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EMERGENCY AND INTENSIVE CRITICAL CARE (121 journals)                     

Showing 1 - 123 of 123 Journals sorted alphabetically
AACN Advanced Critical Care     Full-text available via subscription   (Followers: 36)
Academic Emergency Medicine     Hybrid Journal   (Followers: 100)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 2)
Acute and Critical Care     Open Access   (Followers: 10)
Acute Cardiac Care     Hybrid Journal   (Followers: 12)
Acute Medicine     Full-text available via subscription   (Followers: 7)
Advances in Emergency Medicine     Open Access   (Followers: 21)
Advances in Neonatal Care     Hybrid Journal   (Followers: 45)
African Journal of Anaesthesia and Intensive Care     Full-text available via subscription   (Followers: 8)
African Journal of Emergency Medicine     Open Access   (Followers: 6)
AINS - Anasthesiologie - Intensivmedizin - Notfallmedizin - Schmerztherapie     Hybrid Journal   (Followers: 5)
American Journal of Emergency Medicine     Hybrid Journal   (Followers: 57)
Annals of Emergency Medicine     Hybrid Journal   (Followers: 150)
Annals of Intensive Care     Open Access   (Followers: 39)
Annals of the American Thoracic Society     Full-text available via subscription   (Followers: 15)
Archives of Academic Emergency Medicine     Open Access   (Followers: 6)
Archives of Trauma Research     Open Access   (Followers: 5)
ASAIO Journal     Hybrid Journal   (Followers: 2)
Australasian Journal of Paramedicine     Open Access   (Followers: 9)
Australian Critical Care     Full-text available via subscription   (Followers: 21)
Bangladesh Critical Care Journal     Open Access   (Followers: 1)
BMC Emergency Medicine     Open Access   (Followers: 29)
BMJ Quality & Safety     Hybrid Journal   (Followers: 66)
Burns Open     Open Access   (Followers: 1)
Canadian Journal of Respiratory, Critical Care, and Sleep Medicine     Hybrid Journal   (Followers: 2)
Case Reports in Acute Medicine     Open Access   (Followers: 4)
Case Reports in Critical Care     Open Access   (Followers: 14)
Case Reports in Emergency Medicine     Open Access   (Followers: 23)
Chronic Wound Care Management and Research     Open Access   (Followers: 9)
Clinical and Applied Thrombosis/Hemostasis     Open Access   (Followers: 28)
Clinical Medicine Insights : Trauma and Intensive Medicine     Open Access   (Followers: 3)
Clinical Risk     Hybrid Journal   (Followers: 5)
Crisis: The Journal of Crisis Intervention and Suicide Prevention     Hybrid Journal   (Followers: 17)
Critical Care     Open Access   (Followers: 78)
Critical Care and Resuscitation     Full-text available via subscription   (Followers: 29)
Critical Care Clinics     Full-text available via subscription   (Followers: 35)
Critical Care Explorations     Open Access   (Followers: 3)
Critical Care Medicine     Hybrid Journal   (Followers: 325)
Critical Care Research and Practice     Open Access   (Followers: 13)
Current Emergency and Hospital Medicine Reports     Hybrid Journal   (Followers: 6)
Current Opinion in Critical Care     Hybrid Journal   (Followers: 74)
Disaster and Emergency Medicine Journal     Open Access   (Followers: 12)
Egyptian Journal of Critical Care Medicine     Open Access   (Followers: 2)
EMC - Urgenze     Full-text available via subscription  
Emergency Care Journal     Open Access   (Followers: 8)
Emergency Medicine (Medicina neotložnyh sostoânij)     Open Access  
Emergency Medicine Australasia     Hybrid Journal   (Followers: 18)
Emergency Medicine Clinics of North America     Full-text available via subscription   (Followers: 19)
Emergency Medicine International     Open Access   (Followers: 8)
Emergency Medicine Journal     Hybrid Journal   (Followers: 56)
Emergency Medicine News     Full-text available via subscription   (Followers: 7)
Emergency Nurse     Full-text available via subscription   (Followers: 16)
Enfermería Intensiva (English ed.)     Full-text available via subscription   (Followers: 2)
European Burn Journal     Open Access   (Followers: 9)
European Journal of Emergency Medicine     Hybrid Journal   (Followers: 25)
Frontiers in Emergency Medicine     Open Access   (Followers: 8)
Global Journal of Transfusion Medicine     Open Access   (Followers: 1)
Hong Kong Journal of Emergency Medicine     Full-text available via subscription   (Followers: 5)
Indian Journal of Burns     Open Access   (Followers: 3)
Injury     Hybrid Journal   (Followers: 21)
Intensive Care Medicine     Hybrid Journal   (Followers: 87)
Intensive Care Medicine Experimental     Open Access   (Followers: 2)
Intensivmedizin up2date     Hybrid Journal   (Followers: 4)
International Journal of Critical Illness and Injury Science     Open Access   (Followers: 1)
International Journal of Emergency Medicine     Open Access   (Followers: 9)
International Journal of Emergency Mental Health and Human Resilience     Open Access   (Followers: 2)
International Paramedic Practice     Full-text available via subscription   (Followers: 17)
Iranian Journal of Emergency Medicine     Open Access  
Irish Journal of Paramedicine     Open Access   (Followers: 3)
Journal Européen des Urgences et de Réanimation     Hybrid Journal   (Followers: 1)
Journal of Acute Care Physical Therapy     Hybrid Journal   (Followers: 4)
Journal of Cardiac Critical Care TSS     Open Access   (Followers: 1)
Journal Of Cardiovascular Emergencies     Open Access  
Journal of Concussion     Open Access  
Journal of Critical Care     Hybrid Journal   (Followers: 51)
Journal of Critical Care Medicine     Open Access   (Followers: 18)
Journal of Education and Teaching in Emergency Medicine     Open Access   (Followers: 1)
Journal of Emergencies, Trauma and Shock     Open Access   (Followers: 13)
Journal of Emergency Medical Services     Full-text available via subscription   (Followers: 12)
Journal of Emergency Medicine     Hybrid Journal   (Followers: 53)
Journal of Emergency Medicine, Trauma and Acute Care     Open Access   (Followers: 26)
Journal of Emergency Practice and Trauma     Open Access   (Followers: 6)
Journal of Intensive Care     Open Access   (Followers: 9)
Journal of Intensive Care Medicine     Hybrid Journal   (Followers: 23)
Journal of Intensive Medicine     Open Access   (Followers: 1)
Journal of Neuroanaesthesiology and Critical Care     Open Access   (Followers: 4)
Journal of Stroke Medicine     Hybrid Journal   (Followers: 3)
Journal of the American College of Emergency Physicians Open     Open Access   (Followers: 2)
Journal of the Intensive Care Society     Hybrid Journal   (Followers: 5)
Journal of the Royal Army Medical Corps     Hybrid Journal   (Followers: 7)
Journal of Thrombosis and Haemostasis     Hybrid Journal   (Followers: 52)
Journal of Translational Critical Care Medicine     Open Access   (Followers: 3)
Journal of Trauma and Acute Care Surgery, The     Hybrid Journal   (Followers: 36)
La Presse Médicale Open     Open Access  
Médecine de Catastrophe - Urgences Collectives     Hybrid Journal  
Medicina Intensiva     Open Access   (Followers: 3)
Medicina Intensiva (English Edition)     Hybrid Journal   (Followers: 1)
Mediterranean Journal of Emergency Medicine & Acute Care : MedJEM     Open Access  
Notfall + Rettungsmedizin     Hybrid Journal   (Followers: 4)
OA Critical Care     Open Access   (Followers: 3)
OA Emergency Medicine     Open Access   (Followers: 2)
Open Access Emergency Medicine     Open Access   (Followers: 6)
Open Journal of Emergency Medicine     Open Access   (Followers: 2)
Palliative Care : Research and Treatment     Open Access   (Followers: 22)
Palliative Medicine     Hybrid Journal   (Followers: 56)
Prehospital Emergency Care     Hybrid Journal   (Followers: 20)
Regulatory Toxicology and Pharmacology     Hybrid Journal   (Followers: 25)
Research and Opinion in Anesthesia and Intensive Care     Open Access   (Followers: 3)
Resuscitation     Hybrid Journal   (Followers: 59)
Resuscitation Plus     Open Access   (Followers: 2)
Saudi Critical Care Journal     Open Access   (Followers: 2)
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine     Open Access   (Followers: 12)
Seminars in Thrombosis and Hemostasis     Hybrid Journal   (Followers: 28)
Shock : Injury, Inflammation, and Sepsis : Laboratory and Clinical Approaches     Hybrid Journal   (Followers: 12)
Sklifosovsky Journal Emergency Medical Care     Open Access  
The Journal of Trauma Injury Infection and Critical Care     Full-text available via subscription   (Followers: 23)
Therapeutics and Clinical Risk Management     Open Access   (Followers: 1)
Transplant Research and Risk Management     Open Access   (Followers: 1)
Trauma Case Reports     Open Access   (Followers: 1)
Trauma Monthly     Open Access   (Followers: 4)
Visual Journal of Emergency Medicine     Full-text available via subscription   (Followers: 1)
Western Journal of Emergency Medicine     Open Access   (Followers: 11)
 AEM Education and Training : A Global Journal of Emergency Care     Open Access   (Followers: 1)

           

Similar Journals
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Critical Care Explorations
Number of Followers: 3  

  This is an Open Access Journal Open Access journal
ISSN (Online) 2639-8028
Published by LWW Wolters Kluwer Homepage  [330 journals]
  • Inhaled Volatiles for Status Asthmaticus, Epilepsy, and Difficult Sedation
           in Adult ICU and PICU: A Systematic Review

    • Authors: Gorsky; Kevin; Cuninghame, Sean; Jayaraj, Kesikan; Slessarev, Marat; Francoeur, Conall; Withington, Davinia E.; Chen, Jennifer; Cuthbertson, Brian H.; Martin, Claudio; Chapman, Martin; Ganesan, Saptharishi Lalgudi; McKinnon, Nicole; Jerath, Angela; on behalf of the SAVE-ICU Study Investigators
      Abstract: imageOBJECTIVES: Inhaled volatile anesthetics support management of status asthmaticus (SA), status epilepticus (SE), and difficult sedation (DS). This study aimed to evaluate the effectiveness, safety, and feasibility of using inhaled anesthetics for SA, SE, and DS in adult ICU and PICU patients.DATA SOURCES: MEDLINE, Cochrane Central Register of Controlled Trials, and Embase.STUDY SELECTION: Primary literature search that reported the use of inhaled anesthetics in ventilated patients with SA, SE, and DS from 1970 to 2021.DATA EXTRACTION: Study data points were extracted by two authors independently. Quality assessment was performed using the Joanna Briggs Institute appraisal tool for case studies/series, Newcastle criteria for cohort/case–control studies, and risk-of-bias framework for clinical trials.DATA SYNTHESIS: Primary outcome was volatile efficacy in improving predefined clinical or physiologic endpoints. Secondary outcomes were adverse events and delivery logistics. From 4281 screened studies, the number of included studies/patients across diagnoses and patient groups were: SA (adult: 38/121, pediatric: 28/142), SE (adult: 18/37, pediatric: 5/10), and DS (adult: 21/355, pediatric: 10/90). Quality of evidence was low, consisting mainly of case reports and series. Clinical and physiologic improvement was seen within 1–2 hours of initiating volatiles, with variable efficacy across diagnoses and patient groups: SA (adult: 89–95%, pediatric: 80–97%), SE (adults: 54–100%, pediatric: 60–100%), and DS (adults: 60–90%, pediatric: 62–90%). Most common adverse events were cardiovascular, that is, hypotension and arrhythmias. Inhaled sedatives were commonly delivered using anesthesia machines for SA/SE and miniature vaporizers for DS. Few (10%) of studies reported required non-ICU personnel, and only 16% had ICU volatile delivery protocol.CONCLUSIONS: Volatile anesthetics may provide effective treatment in patients with SA, SE, and DS scenarios but the quality of evidence is low. Higher-quality powered prospective studies of the efficacy and safety of using volatile anesthetics to manage SA, SE, and DS patients are required. Education regarding inhaled anesthetics and the protocolization of their use is needed.
      PubDate: Tue, 20 Feb 2024 00:00:00 GMT-
       
  • Regional Practice Variation and Outcomes in the Standard Versus
           Accelerated Initiation of Renal Replacement Therapy in Acute Kidney Injury
           (STARRT-AKI) Trial: A Post Hoc Secondary Analysis

    • Authors: Vaara; Suvi T.; Serpa Neto, Ary; Bellomo, Rinaldo; Adhikari, Neill K. J.; Dreyfuss, Didier; Gallagher, Martin; Gaudry, Stephane; Hoste, Eric; Joannidis, Michael; Pettilä, Ville; Wang, Amanda Y.; Kashani, Kianoush; Wald, Ron; Bagshaw, Sean M.; Ostermann, Marlies; on behalf of the STandard vs. Accelerated initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI Investigators
      Abstract: imageOBJECTIVES: Among patients with severe acute kidney injury (AKI) admitted to the ICU in high-income countries, regional practice variations for fluid balance (FB) management, timing, and choice of renal replacement therapy (RRT) modality may be significant.DESIGN: Secondary post hoc analysis of the STandard vs. Accelerated initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial (ClinicalTrials.gov number NCT02568722).SETTING: One hundred-fifty-three ICUs in 13 countries.PATIENTS: Altogether 2693 critically ill patients with AKI, of whom 994 were North American, 1143 European, and 556 from Australia and New Zealand (ANZ).INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: Total mean FB to a maximum of 14 days was +7199 mL in North America, +5641 mL in Europe, and +2211 mL in ANZ (p < 0.001). The median time to RRT initiation among patients allocated to the standard strategy was longest in Europe compared with North America and ANZ (p < 0.001; p < 0.001). Continuous RRT was the initial RRT modality in 60.8% of patients in North America and 56.8% of patients in Europe, compared with 96.4% of patients in ANZ (p < 0.001). After adjustment for predefined baseline characteristics, compared with North American and European patients, those in ANZ were more likely to survive to ICU (p < 0.001) and hospital discharge (p < 0.001) and to 90 days (for ANZ vs. Europe: risk difference [RD], –11.3%; 95% CI, –17.7% to –4.8%; p < 0.001 and for ANZ vs. North America: RD, –10.3%; 95% CI, –17.5% to –3.1%; p = 0.007).CONCLUSIONS: Among STARRT-AKI trial centers, significant regional practice variation exists regarding FB, timing of initiation of RRT, and initial use of continuous RRT. After adjustment, such practice variation was associated with lower ICU and hospital stay and 90-day mortality among ANZ patients compared with other regions.
      PubDate: Mon, 19 Feb 2024 00:00:00 GMT-
       
  • Serum Bicarbonate Levels Among Patients on Venovenous Extracorporeal
           Membrane Oxygenation for Acute Respiratory Distress Syndrome With and
           Without Kidney Replacement Therapy

    • Authors: Adkisson; Wren S.; Gannon, Whitney D.; Qian, Edward T.; Bacchetta, Matthew; Siew, Edward D.; Ford, Daniel J.; Landsperger, Janna S.; Rice, Todd W.; Casey, Jonathan D.; Semler, Matthew W.; for the Pragmatic Critical Care Research Group
      Abstract: imageOBJECTIVES: For patients with acute respiratory distress syndrome (ARDS) receiving venovenous extracorporeal membrane oxygenation (ECMO) who develop acute kidney injury (AKI) requiring kidney replacement therapy (KRT), the inability to renally compensate for respiratory acidosis could result in increased sweep gas flow to normalize arterial pH. Our objective was to examine the relationship of serum bicarbonate levels, arterial pH, sweep gas flow, and Paco2.DESIGN: This is a retrospective cohort study. We compared patients who received KRT while undergoing venovenous ECMO to patients who did not.SETTING: Vanderbilt University Medical Center, February 2019 to February 2022.PATIENTS: We examined data from adult patients receiving venovenous ECMO for ARDS.INTERVENTIONS: Values for serum bicarbonate, arterial pH, Paco2, and sweep gas flow were collected daily from time of cannulation until the earlier of decannulation, 30 days, or death.MEASUREMENTS AND MAIN RESULTS: Of the 126 patients included, 53 (42.1%) received KRT and 73 (57.9%) did not. In patients who received KRT, mean serum bicarbonate levels remained between 22 and 28 mmol/L throughout the study period. Patients who did not receive KRT experienced an increase in mean serum bicarbonate levels over time up to 40 mmol/L (mean difference = –4.4 mmol/L [95% CI, –6.3 to –2.5 mmol/L]; p < 0.0001). Mean values for Paco2 (–5.2 [95% CI, –8.8 to –1.7]; p = 0.004) and pH (–0.03 [95% CI, –0.03 to –0.02]; p < 0.0001) were lower in patients who received KRT than in patients who did not, despite higher sweep gas flow rates in patients who received KRT than in patients who did not (mean difference = 1.5 [95% CI, 0.8–2.3]; p < 0.001).CONCLUSIONS: ARDS patients on venovenous ECMO with preserved kidney function experience an increase in bicarbonate concentration over time, compared to patients with AKI on KRT. Whether this increase in bicarbonate concentration increases pH, decreases sweep gas flow requirements, and facilitate weaning from venovenous ECMO requires examination in future research.
      PubDate: Tue, 13 Feb 2024 00:00:00 GMT-
       
  • Impact of Skin Pigmentation on Cerebral Regional Saturation of Oxygen
           Using Near-Infrared Spectroscopy: A Systematic Review

    • Authors: Patel; Nikunj A.; Bhattal, Harvir S.; Griesdale, Donald E.; Hoiland, Ryan L.; Sekhon, Mypinder S.
      Abstract: imageOBJECTIVES: Near-infrared spectroscopy (NIRS) is used in critical care settings to measure regional cerebral tissue oxygenation (rSo2). However, the accuracy of such measurements has been questioned in darker-skinned individuals due to the confounding effects of light absorption by melanin. In this systematic review, we aim to synthesize the available evidence on the effect of skin pigmentation on rSo2 readings.DATA SOURCES: We systematically searched MEDLINE, Cochrane Database of Systematic Reviews, Embase, and Google Scholar from inception to July 1, 2023.STUDY SELECTION: In compliance with our PROSPERO registration (CRD42022347548), we selected articles comparing rSo2 measurements in adults either between racial groups or at different levels of skin pigmentation. Two independent reviewers conducted full-text reviews of all potentially relevant articles.DATA EXTRACTION: We extracted data on self-reported race or level of skin pigmentation and mean rSo2 values.DATA SYNTHESIS: Of the 11,495 unique records screened, two studies (n = 7,549) met our inclusion criteria for systematic review. Sun et al (2015) yielded significantly lower rSo2 values for African Americans compared with Caucasians, whereas Stannard et al (2021) found little difference between self-reported racial groups. This discrepancy is likely because Stannard et al (2021) used a NIRS platform which specifically purports to control for the effects of melanin. Several other studies that did not meet our inclusion criteria corroborated the notion that skin pigmentation results in lower rSo2 readings.CONCLUSIONS: Skin pigmentation likely results in attenuated rSo2 readings. However, the magnitude of this effect may depend on the specific NIRS platform used.
      PubDate: Mon, 12 Feb 2024 00:00:00 GMT-
       
  • Temporal Relationship and Clinical Outcomes of Acute Kidney Injury
           Following Acute Respiratory Distress Syndrome: A Systematic Review and
           Meta-Analysis

    • Authors: Charkviani; Mariam; Truong, Hong Hieu; Nikravangolsefid, Nasrin; Ninan, Jacob; Prokop, Larry J.; Reddy, Swetha; Kashani, Kianoush B.; Domecq Garces, Juan Pablo
      Abstract: imageOBJECTIVES: Conduct a systematic review and meta-analysis to assess prevalence and timing of acute kidney injury (AKI) development after acute respiratory distress syndrome (ARDS) and its association with mortality.DATA SOURCES: Ovid MEDLINE(R), Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, Ovid PsycINFO database, Scopus, and Web of Science thought April 2023.STUDY SELECTION: Titles and abstracts were screened independently and in duplicate to identify eligible studies. Randomized controlled trials and prospective or retrospective cohort studies reporting the development of AKI following ARDS were included.DATA EXTRACTION: Two reviewers independently extracted data using a pre piloted abstraction form. We used Review Manager 5.4 software (Cochrane Library, Oxford, United Kingdom) and Open Meta software (Brown University, Providence, RI) for statistical analyses.DATA SYNTHESIS: Among the 3646 studies identified and screened, 17 studies comprising 9359 ARDS patients met the eligibility criteria and were included in the meta-analysis. AKI developed in 3287 patients (40%) after the diagnosis of ARDS. The incidence of AKI at least 48 hours after ARDS diagnosis was 20% (95% CI, 0.18–0.21%). The pooled risk ratio (RR) for the hospital (or 30-d) mortality among ARDS patients who developed AKI was 1.93 (95% CI, 1.71–2.18). AKI development after ARDS was identified as an independent risk factor for mortality in ARDS patients, with a pooled odds ratio from multivariable analysis of 3.69 (95% CI, 2.24–6.09). Furthermore, two studies comparing mortality between patients with late vs. early AKI initiation after ARDS revealed higher mortality in late AKI patients with RR of 1.46 (95% CI, 1.19–1.8). However, the certainty of evidence for most outcomes was low to very low.CONCLUSIONS: While our findings highlight a significant association between ARDS and subsequent development of AKI, the low to very low certainty of evidence underscores the need for cautious interpretation. This systematic review identified a significant knowledge gap, necessitating further research to establish a more definitive understanding of this relationship and its clinical implications.
      PubDate: Mon, 12 Feb 2024 00:00:00 GMT-
       
  • Cell-Free Hemoglobin in the Pathophysiology of Trauma: A Scoping Review

    • Authors: Ross; James T.; Robles, Anamaria J.; Mazer, Monty B.; Studer, Amy C.; Remy, Kenneth E.; Callcut, Rachael A.
      Abstract: imageOBJECTIVES: Cell-free hemoglobin (CFH) is a potent mediator of endothelial dysfunction, organ injury, coagulopathy, and immunomodulation in hemolysis. These mechanisms have been demonstrated in patients with sepsis, hemoglobinopathies, and those receiving transfusions. However, less is known about the role of CFH in the pathophysiology of trauma, despite the release of equivalent levels of free hemoglobin.DATA SOURCES: Ovid MEDLINE, Embase, Web of Science Core Collection, and BIOSIS Previews were searched up to January 21, 2023, using key terms related to free hemoglobin and trauma.DATA EXTRACTION: Two independent reviewers selected studies focused on hemolysis in trauma patients, hemoglobin breakdown products, hemoglobin-mediated injury in trauma, transfusion, sepsis, or therapeutics.DATA SYNTHESIS: Data from the selected studies and their references were synthesized into a narrative review.CONCLUSIONS: Free hemoglobin likely plays a role in endothelial dysfunction, organ injury, coagulopathy, and immune dysfunction in polytrauma. This is a compelling area of investigation as multiple existing therapeutics effectively block these pathways.
      PubDate: Mon, 12 Feb 2024 00:00:00 GMT-
       
  • Association of Epigenetic Age and Outcome in Critically Ill Patients

    • Authors: Sharma-Oates; Archana; Sullivan, Jack; Pestana, Daniel; dos Santos, Claudia C.; Binnie, Alexandra; Lord, Janet M.
      Abstract: imageOBJECTIVES: DNA methylation can be used to determine an individual’s biological age, as opposed to chronological age, an indicator of underlying health status. This study aimed to assess epigenetic age in critically ill patients with and without sepsis to determine if higher epigenetic age is associated with admission diagnosis or mortality.DESIGN: Secondary analysis of whole blood DNA methylation data generated from a nested case–control study of critically ill septic and nonseptic patients.SETTING: Four tertiary care hospitals in Canada.INTERVENTIONS: None.PATIENTS: Critically ill patients with and without sepsis.MEASUREMENTS AND MAIN RESULTS: Epigenetic age was derived from DNA methylation data using the Hannum and PhenoAge algorithms and deviation from the patient’s chronological age in years was determined. Of the 66 patients with sepsis, 34 were male (51.5%), the mean age was 65.03 years and 25 patients (37.8%) died before discharge. Of the 68 nonseptic patients, 47 were male (69.1%), the mean age was 64.92 years and 25 (36.7%) died before discharge. Epigenetic age calculated using the PhenoAge algorithm showed a significant age acceleration of 4.97 years in septic patients (p = 0.045), but no significant acceleration in nonseptic patients. Epigenetic age calculated using the Hannum algorithm showed no significant acceleration in the septic or nonseptic patients. Similarly, in the combined septic and nonseptic cohorts, nonsurvivors showed an epigenetic age acceleration of 7.62 years (p = 0.004) using the PhenoAge algorithm while survivors showed no significant age acceleration. Survivor status was not associated with age acceleration using the Hannum algorithm.CONCLUSIONS: In critically ill patients, epigenetic age acceleration, as calculated by the PhenoAge algorithm, was associated with sepsis diagnosis and mortality.
      PubDate: Thu, 08 Feb 2024 00:00:00 GMT-
       
  • A Case Series of Patients With Complex Airway Disease and Large Thyroid
           Tumors Anterior to the Trachea Precluding Tracheostomy

    • Authors: Imran; Saira; Chen, Leon L.; Rausen, Michelle; Morris, Luc G.T.; Patel, Snehal; Halpern, Neil A.
      Abstract: imageBACKGROUND: This case series explores the management of respiratory failure in patients with large anterior tracheal thyroid tumors where tracheostomy is not an option. To our knowledge, this study is the first to address the challenges associated with caring for such patients.CASE SUMMARY: We present the clinical courses of four intubated adults with advanced thyroid cancer and complex airway issues that preclude surgical tracheostomy. Interventions included custom airway stents, long-term intubation, and oncological therapies. Ethical quandaries around patient autonomy and capacity emerged, exacerbated by the absence of viable exit strategies for prolonged intubation, notably the performance of a tracheostomy, causing emotional distress in patients, families, and staff.CONCLUSIONS: This study showcases the multifaceted challenges in medical, ethical, and emotional domains associated with managing intubated patients with complex disease precluding tracheotomies. We advocate for a nuanced, multidisciplinary, and personalized approach to confront unique issues in airway management, ethical considerations, and disposition.
      PubDate: Thu, 08 Feb 2024 00:00:00 GMT-
       
  • Liver Elastography in Acute Liver Failure: A Pilot Study

    • Authors: Trovato; Francesca M.; Artru, Florent; Miquel, Rosa; Pirani, Tasneem; McPhail, Mark J.W.
      Abstract: imageOBJECTIVES: We aimed to assess the feasibility and reliability of sequential ultrasonographic and elastographic monitoring in acute liver failure (ALF).DESIGN: Observational study.SETTING: ALF is a rare, life-threatening disease that requires intensive care admission and often liver transplant, where the accurate selection of patients is crucial. Liver elastography is a noninvasive tool that can measure hepatic stiffness, but previous results have been inconclusive in ALF.PATIENTS: Patients admitted between October 2021 and March 2023 to the Liver Intensive Therapy Unit at King’s College Hospital with ALF were recruited, with healthy control (HC) individuals and acute-on-chronic liver failure (ACLF) used as controls.INTERVENTION: None.MEASUREMENTS: Average shear wave velocity was recorded with ElastPQ on the right and left liver lobes and the spleen. Portal vein flow, hepatic artery resistive index, and peak systolic velocity were also recorded. Physiologic and histologic data were used for comparison.MAIN RESULTS: Forty patients with ALF, 22 patients with ACLF, and 9 HC individuals were included in the study. At admission, liver stiffness measurement (LSM) of the right lobe was statistically different between HC individuals (5.6 ± 2 kPa), ALF (31.7 ± 17 kPa), and ACLF (76.3 ± 71 kPa) patients (ALF vs. ACLF, p = 0.0301). Spleen size and stiffness discriminated between ALF (10.4 ± 2 cm and 21.4 ± 16.6 kPa) and ACLF (14 ± 2.3 cm and 42.6 ± 26 kPa). At admission, LSM was not different between ALF patients who spontaneously survived versus patients who died or were transplanted in the following 90 days. However, the trend over the first 10 days of admission was different with a peak of LSM at day 5 in spontaneous survivors followed by reduction during the recovery phase. ALF patients with poor prognosis showed a persistently increased LSM.CONCLUSIONS: In ALF stiffness peaks at day 5 of admission with subsequent reduction in patients spontaneously surviving, showing significant difference according to the prognosis at day 7 of admission. LSM might be useful in distinguishing acute from acute-on-chronic liver failure together with spleen volume and stiffness.
      PubDate: Thu, 08 Feb 2024 00:00:00 GMT-
       
  • Successful Versus Failed Transition From Controlled Ventilation to
           Pressure Support Ventilation in COVID-19 Patients: A Retrospective Cohort
           Study

    • Authors: Polo Friz; Melisa; Rezoagli, Emanuele; Safaee Fakhr, Bijan; Florio, Gaetano; Carlesso, Eleonora; Giudici, Riccardo; Forlini, Clarissa; Tardini, Francesca; Langer, Thomas; Laratta, Matteo; Casella, Giampaolo; Forastieri Molinari, Andrea; Protti, Alessandro; Cecconi, Maurizio; Cabrini, Luca; Biagioni, Emanuela; Berselli, Angela; Mirabella, Lucia; Tonetti, Tommaso; De Robertis, Edoardo; Grieco, Domenico Luca; Antonelli, Massimo; Citerio, Giuseppe; Fumagalli, Roberto; Foti, Giuseppe; Zanella, Alberto; Grasselli, Giacomo; Bellani, Giacomo; for the COVID-19 Lombardy ICU Network
      Abstract: imageOBJECTIVES: In patients with COVID-19 respiratory failure, controlled mechanical ventilation (CMV) is often necessary during the acute phases of the disease. Weaning from CMV to pressure support ventilation (PSV) is a key objective when the patient’s respiratory functions improve. Limited evidence exists regarding the factors predicting a successful transition to PSV and its impact on patient outcomes.DESIGN: Retrospective observational cohort study.SETTING: Twenty-four Italian ICUs from February 2020 to May 2020.PATIENTS: Mechanically ventilated ICU patients with COVID-19-induced respiratory failure.INTERVENTION: The transition period from CMV to PSV was evaluated. We defined it as “failure of assisted breathing” if the patient returned to CMV within the first 72 hours.MEASUREMENTS AND MAIN RESULTS: Of 1260 ICU patients screened, 514 were included. Three hundred fifty-seven patients successfully made the transition to PSV, while 157 failed. Pao2/Fio2 ratio before the transition emerged as an independent predictor of a successful shift (odds ratio 1.00; 95% CI, 0.99–1.00; p = 0.003). Patients in the success group displayed a better trend in Pao2/Fio2, Paco2, plateau and peak pressure, and pH level. Subjects in the failure group exhibited higher ICU mortality (hazard ratio 2.08; 95% CI, 1.42–3.06; p < 0.001), an extended ICU length of stay (successful vs. failure 21 ± 14 vs. 27 ± 17 d; p < 0.001) and a longer duration of mechanical ventilation (19 ± 18 vs. 24 ± 17 d, p = 0.04).CONCLUSIONS: Our study emphasizes that the Pao2/Fio2 ratio was the sole independent factor associated with a failed transition from CMV to PSV. The unsuccessful transition was associated with worse outcomes.
      PubDate: Thu, 08 Feb 2024 00:00:00 GMT-
       
  • Association of Sepsis With Neurologic Outcomes of Adult Patients Treated
           With Venoarterial Extracorporeal Membrane Oxygnenation

    • Authors: Tridon; Chloé; Bachelet, Delphine; El Baied, Majda; Eloy, Philippine; Ortuno, Sofia; Para, Marylou; Wicky, Paul-Henri; Vellieux, Geoffroy; de Montmollin, Etienne; Bouadma, Lila; Manceau, Hana; Timsit, Jean-François; Peoc’h, Katell; Sonneville, Romain
      Abstract: imageOBJECTIVES: Neurologic outcomes of patients under venoarterial extracorporeal membrane oxygenation (VA-ECMO) may be worsened by secondary insults of systemic origin. We aimed to assess whether sepsis, commonly observed during ECMO support, is associated with brain injury and outcomes.DESIGN: Single-center cohort study of the “exposed-non-exposed” type on consecutive adult patients treated by VA-ECMO.SETTING: Medical ICU of a university hospital, France, 2013–2020.PATIENTS: Patients with sepsis at the time of VA-ECMO cannulation (“sepsis” group) were compared with patients without sepsis (“no sepsis” group). The primary outcome measure was poor functional outcome at 90 days, defined by a score greater than or equal to 4 on the modified Rankin scale (mRS), indicating severe disability or death.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: A total of 196 patients were included (“sepsis,” n = 128; “no sepsis,” n = 68), of whom 87 (44.4%) had presented cardiac arrest before VA-ECMO cannulation. A poor functional outcome (mRS ≥ 4) was observed in 99 of 128 patients (77.3%) of the “sepsis” group and 46 of 68 patients (67.6%) of the “no sepsis” group (adjusted logistic regression odds ratio (OR) 1.21, 95% CI, 0.58–2.47; inverse probability of treatment weighting (IPTW) OR 1.24; 95% CI, 0.79–1.95). Subsequent analyses performed according to pre-ECMO cardiac arrest status suggested that sepsis was independently associated with poorer functional outcomes in the subgroup of patients who had experienced pre-ECMO cardiac arrest (adjusted logistic regression OR 3.44; 95% CI, 1.06–11.40; IPTW OR 3.52; 95% CI, 1.68–7.73), whereas no such association was observed in patients without pre-ECMO cardiac arrest (adjusted logistic regression OR 0.69; 95% CI, 0.27–1.69; IPTW OR 0.76; 95% CI, 0.42–1.35). Compared with the “no sepsis” group, “sepsis” patients presented a significant increase in S100 calcium-binding protein beta concentrations at day 1 (0.94 μg/L vs. 0.52 μg/L, p = 0.03), and more frequent EEG alterations (i.e., severe slowing, discontinuous background, and a lower prevalence of sleep patterns), suggesting brain injury.CONCLUSION: We observed a detrimental role of sepsis on neurologic outcomes in the subgroup of patients who had experienced pre-ECMO cardiac arrest, but not in other patients.
      PubDate: Wed, 07 Feb 2024 00:00:00 GMT-
       
  • Validation of a Novel, Rapid Sepsis Diagnostic for Emergency Department
           Use

    • Authors: O’Neal; Hollis R. Jr; Sheybani, Roya; Janz, David R.; Scoggins, Robert; Jagneaux, Tonya; Walker, James E.; Henning, Daniel J.; Rosenman, Elizabeth; Mahler, Simon A.; Regunath, Hariharan; Sampson, Christopher S.; Files, D. Clark; Fremont, Richard D.; Noto, Michael J.; Schneider, Erica E.; Shealey, Wesley R.; Berlinger, Matthew S.; Carver, Thomas C.; Walker, Morgan K.; Ledeboer, Nathan A.; Shah, Ajay M.; Tse, Henry T.K.; DiCarlo, Dino; Rice, Todd W.; Thomas, Christopher B.
      Abstract: imageOBJECTIVES: To assess the in vitro IntelliSep test, a microfluidic assay that quantifies the state of immune activation by evaluating the biophysical properties of leukocytes, as a rapid diagnostic for sepsis.DESIGN: Prospective cohort study.SETTING: Five emergency departments (EDs) in Louisiana, Missouri, North Carolina, and Washington.PATIENTS: Adult patients presenting to the ED with signs (two of four Systemic Inflammatory Response Syndrome criteria, where one must be temperature or WBC count) or suspicion (provider-ordered culture) of infection.INTERVENTIONS: All patients underwent testing with the IntelliSep using ethylene diamine tetraacetic acid-anticoagulated whole blood followed by retrospective adjudication for sepsis by sepsis-3 criteria by a blinded panel of physicians.MEASUREMENTS AND MAIN RESULTS: Of 599 patients enrolled, 572 patients were included in the final analysis. The result of the IntelliSep test is reported as the IntelliSep Index (ISI), ranging from 0.1 to 10.0, divided into three interpretation bands for the risk of sepsis: band 1 (low) to band 3 (high). The median turnaround time for ISI results was 7.2 minutes. The ISI resulted band 1 in 252 (44.1%), band 2 in 160 (28.0%), and band 3 in 160 (28.0%). Sepsis occurred in 26.6% (152 of 572 patients). Sepsis prevalence was 11.1% (95% CI, 7.5–15.7%) in band 1, 28.1% (95% CI, 21.3–35.8%) in band 2, and 49.4% (95% CI, 41.4–57.4%) in band 3. The Positive Percent Agreement of band 1 was 81.6% and the Negative Percent Agreement of band 3 was 80.7%, with an area under the receiver operating characteristic curve of 0.74. Compared with band 1, band 3 correlated with adverse clinical outcomes, including mortality, and resource utilization.CONCLUSIONS: Increasing ISI interpretation band is associated with increasing probability of sepsis in patients presenting to the ED with suspected infection.
      PubDate: Wed, 07 Feb 2024 00:00:00 GMT-
       
  • Ruxolitinib, IV Immunoglobulin, and High-Dose Glucocorticoids for
           Critically Ill Adults With Secondary Hemophagocytic Lymphohistiocytosis: A
           Single-Center Observational Pilot Study

    • Authors: Scholz; Laura; Posch, Florian; Schulz, Eduard; Gornicec, Max; Wölfler, Albert; Reisinger, Alexander C.; Reinisch, Andreas; Eller, Philipp; Eisner, Florian; Kreuzer, Philipp; Stradner, Martin; Rosenkranz, Alexander R.; Krammer, Florian; Schilcher, Gernot; Krause, Robert; Hatzl, Stefan
      Abstract: imageOBJECTIVES: Secondary hemophagocytic lymphohistiocytosis (sHLH) is a cytokine-driven inflammatory syndrome that is associated with substantial morbidity and mortality and frequently leads to ICU admission. Overall survival in adults with sHLH remains poor, especially in those requiring intensive care. Classical chemotherapeutic treatment exhibits myelosuppression and toxicity. Recently, inhibition of Janus kinase signaling by ruxolitinib has shown efficacy in pediatric HLH. We therefore aimed to determine the activity and safety of a ruxolitinib-based regimen, in critically ill adults with sHLH.DESIGN: Observational pilot study.SETTING: Single-center tertiary academic ICU.PATIENTS: Nine adults (≥ 18 yr) who fulfilled at least five of the eight HLH-2004 criteria.INTERVENTION: Triplet regimen combining: 1) ruxolitinib, 2) polyvalent human IV immunoglobulins (IVIG) at a dose of 1 g/kg bodyweight for 5 days, and 3) high-dose corticosteroids (CSs, dexamethasone 10 mg/m² body surface area, or methylprednisolone equivalent) with subsequent tapering according to the HLH-2004 protocol.MEASUREMENT AND MAIN RESULTS: Nine patients (median age: 42 yr [25th-75th percentile: 32–54]; male: n = 6 males, median H-score: 299 [255–304]) were treated with the triplet regimen. The median Sequential Organ Failure Assessment score at HLH diagnosis was 9 (median; 25th–75th percentile: 7–12), indicating multiple-organ dysfunction in all patients. Within 10 days a significant decrease of the inflammatory parameters soluble interleukin-2 receptor and ferritin as well as a stabilization of the blood count could be shown. All patients were alive at ICU discharge (100% ICU survival), 1 patient died after ICU discharge because of traumatic intracerebral hemorrhage that might be related to HLH or treatment, corresponding to an overall survival of 86% in a 6 months follow-up period.CONCLUSION: In this small case series, a triplet regimen of ruxolitinib in combination with IVIG and CS was highly effective and save for treating critically ill adults with sHLH.
      PubDate: Fri, 02 Feb 2024 00:00:00 GMT-
       
  • Nebulized Furosemide for Pulmonary Inflammation in Intubated Patients With
           COVID-19: A Phase 2 Randomized Controlled Double-Blind Study

    • Authors: Muscedere; John; Maslove, David M.; Barden, Christopher J.; Weaver, Donald F.; Boyd, J. Gordon; Sibley, Stephanie; Boyd, Tracy; Rewa, Oleksa; Albert, Martin; Roussos, Marios; Norman, Patrick A.; Day, Andrew G.; for the Canadian Critical Care Trials Group
      Abstract: imageOBJECTIVES: Respiratory failure secondary to COVID-19 is associated with morbidity and mortality. Current anti-inflammatory therapies are effective but are given systemically and have significant side effects. Furosemide has anti-inflammatory properties, can be administered by inhalation, and is inexpensive. We investigated the efficacy of nebulized furosemide as an adjunctive therapy for COVID-19 respiratory failure.DESIGN: A double-blind, randomized, placebo-controlled trial.SETTING: Multicenter ICU study.PATIENTS: Adults requiring invasive mechanical ventilation secondary to COVID-19.INTERVENTION: Patients were randomized within 48 hours of intubation to receive inhaled furosemide or placebo until day 28, death, or liberation from mechanical ventilation.MEASUREMENTS AND MAIN RESULTS: The study was stopped early due to waning incidence of COVID-19; 39 patients were available for analysis with mean ± sd age of 70.5 (10.8) years, Acute Physiology and Chronic Health Evaluation II 26.1 (7.8) and Fio2 60.0% (21.9). Baseline characteristics were similar between the groups. For the primary outcome of change in Pao2/Fio2 ratio between day 1 and day 6, it was +31.4 (83.5) in the furosemide arm versus +20.1 (92.8) in the control (p = 0.58). For secondary outcomes, furosemide versus control: 60-day mortality was 48% versus 71% (p = 0.20), hospital stay was 25.6 (21.9) versus 27.4 (25.0) days, p = 0.94 and VFD was 6.0 (9.1) versus 3.1 (7.1), p value of equals to 0.28. A post hoc analysis of the hierarchical composite outcome, alive and ventilator-free favored furosemide. There were no adverse events.CONCLUSIONS: In this trial of inhaled furosemide for COVID-19 respiratory failure, differences in Pao2/Fio2 ratio to day 6 and other clinical outcomes were not significantly different, although the trial was underpowered due to early termination. Given the favorable profile of inhaled furosemide, further study is warranted in disease states where acute pulmonary inflammation contributes to the underlying pathophysiology.
      PubDate: Fri, 02 Feb 2024 00:00:00 GMT-
       
  • Epidemiology, Clinical Characteristics, and Outcomes of 4546 Adult
           Admissions to High-Dependency and ICUs in Kenya: A Multicenter
           Registry-Based Observational Study

    • Authors: Njoki; Carolyne; Simiyu, Nabukwangwa; Kaddu, Ronnie; Mwangi, Wambui; Sulemanji, Demet; Oduor, Peter; Dona, Dilanthi Gamage; Otieno, Dorothy; Abonyo, Teddy Thaddeus; Wangeci, Patricia; Kabanya, Thomas; Mutuku, Selina; Kioko, Annastacia; Muthoni, Joy; Kamau, Peter Mburu; Beane, Abigail; Haniffa, Rashan; Dondorp, Arjen; Misango, David; Pisani, Luigi; Waweru-Siika, Wangari
      Abstract: imageOBJECTIVES: To describe clinical, management, and outcome features of critically ill patients admitted to ICUs and high-dependency units (HDUs) in Kenya.DESIGN: Prospective registry-based observational study.SETTING: Three HDUs and eight ICUs in Kenya.PATIENTS: Consecutive adult patients admitted between January 2021 and June 2022.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: Data were entered in a cloud-based platform using a common data model. Study endpoints included case-mix variables, management features, and patient-centered outcomes. Patients with COVID-19 were reported separately. Of the 3892 of 4546 patients without COVID-19, 2445 patients (62.8%) were from HDUs, and 1447 patients (37.2%) were from ICUs. Patients had a median age of 53 years (interquartile range [IQR] 38–68), with HDU patients being older but with a lower severity (Acute Physiology and Chronic Health Evaluation II 6 [3–9] in HDUs vs. 12 [7–17] in ICUs; p < 0.001). One in four patients was postoperative with 604 (63.4%) receiving emergency surgery. Readmission rate was 4.8%. Hypertension and diabetes were prevalent comorbidities, with a 4.0% HIV/AIDS rate. Invasive mechanical ventilation was applied in 3.4% in HDUs versus 47.6% in ICUs (p < 0.001), with a duration of 7 days (IQR 3–21). There was a similar use of renal replacement therapy (4.0% vs. 4.7%; p < 0.001). Vasopressor use was infrequent while half of patients received antibiotics. Average length of stay was 2 days (IQR 1–5). Crude HDU mortality rate was 6.5% in HDUs versus 30.5% in the ICUs (p < 0.001). Of the 654 COVID-19 admissions, most were admitted in ICUs (72.3%) with a 33.2% mortality.CONCLUSIONS: We provide the first multicenter observational cohort study from an African ICU National Registry. Distinct management features and outcomes characterize HDU from ICU patients.
      PubDate: Fri, 02 Feb 2024 00:00:00 GMT-
       
  • Changes in Pulmonary Vascular Resistance and Obstruction Score Following
           Acute Pulmonary Embolism in Pigs

    • Authors: Merit; Victor T.; Kirk, Mathilde E.; Schultz, Jacob G.; Hansen, Jacob V.; Lyhne, Mads D.; Kramer, Anders D.; Pedersen, Christina C. E.; Karout, Lina; Kalra, Mannudeep K.; Andersen, Asger; Nielsen-Kudsk, Jens Erik
      Abstract: imageOBJECTIVES: To investigate the contribution of mechanical obstruction and pulmonary vasoconstriction to pulmonary vascular resistance (PVR) in acute pulmonary embolism (PE) in pigs.DESIGN: Controlled, animal study.SETTING: Tertiary university hospital, animal research laboratory.SUBJECTS: Female Danish slaughter pigs (n = 12, ~60 kg).INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: PE was induced by infusion of autologous blood clots in pigs. CT pulmonary angiograms were performed at baseline, after PE (first experimental day [PEd0]) and the following 2 days (second experimental day [PEd1] and third experimental day [PEd2]), and clot burden quantified by a modified Qanadli Obstruction Score. Hemodynamics were evaluated with left and right heart catheterization and systemic invasive pressures each day before, under, and after treatment with the pulmonary vasodilators sildenafil (0.1 mg/kg) and oxygen (Fio2 40%). PE increased PVR (baseline vs. PEd0: 178 ± 54 vs. 526 ± 160 dynes; p < 0.0001) and obstruction score (baseline vs. PEd0: 0% vs. 45% ± 13%; p < 0.0001). PVR decreased toward baseline at day 1 (baseline vs. PEd1: 178 ± 54 vs. 219 ± 48; p = 0.16) and day 2 (baseline vs. PEd2: 178 ± 54 vs. 201 ± 50; p = 0.51). Obstruction score decreased only slightly at day 1 (PEd0 vs. PEd1: 45% ± 12% vs. 43% ± 14%; p = 0.04) and remained elevated throughout the study (PEd1 vs. PEd2: 43% ± 14% vs. 42% ± 17%; p = 0.74). Sildenafil and oxygen in combination decreased PVR at day 0 (–284 ± 154 dynes; p = 0.0064) but had no effects at day 1 (–8 ± 27 dynes; p = 0.4827) or day 2 (–18 ± 32 dynes; p = 0.0923).CONCLUSIONS: Pulmonary vasoconstriction, and not mechanical obstruction, was the predominant cause of increased PVR in acute PE in pigs. PVR rapidly declined over the first 2 days after onset despite a persistent mechanical obstruction of the pulmonary circulation from emboli. The findings suggest that treatment with pulmonary vasodilators might only be effective in the acute phase of PE thereby limiting the window for such therapy.
      PubDate: Fri, 02 Feb 2024 00:00:00 GMT-
       
  • Ketamine for Primary Analgosedation in Critically Ill Surgery and Trauma
           Patients Requiring Mechanical Ventilation

    • Authors: Peters; Bradley J.; Kooda, Kirstin J.; Brown, Caitlin S.; Miles, Todd M.; Kangas, Corrie A.; Mara, Kristin C.; Rivera, Mariela; Skrupky, Lee P.
      Abstract: imageOBJECTIVES: Evaluate effectiveness and safety outcomes associated with the use of ketamine for primary analgosedation in the surgical/trauma ICU setting.DESIGN: Retrospective cohort study.SETTING: Academic medical center in Minnesota.PATIENTS: Patients admitted to the surgical ICU between 2015 and 2019 requiring mechanical ventilation and meeting one of three definitions for ketamine primary analgosedation were included: 1) no concomitant opioid infusion, 2) ketamine monotherapy for greater than or equal to 6 hours with subsequent opioid infusion, or 3) ketamine initiated concomitantly or within 4 hours of opioid and total opioid duration less than 4 hours.INTERVENTIONS: None.MEASUREMENTS: Use of ketamine, analgesics, and sedatives were evaluated. Pain, sedation, and delirium assessments immediately before and during ketamine infusion were collected and compared with reported goals. Concomitant analgesics, sedatives, and psychotropics were recorded. Reported failures due to ineffectiveness and toxicity were collected.MAIN RESULTS: Of 164 included patients, 88% never received a concomitant opioid infusion (primary analgosedation definition 1), 12% met alternative criteria for primary analgosedation (definitions 2 and 3). A majority, 68%, were surgical admissions and mean Acute Physiology and Chronic Health Evaluation III score was 90 (± 30). Median mechanical ventilation duration was 2.5 days (1.1–4.5) and ICU length of stay of 4.9 days (3–8). The median ketamine infusion dose and duration were 0.18 mg/kg/hr (0.1–0.3) and 30 hours (15.1–51.8). Concomitant infusions of propofol and dexmedetomidine were administered in 49% and 29% of patients, respectively. During ketamine infusion, the median percent of total pain scores at goal was 62% (33–96%), while 64% (37–91%) of Richmond Agitation Sedation Scale scores were at goal, and 47% of patients were Confusion Assessment Method-ICU positive during the ketamine infusion. Hallucinations were documented in 14% of patients and ketamine failure occurred in 11% of patients.CONCLUSIONS: Ketamine may be an effective primary analgosedation option in intubated surgical ICU patients, but prospective randomized studies are needed to evaluate this strategy.
      PubDate: Thu, 25 Jan 2024 00:00:00 GMT-
       
 
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Showing 1 - 123 of 123 Journals sorted alphabetically
AACN Advanced Critical Care     Full-text available via subscription   (Followers: 36)
Academic Emergency Medicine     Hybrid Journal   (Followers: 100)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 2)
Acute and Critical Care     Open Access   (Followers: 10)
Acute Cardiac Care     Hybrid Journal   (Followers: 12)
Acute Medicine     Full-text available via subscription   (Followers: 7)
Advances in Emergency Medicine     Open Access   (Followers: 21)
Advances in Neonatal Care     Hybrid Journal   (Followers: 45)
African Journal of Anaesthesia and Intensive Care     Full-text available via subscription   (Followers: 8)
African Journal of Emergency Medicine     Open Access   (Followers: 6)
AINS - Anasthesiologie - Intensivmedizin - Notfallmedizin - Schmerztherapie     Hybrid Journal   (Followers: 5)
American Journal of Emergency Medicine     Hybrid Journal   (Followers: 57)
Annals of Emergency Medicine     Hybrid Journal   (Followers: 150)
Annals of Intensive Care     Open Access   (Followers: 39)
Annals of the American Thoracic Society     Full-text available via subscription   (Followers: 15)
Archives of Academic Emergency Medicine     Open Access   (Followers: 6)
Archives of Trauma Research     Open Access   (Followers: 5)
ASAIO Journal     Hybrid Journal   (Followers: 2)
Australasian Journal of Paramedicine     Open Access   (Followers: 9)
Australian Critical Care     Full-text available via subscription   (Followers: 21)
Bangladesh Critical Care Journal     Open Access   (Followers: 1)
BMC Emergency Medicine     Open Access   (Followers: 29)
BMJ Quality & Safety     Hybrid Journal   (Followers: 66)
Burns Open     Open Access   (Followers: 1)
Canadian Journal of Respiratory, Critical Care, and Sleep Medicine     Hybrid Journal   (Followers: 2)
Case Reports in Acute Medicine     Open Access   (Followers: 4)
Case Reports in Critical Care     Open Access   (Followers: 14)
Case Reports in Emergency Medicine     Open Access   (Followers: 23)
Chronic Wound Care Management and Research     Open Access   (Followers: 9)
Clinical and Applied Thrombosis/Hemostasis     Open Access   (Followers: 28)
Clinical Medicine Insights : Trauma and Intensive Medicine     Open Access   (Followers: 3)
Clinical Risk     Hybrid Journal   (Followers: 5)
Crisis: The Journal of Crisis Intervention and Suicide Prevention     Hybrid Journal   (Followers: 17)
Critical Care     Open Access   (Followers: 78)
Critical Care and Resuscitation     Full-text available via subscription   (Followers: 29)
Critical Care Clinics     Full-text available via subscription   (Followers: 35)
Critical Care Explorations     Open Access   (Followers: 3)
Critical Care Medicine     Hybrid Journal   (Followers: 325)
Critical Care Research and Practice     Open Access   (Followers: 13)
Current Emergency and Hospital Medicine Reports     Hybrid Journal   (Followers: 6)
Current Opinion in Critical Care     Hybrid Journal   (Followers: 74)
Disaster and Emergency Medicine Journal     Open Access   (Followers: 12)
Egyptian Journal of Critical Care Medicine     Open Access   (Followers: 2)
EMC - Urgenze     Full-text available via subscription  
Emergency Care Journal     Open Access   (Followers: 8)
Emergency Medicine (Medicina neotložnyh sostoânij)     Open Access  
Emergency Medicine Australasia     Hybrid Journal   (Followers: 18)
Emergency Medicine Clinics of North America     Full-text available via subscription   (Followers: 19)
Emergency Medicine International     Open Access   (Followers: 8)
Emergency Medicine Journal     Hybrid Journal   (Followers: 56)
Emergency Medicine News     Full-text available via subscription   (Followers: 7)
Emergency Nurse     Full-text available via subscription   (Followers: 16)
Enfermería Intensiva (English ed.)     Full-text available via subscription   (Followers: 2)
European Burn Journal     Open Access   (Followers: 9)
European Journal of Emergency Medicine     Hybrid Journal   (Followers: 25)
Frontiers in Emergency Medicine     Open Access   (Followers: 8)
Global Journal of Transfusion Medicine     Open Access   (Followers: 1)
Hong Kong Journal of Emergency Medicine     Full-text available via subscription   (Followers: 5)
Indian Journal of Burns     Open Access   (Followers: 3)
Injury     Hybrid Journal   (Followers: 21)
Intensive Care Medicine     Hybrid Journal   (Followers: 87)
Intensive Care Medicine Experimental     Open Access   (Followers: 2)
Intensivmedizin up2date     Hybrid Journal   (Followers: 4)
International Journal of Critical Illness and Injury Science     Open Access   (Followers: 1)
International Journal of Emergency Medicine     Open Access   (Followers: 9)
International Journal of Emergency Mental Health and Human Resilience     Open Access   (Followers: 2)
International Paramedic Practice     Full-text available via subscription   (Followers: 17)
Iranian Journal of Emergency Medicine     Open Access  
Irish Journal of Paramedicine     Open Access   (Followers: 3)
Journal Européen des Urgences et de Réanimation     Hybrid Journal   (Followers: 1)
Journal of Acute Care Physical Therapy     Hybrid Journal   (Followers: 4)
Journal of Cardiac Critical Care TSS     Open Access   (Followers: 1)
Journal Of Cardiovascular Emergencies     Open Access  
Journal of Concussion     Open Access  
Journal of Critical Care     Hybrid Journal   (Followers: 51)
Journal of Critical Care Medicine     Open Access   (Followers: 18)
Journal of Education and Teaching in Emergency Medicine     Open Access   (Followers: 1)
Journal of Emergencies, Trauma and Shock     Open Access   (Followers: 13)
Journal of Emergency Medical Services     Full-text available via subscription   (Followers: 12)
Journal of Emergency Medicine     Hybrid Journal   (Followers: 53)
Journal of Emergency Medicine, Trauma and Acute Care     Open Access   (Followers: 26)
Journal of Emergency Practice and Trauma     Open Access   (Followers: 6)
Journal of Intensive Care     Open Access   (Followers: 9)
Journal of Intensive Care Medicine     Hybrid Journal   (Followers: 23)
Journal of Intensive Medicine     Open Access   (Followers: 1)
Journal of Neuroanaesthesiology and Critical Care     Open Access   (Followers: 4)
Journal of Stroke Medicine     Hybrid Journal   (Followers: 3)
Journal of the American College of Emergency Physicians Open     Open Access   (Followers: 2)
Journal of the Intensive Care Society     Hybrid Journal   (Followers: 5)
Journal of the Royal Army Medical Corps     Hybrid Journal   (Followers: 7)
Journal of Thrombosis and Haemostasis     Hybrid Journal   (Followers: 52)
Journal of Translational Critical Care Medicine     Open Access   (Followers: 3)
Journal of Trauma and Acute Care Surgery, The     Hybrid Journal   (Followers: 36)
La Presse Médicale Open     Open Access  
Médecine de Catastrophe - Urgences Collectives     Hybrid Journal  
Medicina Intensiva     Open Access   (Followers: 3)
Medicina Intensiva (English Edition)     Hybrid Journal   (Followers: 1)
Mediterranean Journal of Emergency Medicine & Acute Care : MedJEM     Open Access  
Notfall + Rettungsmedizin     Hybrid Journal   (Followers: 4)
OA Critical Care     Open Access   (Followers: 3)
OA Emergency Medicine     Open Access   (Followers: 2)
Open Access Emergency Medicine     Open Access   (Followers: 6)
Open Journal of Emergency Medicine     Open Access   (Followers: 2)
Palliative Care : Research and Treatment     Open Access   (Followers: 22)
Palliative Medicine     Hybrid Journal   (Followers: 56)
Prehospital Emergency Care     Hybrid Journal   (Followers: 20)
Regulatory Toxicology and Pharmacology     Hybrid Journal   (Followers: 25)
Research and Opinion in Anesthesia and Intensive Care     Open Access   (Followers: 3)
Resuscitation     Hybrid Journal   (Followers: 59)
Resuscitation Plus     Open Access   (Followers: 2)
Saudi Critical Care Journal     Open Access   (Followers: 2)
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine     Open Access   (Followers: 12)
Seminars in Thrombosis and Hemostasis     Hybrid Journal   (Followers: 28)
Shock : Injury, Inflammation, and Sepsis : Laboratory and Clinical Approaches     Hybrid Journal   (Followers: 12)
Sklifosovsky Journal Emergency Medical Care     Open Access  
The Journal of Trauma Injury Infection and Critical Care     Full-text available via subscription   (Followers: 23)
Therapeutics and Clinical Risk Management     Open Access   (Followers: 1)
Transplant Research and Risk Management     Open Access   (Followers: 1)
Trauma Case Reports     Open Access   (Followers: 1)
Trauma Monthly     Open Access   (Followers: 4)
Visual Journal of Emergency Medicine     Full-text available via subscription   (Followers: 1)
Western Journal of Emergency Medicine     Open Access   (Followers: 11)
 AEM Education and Training : A Global Journal of Emergency Care     Open Access   (Followers: 1)

           

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