 Aug 2023 00:00:00 GMT-
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- Effectiveness of Sublingual Buprenorphine for Pain Control in the ICU*
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Authors: Patanwala; Asad E.; Moran, Benjamin; Johnstone, Charlotte; Koelzow, Heike; Penm, Jonathan
Abstract:
OBJECTIVES: The objective of this study was to compare pain control and opioid consumption in critically ill patients who were treated with buprenorphine sublingual or oxycodone oral/enteral during ICU admission.DESIGN: This was a retrospective, parallel, cohort study.SETTING: General medical or surgical ICUs of a quaternary, urban hospital in Sydney, NSW, Australia.PATIENTS: Data were obtained for all patients admitted to two general medical or surgical ICU from January 2019 to January 2023. Patients were grouped as those who received buprenorphine sublingual versus oxycodone oral/enteral.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: Pain control was compared between a propensity score matched cohort of patients who received buprenorphine versus oxycodone. The primary outcome was the probability of significant pain. A significant pain score was defined as greater than or equal to 4 on the 0–10 Numeric Rating Scale or greater than or equal to 6 on the Behavioral Pain Scale. The study cohort included 1,070 patients (288 buprenorphine and 782 oxycodone). After propensity score matching, there were 288 patients in each group. The mean age of the matched cohort was 64 ± 16 years, 295 (51%) were male, and 359 (62%) had a surgical admission. The median probability of significant pain was 0.16 with buprenorphine and 0.17 with oxycodone (median difference, 0.01; 95% CI, –0.02 to 0.04; p = 0.50). Median opioid consumption in oral morphine milligram equivalents (MMEs) was 65 with buprenorphine and 70 with oxycodone (median difference, –1 mg; 95% CI, –10 to 10 mg; p = 0.73). Median MME per ICU day was 22 with buprenorphine and 22 with oxycodone (median difference, 1 mg; 95% CI, –2 to 5 mg; p = 0.38).CONCLUSIONS: Buprenorphine sublingual is as effective as oxycodone oral/enteral with regard to pain control and opioid consumption in the ICU. Buprenorphine sublingual is an appropriate option for patients in the ICU who are unable to take oral/enteral medications.
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
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- Healthcare Trajectories and Outcomes in the First Year After Tracheostomy
Based on Patient Characteristics*-
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Authors: Mehta; Anuj B.; Matlock, Daniel D.; Shorr, Andrew F.; Douglas, Ivor S.
Abstract:
OBJECTIVES: To define healthcare trajectories after tracheostomy to inform shared decision-making efforts for critically ill patients.DESIGN: Retrospective epidemiologic cohort study.SETTING: California Patient Discharge Database 2018–2019.PATIENTS: Patients who received a tracheostomy.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: We tracked 1-year outcomes after tracheostomy, including survival and time alive in and out of a healthcare facility (HCF. Patients were stratified based on surgical status (did the patient require a major operating room procedure or not), age (65 yr old or older and less than 65 yr), pre-ICU comorbid states (frailty, chronic organ dysfunction, cancer, and robustness), and the need for dialysis during the tracheostomy admission. We identified 4,274 nonsurgical adults who received a tracheostomy during the study period with 50.9% being 65 years old or older. Among adults 65 years old or older, median survival after tracheostomy was less than 3 months for individuals with frailty, chronic organ dysfunction, cancer, or dialysis. Median survival was 3 months for adults younger than 65 years with cancer or dialysis. Most patients spent the majority of days alive after a tracheostomy in an HCF in the first 3 months. Older adults had very few days alive and out of an HCF in the first 3 months after tracheostomy. Most patients who ultimately died in the first year after tracheostomy spent almost all days alive in an HCF.CONCLUSIONS: Cumulative mortality and median survival after a tracheostomy were very poor across most ages and groups. Older adults and several subgroups of younger adults experienced high rates of prolonged hospitalization with few days alive and out of an HCF. This information may aid some patients, surrogates, and providers in decision-making.
PubDate: Mon, 28 Aug 2023 00:00:00 GMT-
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- The Long-Term Use of Diagnostic Subdural Electroencephalogram Electrodes
and Subdural Hematoma: A Prospective Cohort Study*-
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Authors: Won; Sae-Yeon; Freiman, Thomas M.; Lee-Müller, Sara Sujin; Dubinski, Daniel; Willems, Laurent M.; Reif, Philipp S.; Hattingen, Elke; Ullmann, Joana; Herrmann, Eva; Melzer, Nico; Seifert, Volker; Gessler, Florian; Rosenow, Felix; Konczalla, Juergen; Strzelczyk, Adam
Abstract:
OBJECTIVES: Seizures and status epilepticus (SE) are frequent complications of acute subdural hematoma (aSDH) associated with increased morbidity and mortality. Therefore, we aimed to evaluate whether invasive subdural electroencephalogram recording leads to earlier seizure detection and treatment initiation in patients with aSDH.DESIGN: Prospective, single-center, cohort trial.SETTING: Neurologic and neurosurgical ICUs of one academic hospital in Germany.PATIENTS: Patients with aSDH undergoing surgical treatment. In total, 76 patients were enrolled in this study, 31 patients (40.8%) were assigned to the invasive electroencephalogram (iEEG) monitoring group and 45 patients (59.2%) to control group.INTERVENTIONS: The electrode group was implanted with a subdural strip electrode providing up to 7 days of real-time electroencephalogram recording in the neurointensive care unit, whereas the control group received regular normal surface electroencephalograms during the 7-day period. The primary outcomes were the prevalence and time to seizures and SE occurrence. Secondary outcomes included neurologic outcomes assessed using the Glasgow Outcome Scale (GOS) at discharge and 6-month follow-up and the prevalence of focal structural epilepsy within 2 years after discharge.MEASUREMENTS AND MAIN RESULTS: The trial was stopped after a study committee meeting when the prespecified criteria were met. The iEEG and control groups were well-matched for clinical characteristics at admission. Frequencies of seizures and SE detection were significantly higher in the iEEG group than in the control group (61% vs 15.6%; p < 0.001 and 38.7% vs 11.1%; p = 0.005). Time to seizure and SE detection was significantly earlier (median 29.2 vs 83.8 hr; p = 0.018 and 17.2 vs 83.8 hr; p = 0.033) in the iEEG group than in the control group. Favorable outcomes (GOS 4–5) were more frequently achieved in the iEEG group than in the control group (58% vs 31%; p = 0.065). No significant differences were detected in long-term mortality or post-traumatic epilepsy.CONCLUSIONS: Invasive subdural electroencephalogram monitoring is valuable and safe for early seizure/SE detection and treatment and might improve outcomes in the neurocritical care of patients with aSDH.
PubDate: Mon, 28 Aug 2023 00:00:00 GMT-
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- Extracorporeal Membrane Oxygenation Without Invasive Ventilation for
Respiratory Failure in Adults: A Systematic Review*-
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Authors: Belletti; Alessandro; Sofia, Rosaria; Cicero, Perla; Nardelli, Pasquale; Franco, Annalisa; Calabrò, Maria Grazia; Fominskiy, Evgeny V.; Triulzi, Margherita; Landoni, Giovanni; Scandroglio, Anna Mara; Zangrillo, Alberto
Abstract:
OBJECTIVES: Extracorporeal membrane oxygenation (ECMO) is an advanced treatment for acute severe respiratory failure. Patients on ECMO are frequently maintained sedated and immobilized until weaning from ECMO, first, and then from mechanical ventilation. Avoidance of sedation and invasive ventilation during ECMO may have potential advantages. We performed a systematic literature review to assess efficacy and safety of awake ECMO without invasive ventilation in patients with respiratory failure.DATA SOURCES: PubMed, Web of Science, and Scopus were searched for studies reporting outcome of awake ECMO for adult patients with respiratory failure.STUDY SELECTION: We included all studies reporting outcome of awake ECMO in patients with respiratory failure. Studies on ECMO for cardiovascular failure, cardiac arrest, or perioperative support and studies on pediatric patients were excluded. Two investigators independently screened and selected studies for inclusion.DATA EXTRACTION: Two investigators abstracted data on study characteristics, rate of awake ECMO failure, and mortality. Primary outcome was rate of awake ECMO failure (need for intubation). Pooled estimates with corresponding 95% CIs were calculated. Subgroup analyses by setting were performed.DATA SYNTHESIS: A total of 57 studies (28 case reports) included data from 467 awake ECMO patients. The subgroup of patients with acute respiratory distress syndrome showed a pooled estimate for awake ECMO failure of 39.3% (95% CI, 24.0–54.7%), while in patients bridged to lung transplantation, pooled estimate was 23.4% (95% CI, 13.3–33.5%). Longest follow-up mortality was 121 of 439 (pooled estimate, 28%; 95% CI, 22.3–33.6%). Mortality in patients who failed awake ECMO strategy was 43 of 74 (pooled estimate, 57.2%; 95% CI, 40.2–74.3%). Two cases of cannula self-removal were reported.CONCLUSIONS: Awake ECMO is feasible in selected patients, although the effect on outcome remains to be demonstrated. Mortality is almost 60% in patients who failed awake ECMO strategy.
PubDate: Mon, 28 Aug 2023 00:00:00 GMT-
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- The Effect of CytoSorb on Inflammatory Markers in Critically Ill Patients:
A Systematic Review and Meta-Analysis of Randomized Controlled Trials*-
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Authors: Heymann; Marc; Schorer, Raoul; Putzu, Alessandro
Abstract:
OBJECTIVES: The effectiveness of CytoSorb at removing inflammatory mediators in critically ill patients is controversial.DATA SOURCES: Electronic databases were searched from inception to May 2023.STUDY SELECTION: Randomized controlled trials reporting the effects of CytoSorb therapy on inflammatory parameters in critically ill patients with hyperinflammatory conditions were included.DATA EXTRACTION: Two authors screened articles for eligibility, extracted data, and assessed the risk of bias, conflicts of interest, and certainty of evidence (CoE). The primary outcome was interleukin (IL)-6 at 1 day after initiation of the therapy. Secondary outcomes included various inflammatory markers at 1, 2, 3, and 5 days and mortality. Data were pooled if at least three trials reported the outcome of interest. We conducted meta-analyses of the data using a random-effects model.DATA SYNTHESIS: Seventeen trials (n = 855) were included. Fourteen trials were judged to have notable concern about conflicts of interest. Seven trials were performed in medical ICU patients with hyperinflammatory conditions and 10 in complex cardiovascular surgery under cardiopulmonary bypass. Hemoadsorption with CytoSorb was not associated with lower IL-6 at 1 day (mean difference −5.98 [95% CI, −30.44 to 18.48] pg/mL), 2 days, 3 days, or 5 days after initiation of the treatment, as well as the concentration of procalcitionin. The levels of C-reactive protein were not lower with CytoSorb at 1, 2, and 3 days. The use of CytoSorb was associated with higher mortality at latest follow-up (relative risk = 1.22 [95% CI, 1.02–1.45]) and at 30 days. CoE ranged from low to very low.CONCLUSIONS: The use of CytoSorb hemoadsorption in a mixed population of critically ill patients with hyperinflammatory conditions does not exhibit a consistent decrease in IL-6 and other inflammatory parameters within the first 5 days of treatment. The significant uncertainty surrounding these findings highlights the need for further investigations.
PubDate: Mon, 21 Aug 2023 00:00:00 GMT-
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- Plasma Nitric Oxide Consumption Is Elevated and Associated With Adverse
Outcomes in Critically Ill Patients-
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Authors: Dony; Christina A.; Illipparambil, Lijo C.; Maeda, Tetsuro; Mroczek, Susan K.; Rovitelli, Amy; Wexler, Orren; Malnoske, Michelle; Bice, Tristan; Fe, Alex Z.; Storms, Casey R.; Zhang, Jimmy; Schultz, Rebecca D.; Pietropaoli, Anthony P.
Abstract:
OBJECTIVES: Impaired nitric oxide (NO) bioavailability may contribute to microvascular dysfunction in sepsis. Excessive plasma NO consumption has been attributed to scavenging by circulating cell-free hemoglobin. This may be a mechanism for NO deficiency in sepsis and critical illness. We hypothesized that plasma NO consumption is high in critically ill patients, particularly those with sepsis, acute respiratory distress syndrome (ARDS), shock, and in hospital nonsurvivors. We further hypothesized that plasma NO consumption is correlated with plasma cell-free hemoglobin concentration.DESIGN: Retrospective cohort study.SETTING: Adult ICUs of an academic medical center.PATIENTS AND SUBJECTS: Three hundred sixty-two critically ill patients and 46 healthy control subjects.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: Plasma NO consumption was measured using reductive chemiluminescence and cell-free hemoglobin was measured with a colorimetric assay. Mean (95% CI) plasma NO consumption (µM) was higher in critically ill patients versus healthy control subjects (3.9 [3.7–4.1] vs 2.1 [1.8–2.5]), septic versus nonseptic patients (4.1 [3.8–4.3] vs 3.6 [3.3–3.8]), ARDS versus non-ARDS patients (4.4 [4.0–4.9] vs 3.7 [3.6–3.9]), shock vs nonshock patients (4.4 [4.0–4.8] vs 3.6 [3.4–3.8]), and hospital nonsurvivors versus survivors (5.3 [4.4–6.4] vs 3.7 [3.6–3.9]). These relationships remained significant in multivariable analyses. Plasma cell-free hemoglobin was weakly correlated with plasma NO consumption.CONCLUSIONS: Plasma NO consumption is elevated in critically ill patients and independently associated with sepsis, ARDS, shock, and hospital death. These data suggest that excessive intravascular NO scavenging characterizes sepsis and adverse outcomes of critical illness.
PubDate: Mon, 21 Aug 2023 00:00:00 GMT-
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- Outcomes With Single-Site Dual-Lumen Versus Multisite Cannulation for
Adults With COVID-19 Respiratory Failure Receiving Venovenous
Extracorporeal Membrane Oxygenation*-
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Authors: O’Gara; Brian P.; Tung, Matthew G.; Kennedy, Kevin F.; Espinosa-Leon, Juan P.; Shaefi, Shahzad; Gluck, Jason; Raz, Yuval; Seethala, Raghu; Reich, John A.; Faugno, Anthony J.; Brodie, Daniel; Garan, A. Reshad; Grandin, E. Wilson
Abstract:
OBJECTIVES: To determine whether multisite versus single-site dual-lumen (SSDL) cannulation is associated with outcomes for COVID-19 patients requiring venovenous extracorporeal membrane oxygenation (VV-ECMO).DESIGN: Retrospective analysis of the Extracorporeal Life Support Organization Registry. Propensity score matching (2:1 multisite vs SSDL) was used to control for confounders.PATIENTS: The matched cohort included 2,628 patients (1,752 multisite, 876 SSDL) from 170 centers. The mean (sd) age in the entire cohort was 48 (11) years, and 3,909 (71%) were male. Patients were supported with mechanical ventilation for a median (interquartile range) of 79 (113) hours before VV-ECMO support.INTERVENTIONS: None.MEASUREMENTS: The primary outcome was 90-day survival. Secondary outcomes included survival to hospital discharge, duration of ECMO support, days free of ECMO support at 90 days, and complication rates.MAIN RESULTS: There was no difference in 90-day survival (49.4 vs 48.9%, p = 0.66), survival to hospital discharge (49.8 vs 48.2%, p = 0.44), duration of ECMO support (17.9 vs 17.1 d, p = 0.82), or hospital length of stay after cannulation (28 vs 27.4 d, p = 0.37) between multisite and SSDL groups. More SSDL patients were extubated within 24 hours (4% vs 1.9%, p = 0.001). Multisite patients had higher ECMO flows at 24 hours (4.5 vs 4.1 L/min, p < 0.001) and more ECMO-free days at 90 days (3.1 vs 2.0 d, p = 0.02). SSDL patients had higher rates of pneumothorax (13.9% vs 11%, p = 0.03). Cannula site bleeding (6.4% vs 4.7%, p = 0.03), oxygenator failure (16.7 vs 13.4%, p = 0.03), and circuit clots (5.5% vs 3.4%, p = 0.02) were more frequent in multisite patients.CONCLUSIONS: In this retrospective study of COVID-19 patients requiring VV-ECMO, 90-day survival did not differ between patients treated with a multisite versus SSDL cannulation strategy and there were only modest differences in major complication rates. These findings do not support the superiority of either cannulation strategy in this setting.
PubDate: Mon, 07 Aug 2023 00:00:00 GMT-
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- Measuring the Impact of ICU Strain on Mortality, After-Hours Discharge,
Discharge Delay, Interhospital Transfer, and Readmission in Australia With
the Activity Index*-
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Authors: Pilcher; David V.; Hensman, Tamishta; Bihari, Shailesh; Bailey, Michael; McClure, Jason; Nicholls, Mark; Chavan, Shaila; Secombe, Paul; Rosenow, Melissa; Huckson, Sue; Litton, Edward
Abstract:
OBJECTIVES: ICU resource strain leads to adverse patient outcomes. Simple, well-validated measures of ICU strain are lacking. Our objective was to assess whether the “Activity index,” an indicator developed during the COVID-19 pandemic, was a valid measure of ICU strain.DESIGN: Retrospective national registry-based cohort study.SETTING: One hundred seventy-five public and private hospitals in Australia (June 2020 through March 2022).SUBJECTS: Two hundred seventy-seven thousand seven hundred thirty-seven adult ICU patientsINTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: Data from the Australian and New Zealand Intensive Care Society Adult Patient Database were matched to the Critical Health Resources Information System. The mean daily Activity index of each ICU (census total of “patients with 1:1 nursing” + “invasive ventilation” + “renal replacement” + “extracorporeal membrane oxygenation” + “active COVID-19,” divided by total staffed ICU beds) during the patient’s stay in the ICU was calculated. Patients were categorized as being in the ICU during very quiet (Activity index < 0.1), quiet (0.1 to < 0.6), intermediate (0.6 to < 1.1), busy (1.1 to < 1.6), or very busy time-periods (≥ 1.6). The primary outcome was in-hospital mortality. Secondary outcomes included after-hours discharge from the ICU, readmission to the ICU, interhospital transfer to another ICU, and delay in discharge from the ICU. Median Activity index was 0.87 (interquartile range, 0.40–1.24). Nineteen thousand one hundred seventy-seven patients died (6.9%). In-hospital mortality ranged from 2.4% during very quiet to 10.9% during very busy time-periods. After adjusting for confounders, being in an ICU during time-periods with higher Activity indices, was associated with an increased risk of in-hospital mortality (odds ratio [OR], 1.49; 99% CI, 1.38–1.60), after-hours discharge (OR, 1.27; 99% CI, 1.21–1.34), readmission (OR, 1.18; 99% CI, 1.09–1.28), interhospital transfer (OR, 1.92; 99% CI, 1.72–2.15), and less delay in ICU discharge (OR, 0.58; 99% CI, 0.55–0.62): findings consistent with ICU strain.CONCLUSIONS: The Activity index is a simple and valid measure that identifies ICUs in which increasing strain leads to progressively worse patient outcomes.
PubDate: Mon, 24 Jul 2023 00:00:00 GMT-
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- Blood Purification for Adult Patients With Severe Infection or
Sepsis/Septic Shock: A Network Meta-Analysis of Randomized Controlled
Trials-
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Authors: Chen; Jia-Jin; Lai, Pei-Chun; Lee, Tao-Han; Huang, Yen-Ta
Abstract:
OBJECTIVES: This study aimed to conduct a comprehensive and updated systematic review with network meta-analysis (NMA) to assess the outcome benefits of various blood purification modalities for adult patients with severe infection or sepsis.DATA SOURCES: We conducted a search of PubMed, MEDLINE, clinical trial registries, Cochrane Library, and Embase databases with no language restrictions.STUDY SELECTION: Only randomized controlled trials (RCTs) were selected.DATA EXTRACTION: The primary outcome was overall mortality. The secondary outcomes were the length of mechanical ventilation (MV) days and ICU stay, incidence of acute kidney injury (AKI), and kidney replacement therapy requirement.DATA SYNTHESIS: We included a total of 60 RCTs with 4,595 participants, comparing 16 blood purification modalities with 17 interventions. Polymyxin-B hemoperfusion (relative risk [RR]: 0.70; 95% CI, 0.57–0.86) and plasma exchange (RR: 0.61; 95% CI, 0.42–0.91) were associated with low mortality (very low and low certainty of evidence, respectively). Because of the presence of high clinical heterogeneity and intransitivity, the potential benefit of polymyxin-B hemoperfusion remained inconclusive. The analysis of secondary outcomes was limited by the scarcity of available studies. HA330 with high-volume continuous venovenous hemofiltration (CVVH), HA330, and standard-volume CVVH were associated with shorter ICU stay. HA330 with high-volume CVVH, HA330, and standard-volume CVVH were beneficial in reducing MV days. None of the interventions showed a significant reduction in the incidence of AKI or the need for kidney replacement therapy.CONCLUSIONS: Our NMA suggests that plasma exchange and polymyxin-B hemoperfusion may provide potential benefits for adult patients with severe infection or sepsis/septic shock when compared with standard care alone, but most comparisons were based on low or very low certainty evidence. The therapeutic effect of polymyxin-B hemoperfusion remains uncertain. Further RCTs are required to identify the specific patient population that may benefit from extracorporeal blood purification.
PubDate: Thu, 20 Jul 2023 00:00:00 GMT-
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- Early, Persistent Lymphopenia Is Associated With Prolonged Multiple Organ
Failure and Mortality in Septic Children-
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Authors: Podd; Bradley S.; Banks, Russell K.; Reeder, Ron; Telford, Russell; Holubkov, Richard; Carcillo, Joseph; Berg, Robert A.; Wessel, David; Pollack, Murray M.; Meert, Kathleen; Hall, Mark; Newth, Christopher; Lin, John C.; Doctor, Allan; Shanley, Tom; Cornell, Tim; Harrison, Rick E.; Zuppa, Athena F.; Sward, Katherine; Dean, J. Michael; Randolph, Adrienne G.; on behalf of the Eunice Kennedy Shriver National Institute of Child Health Human Development Collaborative Pediatric Critical Care Research Network
Abstract:
OBJECTIVES: Sepsis-associated immune suppression correlates with poor outcomes. Adult trials are evaluating immune support therapies. Limited data exist to support consideration of immunomodulation in pediatric sepsis. We tested the hypothesis that early, persistent lymphopenia predicts worse outcomes in pediatric severe sepsis.DESIGN: Observational cohort comparing children with severe sepsis and early, persistent lymphopenia (absolute lymphocyte count < 1,000 cells/µL on 2 d between study days 0–5) to children without. The composite outcome was prolonged multiple organ dysfunction syndrome (MODS, organ dysfunction beyond day 7) or PICU mortality.SETTING: Nine PICUs in the National Institutes of Health Collaborative Pediatric Critical Care Research Network between 2015 and 2017.PATIENTS: Children with severe sepsis and indwelling arterial and/or central venous catheters.INTERVENTIONS: Blood sampling and clinical data analysis.MEASUREMENTS AND MAIN RESULTS: Among 401 pediatric patients with severe sepsis, 152 (38%) had persistent lymphopenia. These patients were older, had higher illness severity, and were more likely to have underlying comorbidities including solid organ transplant or malignancy. Persistent lymphopenia was associated with the composite outcome prolonged MODS or PICU mortality (66/152, 43% vs 45/249, 18%; p < 0.01) and its components prolonged MODS (59/152 [39%] vs 43/249 [17%]), and PICU mortality (32/152, 21% vs 12/249, 5%; p < 0.01) versus children without. After adjusting for baseline factors at enrollment, the presence of persistent lymphopenia was associated with an odds ratio of 2.98 (95% CI [1.85–4.02]; p < 0.01) for the composite outcome. Lymphocyte count trajectories showed that patients with persistent lymphopenia generally did not recover lymphocyte counts during the study, had lower nadir whole blood tumor necrosis factor-α response to lipopolysaccharide stimulation, and higher maximal inflammatory markers (C-reactive protein and ferritin) during days 0–3 (p < 0.01).CONCLUSIONS: Children with severe sepsis and persistent lymphopenia are at risk of prolonged MODS or PICU mortality. This evidence supports testing therapies for pediatric severe sepsis patients risk-stratified by early, persistent lymphopenia.
PubDate: Tue, 18 Jul 2023 00:00:00 GMT-
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- Definition and Clinical Evaluation for Trimethoprim-Sulfamethoxazole
Severe Acute Respiratory Failure-
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Authors: Miller; Jenna; Khan, Hason; Mino-Kenudson, Mari; Taylor, Martin; Shih, Angela; Goldman, Jennifer
Abstract: OBJECTIVES: Trimethoprim-sulfamethoxazole (TMP-SMX)-associated severe acute respiratory distress syndrome (ARDS) has gone underrecognized. We propose the first disease definition and clinical evaluation for a novel adverse drug reaction (ADR) based on a series of recently identified rare cases of life-threatening ADRs.DESIGN: A retrospective study was conducted. All medical records were evaluated. Available pathology samples were sent to Massachusetts General for clinical consultation. Blood samples from surviving patients were obtained and human leukocyte antigen (HLA) analysis was performed by the Children’s Mercy Hospital Genomic Center and Vanderbilt University Medical Center.SETTING: U.S. ICUs, 1996–2021.PATIENTS: Nineteen young patients (10–37) were identified. Patients were previously healthy, with no preexisting pulmonary disease, no other cause for respiratory failure, and no chronic history of smoking/vaping.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: Through our retrospective analysis, we analyzed clinical characteristics associated with TMP-SMX. Pathology samples were reviewed, and HLA analysis was performed on available samples by the study team or as standard of care at treatment hospitals in some cases. In 19 critically ill patients, we identified a pattern of severe respiratory failure requiring ICU admission, mechanical ventilation, and frequent extracorporeal membrane oxygenation use. We describe the first three-part clinical diagnosis and evaluation strategy: 1) Clinical definition: Unexplained severe respiratory failure in a patient receiving greater than or equal to 6 days of TMP-SMX at treatment dose (not prophylaxis). TMP-SMX ARDS is a diagnosis of exclusion. 2) Genetic association: One hundred percent of currently available TMP-SMX respiratory failure patient genomic data, (n = 11) have been carriers of both HLA-B*07:02 and HLA-C*07:02 alleles. HLA allele evaluation could be considered in patients with suspected TMP-SMX respiratory failure. 3) Lung pathology: A unique pulmonary pathologic pattern of lung injury termed diffuse alveolar injury with delayed epithelialization has been observed in these cases. In suspected cases, surgical lung biopsy early in the clinical course could be considered.CONCLUSIONS: TMP-SMX is a commonly prescribed antibiotic. However, we find it imperative to share this relatively rare but life-threatening condition with clinicians as the mortality rate approaches 40%.
PubDate: Fri, 14 Jul 2023 00:00:00 GMT-
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- Angiotensin II for the Treatment of Refractory Shock: A Matched Analysis*
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Authors: Smith; Lane M.; Mentz, Graciela B.; Engoren, Milo C.
Abstract:
OBJECTIVES: To determine if angiotensin II is associated with improved outcomes as measured by 30- and 90-day mortality as well as other secondary outcomes such as organ dysfunction and adverse events.DESIGN: Retrospective, matched analysis of patients receiving angiotensin II compared with both historical and concurrent controls receiving equivalent doses of nonangiotensin II vasopressors.SETTING: Multiple ICUs in a large, university-based hospital.PATIENTS: Eight hundred thirteen adult patients with shock admitted to an ICU and requiring vasopressor support.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: Angiotensin II use had no association with the primary outcome of 30-day mortality (60% vs 56%; p = 0.292). The secondary outcome of 90-day mortality was also similar (65% vs 63%; p = 0.440) as were changes in Sequential Organ Failure Assessment scores over a 5-day monitoring period after enrollment. Angiotensin II was not associated with increased rates of kidney replacement therapy (odds ratio [OR], 1.39; 95% CI, 0.88–2.19; p = 0.158) or receipt of mechanical ventilation (OR, 1.50; 95% CI, 0.41–5.51; p = 0.539) after enrollment, and the rate of thrombotic events was similar between angiotensin II and control patients (OR, 1.02; 95% CI, 0.71–1.48; p = 0.912).CONCLUSIONS: In patients with severe shock, angiotensin II was not associated with improved mortality or organ dysfunction and was not associated with an increased rate of adverse events.
PubDate: Wed, 28 Jun 2023 00:00:00 GMT-
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- Analysis of Protein Biomarkers From Hospitalized COVID-19 Patients Reveals
Severity-Specific Signatures and Two Distinct Latent Profiles With
Differential Responses to Corticosteroids*-
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Authors: Verhoef; Philip A.; Spicer, Alexandra B.; Lopez-Espina, Carlos; Bhargava, Akhil; Schmalz, Lee; Sims, Matthew D.; Palagiri, Ashok V.; Iyer, Karthik V.; Crisp, Matthew J.; Halalau, Alexandra; Maddens, Nicholas; Gosai, Falgun; Syed, Anwaruddin; Azad, Saleem; Espinosa, Aimee; Davila, Francisco; Davila, Hugo; Evans, Neil R.; Smith, Scott; Reddy, Bobby; Sinha, Pratik; Churpek, Matthew M.
Abstract:
OBJECTIVES: To identify and validate novel COVID-19 subphenotypes with potential heterogenous treatment effects (HTEs) using electronic health record (EHR) data and 33 unique biomarkers.DESIGN: Retrospective cohort study of adults presenting for acute care, with analysis of biomarkers from residual blood collected during routine clinical care. Latent profile analysis (LPA) of biomarker and EHR data identified subphenotypes of COVID-19 inpatients, which were validated using a separate cohort of patients. HTE for glucocorticoid use among subphenotypes was evaluated using both an adjusted logistic regression model and propensity matching analysis for in-hospital mortality.SETTING: Emergency departments from four medical centers.PATIENTS: Patients diagnosed with COVID-19 based on International Classification of Diseases, 10th Revision codes and laboratory test results.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: Biomarker levels generally paralleled illness severity, with higher levels among more severely ill patients. LPA of 522 COVID-19 inpatients from three sites identified two profiles: profile 1 (n = 332), with higher levels of albumin and bicarbonate, and profile 2 (n = 190), with higher inflammatory markers. Profile 2 patients had higher median length of stay (7.4 vs 4.1 d; p < 0.001) and in-hospital mortality compared with profile 1 patients (25.8% vs 4.8%; p < 0.001). These were validated in a separate, single-site cohort (n = 192), which demonstrated similar outcome differences. HTE was observed (p = 0.03), with glucocorticoid treatment associated with increased mortality for profile 1 patients (odds ratio = 4.54).CONCLUSIONS: In this multicenter study combining EHR data with research biomarker analysis of patients with COVID-19, we identified novel profiles with divergent clinical outcomes and differential treatment responses.
PubDate: Wed, 28 Jun 2023 00:00:00 GMT-
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- Evaluation of the Impact of ABCDEF Bundle Compliance Rates on
Postintensive Care Syndrome: A Secondary Analysis Study*-
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Authors: Kawakami; Daisuke; Fujitani, Shigeki; Koga, Hidenobu; Dote, Hisashi; Takita, Mumon; Takaba, Akihiro; Hino, Masaaki; Nakamura, Michitaka; Irie, Hiromasa; Adachi, Tomohiro; Shibata, Mami; Kataoka, Jun; Korenaga, Akira; Yamashita, Tomoya; Okazaki, Tomoya; Okumura, Masatoshi; Tsunemitsu, Takefumi
Abstract:
OBJECTIVES: This study aimed to examine the association between ABCDEF bundles and long-term postintensive care syndrome (PICS)-related outcomes.DESIGN: Secondary analysis of the J-PICS study.SETTING: This study was simultaneously conducted in 14 centers and 16 ICUs in Japan between April 1, 2019, and September 30, 2019.PATIENTS: Adult ICU patients who were expected to be on a ventilator for at least 48 hours.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: Bundle compliance for the last 24 hours was recorded using a checklist at 8:00 am The bundle compliance rate was defined as the 3-day average of the number of bundles performed each day divided by the total number of bundles. The relationship between the bundle compliance rate and PICS prevalence (defined by the 36-item Short Form Physical Component Scale, Mental Component Scale, and Short Memory Questionnaire) was examined. A total of 191 patients were included in this study. Of these, 33 patients (17.3%) died in-hospital and 48 (25.1%) died within 6 months. Of the 96 patients with 6-month outcome data, 61 patients (63.5%) had PICS and 35 (36.5%) were non-PICS. The total bundle compliance rate was 69.8%; the rate was significantly lower in the 6-month mortality group (66.6% vs 71.6%, p = 0.031). Bundle compliance rates in patients with and without PICS were 71.3% and 69.9%, respectively (p = 0.61). After adjusting for confounding variables, bundle compliance rates were not significantly different in the context of PICS prevalence (p = 0.56). A strong negative correlation between the bundle compliance rate and PICS prevalence (r = –0.84, R2 = 0.71, p = 0.035) was observed in high-volume centers.CONCLUSIONS: The bundle compliance rate was not associated with PICS prevalence. However, 6-month mortality was lower with a higher bundle compliance rate. A trend toward a lower PICS prevalence was associated with higher bundle compliance in high-volume centers.
PubDate: Fri, 23 Jun 2023 00:00:00 GMT-
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