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Journal of Intensive Care Medicine
Journal Prestige (SJR): 0.82  Citation Impact (citeScore): 2 Number of Followers: 24  Hybrid journal (It can contain Open Access articles)ISSN (Print) 0885-0666 - ISSN (Online) 1525-1489 Published by Sage Publications  [1176 journals]
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- Association of 91 Inflammatory Factors and 1400 Metabolites with Sepsis: A
Mendelian Randomization Analysis-
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Authors: Naiqiang Hu; Junhong Gan, Huanchu Zhang, Tongxing Lu, Qiulian Tang, Yufang Chen, Meiping Yu, Riying Ou, Shenghai Huang, Haiyan Zhao, Xueming He
Pages: 270 - 283
Abstract: Journal of Intensive Care Medicine, Volume 40, Issue 3, Page 270-283, March 2025.
ObjectiveObservational studies suggest links between inflammatory factors, metabolites, and sepsis, yet their causality is uncertain. This study employs Mendelian Randomization (MR) to investigate the causality between these factors and sepsis, aiming to ...
Citation: Journal of Intensive Care Medicine
PubDate: 2025-03-19T06:14:00Z
DOI: 10.1177/08850666241280385
Issue No: Vol. 40, No. 3 (2025)
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- Exploring the Potential Role of the Cholinergic Anti-Inflammatory Pathway
from the Perspective of Sepsis Pathophysiology-
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Authors: Ziyi Zhu; Lixia Liu1Department of Critical Care Medicine, 117878the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Sepsis is one of the most prevalent conditions in critical care medicine and is characterized by a high incidence, mortality, and poor prognosis, with no specific treatment currently available. The pathogenesis of sepsis is complex with a dysregulated ...
Citation: Journal of Intensive Care Medicine
PubDate: 2025-04-14T06:11:57Z
DOI: 10.1177/08850666251334342
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- In-hospital Mortality is Lower in Brain-Injured Patients After Admission
to a Neuroscience Intensive Care Unit: A Multi-Center Cohort Study-
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Authors: Angel J. Cadena-Tejada; Shaista Alam, Varoon Thavapalan, Sara Habib, Fred Rincon
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
ObjectiveTo study the impact of dedicated Neuroscience Intensive Care Units (NSU) on clinical outcomes in patients with acute brain injury.DesignRetrospective, multicenter cohort study.Setting172 intensive care units within the United States.Patients...
Citation: Journal of Intensive Care Medicine
PubDate: 2025-04-13T03:43:34Z
DOI: 10.1177/08850666251325778
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- Association of Admission Times on Mortality in Adult Patients with Severe
Community-Acquired Pneumonia-
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Authors: You-Lian Zhou; Shijie Duan, Xingmei Zhong, Liang Yang, Jun Qiu
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
ObjectivesThe objective of this study was to examine the association between admission time and in-hospital mortality in patients with severe community-acquired pneumonia.Research DesignThe study population consisted of individuals who were enrolled ...
Citation: Journal of Intensive Care Medicine
PubDate: 2025-04-10T02:00:29Z
DOI: 10.1177/08850666251332116
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- Cerebral Venous Thrombosis in Traumatic Brain Injury: A Population-Based
Cross-Sectional Study of 640 Patients-
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Authors: Ankita Jain; Michael Fortunato, Bridget Nolan, Sahdev S. Baweja, Galadu Subah, Sima Vazquez, Candice Dyce, Andy Jiang, Eris Spirollari, Ariel Sacknovitz, Chirag D. Gandhi, Fawaz Al-Mufti
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
BackgroundCerebral venous thrombosis (CVT) is a rare but serious complication of traumatic brain injury (TBI), yet the implications of this association remain poorly understood. This study explores the demographics, risk factors, and clinical outcomes of ...
Citation: Journal of Intensive Care Medicine
PubDate: 2025-04-10T02:00:16Z
DOI: 10.1177/08850666251331522
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- Prediction of Mortality After Convulsive Status Epilepticus: The Status
Epilepticus M3A2S2H Score-
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Authors: Fawaz Al-Mufti; Smit D. Patel, Jonathan Ogulnick, Ariel Sacknovitz, Ankita Jain, Eris Spirollari, Keshav Raghavendran, Leah Blowes, Bridget Nolan, Jessica Bloomfield, Sanjana Marikunte, Galadu Subah, Eric Feldstein, Anaz Uddin, Rolla Nuoman, Jon Rosenberg, Andrew Bauerschmidt, Philip Overby, Venkat Ramani, Steven M. Wolf, Tracey Milligan, Manisha Holmes, Chirag D. Gandhi, Mill Etienne, Stephan A. Mayer
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
PurposeThis study aimed to investigate in-patient mortality and predictors of death associated with convulsive status epilepticus (CSE) in a large nationwide cohort and create a simplified predictive score for in-hospital mortality.MethodsRetrospective ...
Citation: Journal of Intensive Care Medicine
PubDate: 2025-04-02T06:21:55Z
DOI: 10.1177/08850666251331925
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- Real-World Outcomes of Hemoadsorption with CytoSorb® in Patients with
Septic Shock: Insights from a Single-Center Study-
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Authors: Giorgio Berlot; Paolo Carocci, Valentina Votrico, Barbara Iacoviello, Nicolò Taverna, Ugo Gerini, Vittorio di Maso, Ariella Tomasini
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
BackgroundHemoadsorption is currently employed to treat septic shock and other clinical conditions involving massive inflammatory mediator release. CytoSorb®, a device utilizing synthetic resin microbeads, provides a large adsorption surface for blood ...
Citation: Journal of Intensive Care Medicine
PubDate: 2025-04-02T06:17:38Z
DOI: 10.1177/08850666251331905
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- Phenobarbital Addition to Alcohol Withdrawal Treatment Offers Better
Outcomes than Dexmedetomidine in Hospitalized Patients-
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Authors: Mary Matecki; Ahmed Noureldin, Riad Akkari, Zachary Cohen, Matthew McMullan, Katrina Hawkins, Jeffrey Williams, Azuka Nwude, David Yamane, Babak Sarani, Sean M. Lee, Susan Kartiko
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
BackgroundThis study directly compares outcomes of phenobarbital and dexmedetomidine as adjuncts to symptom-triggered benzodiazepine treatment for alcohol withdrawal syndrome (AWS).MethodsThis is a retrospective cohort analysis at a single tertiary ...
Citation: Journal of Intensive Care Medicine
PubDate: 2025-03-28T10:59:41Z
DOI: 10.1177/08850666251328881
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- “Unlocking Airway Predictability: The Role of Ultrasound in Assessing
Cormack-Lehane Grade Through Anterior Neck Soft Tissue Thickness at the
Level of Vocal Cards and Hyoid Bone”-
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Authors: D. G. S. R. Krishnamoorthy; K. J. Devendra Prasad, K. Rajesh, Y. Nikhil Reddy, S. R. Aravind1Department of Emergency Medicine, 29256Sri Devaraj Urs Academy of Higher Education Research Medical College, Kolar, Karnataka, India
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Introduction:Endotracheal intubation in the emergency department can be challenging due to difficult airways. The Cormack-Lehane score helps assess intubation difficulty based on laryngoscopic views, with higher scores indicating poorer visibility. This ...
Citation: Journal of Intensive Care Medicine
PubDate: 2025-03-25T06:16:57Z
DOI: 10.1177/08850666251323257
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- The Relationship Between the Type of Microorganisms Isolated in Cultures
and Outcomes in Children on Extracorporeal Membrane Oxygenation Support
Following Corrective Surgery for Congenital Heart Disease-
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Authors: Mónica Arias-Andrade; Carlos Miguel Santacruz, Martha Cecilia Reyes Casas, Juan Sebastián Barajas, Marco Fidel Sierra-Zuñiga, Catalina Duque, Martha I Àlvarez-Olmos, Nestor Sandoval, Jaime Fernández-Sarmiento
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
ObjetivesExtracorporeal membrane oxygenation (ECMO) after surgery for congenital heart disease (CHD) provides hemodynamic support to patients when their myocardial function is temporarily affected. Postoperative infections in children with CHD on ECMO are ...
Citation: Journal of Intensive Care Medicine
PubDate: 2025-03-24T06:36:49Z
DOI: 10.1177/08850666251327995
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- A Retrospective Cohort Study of the Role of Palliative Care Consultation
for Patients on Extracorporeal Membrane Oxygenation-
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Authors: Samira Teeri; Pooja Singh, Ritika Gadodia, Shikha Kapil, Maxwell Hockstein, Keki Balsara, Akram M Zaaqoq, Anirudh Rao
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
BackgroundExtracorporeal membrane oxygenation (ECMO) serves as a critical intervention for patients with severe cardiac and pulmonary dysfunction. Given the high rates of mortality and morbidity, as well as the impact on families, palliative care (PC) ...
Citation: Journal of Intensive Care Medicine
PubDate: 2025-03-24T06:36:03Z
DOI: 10.1177/08850666251327105
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- The Cleveland Clinic Post-ICU Recovery Clinic: Early Experience During the
COVID-19 Pandemic-
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Authors: Kavya Kommaraju; Heather Torbic, Joshua Veith, Xiaofeng Wang, Michelle Biehl
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
BackgroundOver half of ICU survivors experience post intensive care syndrome (PICS). Few PICS clinics were operational in the United States at the onset of the COVID-19 pandemic. Here we describe early experience of such a clinic at a large academic ...
Citation: Journal of Intensive Care Medicine
PubDate: 2025-03-24T06:34:57Z
DOI: 10.1177/08850666251326551
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- Telemedicine in Intensive Care Unit: Current Practice and Future Prospect
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Authors: Raffaele Merola; Annachiara Marra, Stefania De Simone, Maria Vargas
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Telemedicine in the intensive care unit (tele-ICU) is an increasingly significant field that leverages advanced technology to provide remote critical care services for patients in the ICU. The primary goal of tele-ICU is to enhance access to expert ...
Citation: Journal of Intensive Care Medicine
PubDate: 2025-03-24T06:34:05Z
DOI: 10.1177/08850666251325782
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- Incidence of Acute Kidney Injury (AKI) in Critically Ill Patients
Receiving Concomitant Vancomycin with Piperacillin-Tazobactam or Cefepime;
a Systemic Review and Meta-analysis-
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Authors: Lamees Alaradi; Nada Albariqi, Mona Alanazi, Naif Alghassab, Tief Aseri, Lujain Alahmadi, Ahmad Alahmadi, Aseel Althobaiti, Yousef Alqarafi, Habeeba Bokhari, Rayan A Qutob, Mohanad Almaimani
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Background:Nephrotoxicity remains a significant concern in the management of critically ill patients receiving antibiotic therapy. The combination of Vancomycin and Piperacillin-Tazobactam (VPT) is frequently employed to combat multidrug-resistant ...
Citation: Journal of Intensive Care Medicine
PubDate: 2025-03-24T06:22:15Z
DOI: 10.1177/08850666251323265
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- Multisystem Inflammatory Syndrome in Children: A Comprehensive Review Over
the Past Five Years-
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Authors: Olivia Shyong; Nora Alfakhri, Sara V. Bates, Ryan W. Carroll, Krista Gallagher, Lena Huang, Vandana Madhavan, Sarah A. Murphy, Sylvia A. Okrzesik, Phoebe H. Yager, Lael M. Yonker, Josephine Lok
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Multisystem Inflammatory Syndrome in Children: A Comprehensive Review over the Past Five Years This review explores many facets of Multisystem Inflammatory Syndrome in Children (MIS-C) over the previous 5 years. In the time since the COVID 19 pandemic ...
Citation: Journal of Intensive Care Medicine
PubDate: 2025-03-17T05:28:54Z
DOI: 10.1177/08850666251320558
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- Resuscitative Transesophageal Echocardiography in Critical Care
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Authors: Felipe Teran; Taylor Diederich, Clark G. Owyang, Jennifer A. Stancati, David M. Dudzinski, Rohan Panchamia, Arif Hussain, Phillip Andrus, Gabriele Via
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
The use of focused critical care echocardiography, diagnostic modality aimed to provide immediate and actionable information, represents a core competency of contemporary intensive care medicine. Resuscitative transesophageal echocardiography (TEE) is a ...
Citation: Journal of Intensive Care Medicine
PubDate: 2025-03-17T05:28:26Z
DOI: 10.1177/08850666241272065
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- Association of Number of Oral bacteria with Ventilator-Associated
Pneumonia and Delirium in Patients in the Intensive Care Unit-
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Authors: Chika Arimizu, Tomohiko Akahoshi, Teppei Jinno, Michiko Furuta, Ayako Ohashi, Shinnosuke Takamori, Naohisa Wada; Tomohiko Akahoshi, Teppei Jinno, Michiko Furuta, Ayako Ohashi, Shinnosuke Takamori, Naohisa Wada
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
ObjectivesVentilator-associated pneumonia (VAP) and delirium are major complications among patients in the intensive care unit (ICU). The impact of oral bacterial count on these conditions is not well understood. This study aimed to explore the association between oral bacterial load and the incidence of VAP and delirium in ICU patients.MethodsIn this single-center longitudinal study, 130 patients admitted to the ICU from September 2022 to May 2023 were included. Oral bacteria counts on the tongue were quantified, and assessments of oral health using the Oral Health Assessment Tool (OHAT) and oral moisture levels were also conducted. We examined the associations between oral bacterial count, OHAT scores, and oral moisture with the incidence of VAP and delirium.ResultsThe incidence rates of VAP and delirium were 31.4% and 35.4%, respectively. Patients with a high oral bacterial load (≥5.0 × 107 CFU/mL) at ICU admission had a higher likelihood of developing VAP (odds ratio [OR] 7.43, 95% confidence interval [CI] 1.68-32.87) and delirium (OR 3.30, 95% CI 1.04-10.44) compared with those with lower bacterial counts (
Citation: Journal of Intensive Care Medicine
PubDate: 2025-02-28T07:55:25Z
DOI: 10.1177/08850666251320924
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- A Case Series Study of Airway Pressure Release Ventilation in Patients
with Intracranial Pathologies and Acute Respiratory Failure-
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Authors: Leon Schmidt, Keith Lamb, Dragan Jankovic, Darius Kalasauskas, Michael Kosterhon, Florian Ringel, Thomas Kerz; Keith Lamb, Dragan Jankovic, Darius Kalasauskas, Michael Kosterhon, Florian Ringel, Thomas Kerz
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Background: Airway Pressure Release Ventilation (APRV) is an alternate mode of ventilation in acute respiratory failure (ARF), but there is inconsistent data to support its use over other modes of ventilation. Because of increased intrathoracic pressure for most of the respiratory cycle, a negative impact of APRV on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) has been hypothesized. We evaluated the effects of APRV ventilation, with particular attention to ICP, CPP and ICP-directed therapy, in a real-world cohort of neuro-ICU patients. Methods: Retrospective single-center analysis from January 2021 to December 2023 of neurosurgical ICU patients with ICP monitoring. APRV was used as a rescue mode at the physician's discretion when the Horovitz index (PaO2/FIO2 ratio) fell below 150 despite optimized conventional ventilation. Results: Between 2021 and 2023, APRV was utilized in 29 patients undergoing a total of 60 episodes. Forty patients (66.7%) were female, median age was 49.5 (Q1 34; Q3 61.25) years.After transition to APRV, mean FiO2 decreased by 4.3% (t = 3.5, p
Citation: Journal of Intensive Care Medicine
PubDate: 2025-02-28T07:54:45Z
DOI: 10.1177/08850666251320550
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- The Use of Direct Current Cardioversion for Unstable Atrial Fibrillation
with Rapid Ventricular Response in Critically ill Patients – a
Propensity Score Analysis-
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Authors: Hong Hieu Truong, Aysun Tekin, Lucrezia Rovati, Claudia Castillo Zambrano, Faysal K. Al-Ghoula, Jacob C. Jentzer, Ognjen Gajic; Aysun Tekin, Lucrezia Rovati, Claudia Castillo Zambrano, Faysal K. Al-Ghoula, Jacob C. Jentzer, Ognjen Gajic
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
ObjectivesThere is substantial practice variation in the management strategies for atrial fibrillation (AF) with rapid ventricular rate (RVR) and hemodynamic instability in critically ill patients. This study aimed to evaluate the use and effectiveness of direct current cardioversion (DCCV) for unstable AF RVR in the intensive care unit (ICU).DesignMulticenter retrospective cohort study.SettingNon-cardiac/cardiovascular surgery ICUs of the Mayo Clinic Hospitals in Minnesota, Wisconsin, Florida, and Arizona.PatientsAdult patients who developed paroxysmal AF RVR with hemodynamic instability (heart rate ≥ 130 beats per minute and a documented SBP ≤ 90 mmHg or the need for vasopressors) during ICU stay.InterventionsEmergency DCCV.Measurements and Main ResultsPrimary outcomes were in-hospital mortality, hospital-, ICU-, and organ support-free days. Secondary outcomes were return to sinus rhythm rate before and after discharge. Among 691 patients eligible for inclusion, 47 (6.8%) received emergent DCCV in the ICU. The frequency of DCCV was higher for patients located in surgical ICUs (14.5% vs 6.1%, P = .04). Patients were 1:2 propensity-score matched. The comparative analyses were conducted on 141 patients. Those who underwent DCCV were more likely to restore sinus rhythm (odds ratio [95% confidence interval], 5.2 [1.30 20.8]). However, DCCV was not associated with increased odds of having sinus rhythm at discharge, lower mortality, or higher number of ICU-, or hospital-free days. The number of organ support-free days was significantly lower in the DCCV group (estimate ± standard error, −5.0 ± 2.0, P = .012).ConclusionsEmergency DCCV is rarely used to treat unstable AF in non-cardiac ICUs. Despite increased likelihood of immediate sinus rhythm restoration, DCCV was not associated with improvement in patient-centered outcomes. Prospective studies are warranted to evaluate harms and benefits of DCCV in non-cardiac critically ill patients with unstable AF where the driver of hemodynamic instability is often an underlying condition rather than arrhythmia per se.
Citation: Journal of Intensive Care Medicine
PubDate: 2025-02-28T07:54:16Z
DOI: 10.1177/08850666251315332
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- Balanced Salt Solution Versus Normal Saline as Resuscitation Fluid in
Pediatric Septic Shock: A Systematic Review and Meta-Analysis of
Randomized Controlled Trials-
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Authors: Sudha Chandelia, Suresh Kumar Angurana, Shankar Prasad, Mithlesh Kumar Tiwari, Muralidharan Jayashree, Karthi Nallasamy, Arun Bansal; Suresh Kumar Angurana, Shankar Prasad, Mithlesh Kumar Tiwari, Muralidharan Jayashree, Karthi Nallasamy, Arun BansalDivision of Pediatric Critical Care, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education Research (29751PGIMER), Chandigarh, 160012, India
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
ObjectiveFluid resuscitation is an important intervention in children with septic shock. The composition of resuscitation fluid is a matter of debate. Our aim was to study the effects of balanced salt solution (BSS) versus normal saline (NS) for resuscitation in pediatric septic shock.Data sourcesWe searched MEDLINE, Embase, LILAC, Cochrane Collaboration, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform.Study selectionTwo independent authors screened title and abstracts and then full papers of included studies.Data extractionTwo authors extracted data from full papers independently. Random-effects model was used for analysis of RCTs. We used Cochrane's risk of bias tool for assessing the quality of studies. Primary outcome was mortality and secondary outcomes were rates of acute kidney injury (AKI), need for renal replacement therapy (RRT), and adverse effects (hyperchloremia, metabolic acidosis, and fluid overload); and duration of PICU and hospital stay.Data synthesisFive RCTs with 992 children were included. Resuscitation with BSS versus NS was not associated with reduction in mortality (RR 0.82, 95% CI 0.45-1.50, p = 0.52; RCTs = 5); with similar results on sensitivity analysis (RR 0.76, 95% CI 0.41-1.41, p = 0.52; 4 RCTs = 4). However, resuscitation with BSS was associated with lower rates of AKI (sensitivity analysis RR 0.64, 95% CI 0.50-0.82, p = 0.0004; RCTs = 3); lesser need for RRT (RR 0.52, 95% CI 0.35-0.76, p = 0.0008; RCTs = 2); and lower rate of hyperchloremia (RR 0.74, 95% CI 0.62-0.87, p = 0.0002; RCTs = 3). The data is scant for other secondary outcomes (metabolic acidosis, fluid overload, and duration of PICU and hospital stay) to make any suggestions. The overall ‘risk of bias’ was low and unclear in most domains.ConclusionUse of BSS as resuscitation fluid in pediatric septic shock was not associated with reduction in mortality. However, BSS was associated with decreased risk of AKI, need of RRT and hyperchloremia.Clinical Trial Registration (if any)PROSPERO (CRD42022332208).
Citation: Journal of Intensive Care Medicine
PubDate: 2025-02-24T07:20:45Z
DOI: 10.1177/08850666251315705
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- A Practical Guide to Biostatistics Used in the Journal of Intensive Care
Medicine-
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Authors: Emma Kar, Asahi Murata, Chase Irwin, Eric vanSonnenberg; Asahi Murata, Chase Irwin, Eric vanSonnenberg42283University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
IntroductionBiostatistics is an increasing focus in both the United States Medical Licensing exams (USMLE) and medical school curricula. Nonetheless, literature has documented that it is poorly understood among both practicing physicians and physician trainees. Our purpose is to narrow this knowledge gap by offering readers a “how-to” guide that both supplements essential biostatistics knowledge and assists in constructing research projects.MethodsIn Part II of our tandem manuscripts, we expand our Part I biostatistics analysis of research articles in the Journal of Intensive Care Medicine (JICM) with explanations and practical use of biostatistics, addressing the most common statistical terms and tests used in the JICM.ResultsUnderstanding biostatistics requires interpreting the type of study, type of data collected, statistical tests available for all types of data, and results of the statistical tests.ConclusionGaining proficiency in biostatistics will improve the precision of evidence-based medical outcomes, helping close the current knowledge gap among practicing physicians and trainees.
Citation: Journal of Intensive Care Medicine
PubDate: 2025-02-21T10:31:41Z
DOI: 10.1177/08850666251318692
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- Impact of Sepsis Onset Timing on All-Cause Mortality in Acute
Pancreatitis: A Multicenter Retrospective Cohort Study-
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Authors: Xiaodong Huang, Siyao Liu, Zhihong Xu, Xiong Liu, Jun Hu, Mandong Pan, Chengbin Yang, Jiyan Lin, Xianwei Huang; Siyao Liu, Zhihong Xu, Xiong Liu, Jun Hu, Mandong Pan, Chengbin Yang, Jiyan Lin, Xianwei Huang
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
BackgroundSepsis complicates acute pancreatitis (AP), increasing mortality risk. Few studies have examined how sepsis and its onset timing affect mortality in AP. This study evaluates the association between sepsis occurrence and all-cause mortality in AP, focusing specifically on the impact of sepsis onset timing.MethodsThis multicenter retrospective cohort study included 494 ICU-admitted AP patients from the MIMIC-IV database and 91 from our center. Patients were grouped by sepsis occurrence and onset timing. Clinical outcomes were in-hospital and 90-day all-cause mortality. Machine learning identified key variables associated with mortality. Multivariable regression analyzed the impact of sepsis and its onset timing on mortality. To reduce baseline differences, propensity score matching (PSM) based on time to sepsis was conducted. After PSM, Kaplan-Meier survival analyses incorporated data from our center for validation. Restricted cubic spline analysis examined any nonlinear relationship between sepsis onset timing and mortality.ResultsPatients with sepsis had significantly higher in-hospital and 90-day mortality rates than those without sepsis (p
Citation: Journal of Intensive Care Medicine
PubDate: 2025-02-19T06:51:48Z
DOI: 10.1177/08850666251319289
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- Serial Lactate in Clinical Medicine – A Narrative Review
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Authors: Florian Falter, Samuel A Tisherman, Albert C Perrino, Avinash B Kumar, Stephen Bush, Lennart Nordström, Nazima Pathan, Richard Liu, Alexandre Mebazaa; Samuel A Tisherman, Albert C Perrino, Avinash B Kumar, Stephen Bush, Lennart Nordström, Nazima Pathan, Richard Liu, Alexandre Mebazaa
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
BackgroundBlood lactate is commonly used in clinical medicine as a diagnostic, therapeutic and prognostic guide. Lactate's growing importance in many disciplines of clinical medicine and academic enquiry is underscored by the tenfold increase in publications over the past 10 years. Lactate monitoring is presently shifting from single to serial measurements, offering a means of assessing response to therapy and to guide treatment decisions. With the promise of wearable lactate sensors and their potential integration in electronic patient records and early warning scores, the utility of serial lactate measurement deserves closer scrutiny.MethodsArticles included in this review were identified by searching MEDLINE, PubMed and EMBASE using the term “lactate” alone and in combination with “serial”, “point of care”, “clearance”, “prognosis” and “clinical”.
Authors were assigned vetting of publications according to their specialty (anesthesiology, intensive care, trauma, emergency medicine, obstetrics, pediatrics and general hospital medicine). The manuscript was assembled in multidisciplinary groups guided by underlying pathology rather than hospital area.FindingsLactate's clinical utility as a dynamic parameter is increasingly recognized. Several publications in the last year highlight the value of serial measurements in guiding therapy. Outside acute clinical areas like the emergency room, operating room or intensive care, obtaining lactate levels is often fraught with difficulty and delays.InterpretationMeasuring serial lactate and lactate clearance offers regular feedback on response to therapy and patient status. Particularly on the ward, wearable devices integrated in early warning scores via the hospital IT system are likely to identify deteriorating patients earlier than having to rely on observations by an often-overstretched nursing workforce.
Citation: Journal of Intensive Care Medicine
PubDate: 2025-02-10T08:22:02Z
DOI: 10.1177/08850666241303460
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- The Effects of Inspiratory Muscle Training in Critically ill Adults: A
Systematic Review and Meta-Analysis-
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Authors: Christopher Farley, Ana Oliveira, Dina Brooks, Anastasia N. L. Newman; Ana Oliveira, Dina Brooks, Anastasia N. L. Newman
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
PurposeThe onset of diaphragmatic weakness begins within hours of commencing invasive mechanical ventilation (IMV), which may contribute to the physical disability that can persist at five years after intensive care unit (ICU) discharge. Inspiratory muscle training (IMT) has the potential to alleviate the negative effects of IMV.MethodsWe conducted a systematic review and meta-analysis with an approach consistent with Cochrane methods. We registered our review a priori (PROSPERO: CRD 42023451809) and published our protocol. Randomized controlled trials (RCTs) which enrolled adults (≥18 years) admitted to ICU who required IMV for ≥24 h were eligible if they delivered an IMT intervention using an external device that provided airway resistance (eg, threshold device, tapered flow resistive device) compared to usual care. Our primary outcome was physical function. Secondary outcomes included respiratory muscle strength, mortality, length of stay, IMV weaning time, reintubation rate, dyspnea and endurance. We searched Medline, Embase, Emcare, AMED, CINAHL, CENTRAL and clinicaltrials.gov from inception and used the Covidence platform for study selection and data extraction. We reported results as standardized mean difference (SMD) if outcome measures were similar. We used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) to assess the certainty of evidence.ResultsWe screened 12 945 studies and 18 met the inclusion criteria. Three studies reported the effects of IMT on physical function. IMT may have no effect on physical function (SMD = −0.05, 95% confidence interval: −0.46 to 0.36) however results are very uncertain.ConclusionOur results suggest physical function is not impacted by IMT; however, our results are based on a limited number of studies with small samples sizes. High quality, appropriately powered RCTs are needed to improve the precision of the effect estimate.
Citation: Journal of Intensive Care Medicine
PubDate: 2025-02-10T06:50:07Z
DOI: 10.1177/08850666251317473
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- A Combined Model of Vital Signs and Serum Biomarkers Outperforms Shock
Index in the Prediction of Hemorrhage Control Interventions in Surgical
Intensive Care Unit Patients-
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Authors: John P. Forrester, Manuel Beltran Del Rio, Cristine H. Meyer, Samuel P. R. Paci, Ella R. Rastegar, Timmy Li, Maria G. Sfakianos, Eric N. Klein, Matthew E Bank, Daniel M. Rolston, Nathan A Christopherson, Daniel Jafari; Manuel Beltran Del Rio, Cristine H. Meyer, Samuel P. R. Paci, Ella R. Rastegar, Timmy Li, Maria G. Sfakianos, Eric N. Klein, Matthew E Bank, Daniel M. Rolston, Nathan A Christopherson, Daniel Jafari
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
BackgroundDistinguishing surgical intensive care unit (ICU) patients with ongoing bleeding who require hemorrhage control interventions (HCI) can be challenging. Guidelines recommend risk-stratification with clinical variables and prediction tools, however supporting evidence remains mixed.MethodsThis retrospective study evaluated adult patients admitted to the surgical ICU with concern for ongoing hemorrhage under our institution's “Hemorrhage Watch” (HW) protocol and aimed to derive a clinical prediction model identifying those needing HCI with serial vital signs (VS) and serum biomarkers. The HW protocol included ICU admission followed by a 3-h observation period with VS monitoring every 15 min and hourly biomarkers. The primary outcome was the need for HCI (operative and endovascular interventions) within nine hours of ICU arrival. Secondary outcomes included in-hospital mortality, blood transfusions, and ICU and hospital length-of-stay. A clinical prediction model was developed by utilizing the variables most associated with HCI in a best subsets regression, which was subsequently internally validated using a Bootstrap algorithm.Results305 patients were identified for inclusion and 18 (5.9%) required HCI (3 operative, 15 endovascular). The median age was 70 years (IQR 54, 83), 60% had traumatic injuries, and 73% were enrolled from the emergency department. Blood product transfusion and mortality were similar between the HCI and no-HCI groups. Our analysis demonstrated that a model based on the minimum hemoglobin (9.9 vs 8.1 g/dL), minimum diastolic (57 vs 53 mm Hg) and systolic blood pressures (105 vs 90 mm Hg), and minimum respiratory rate (15 vs 18) could predict HCI with an area under the Receiver Operating Characteristics curve (AUROC) of 0.87, outperforming the Shock Index (SI) (AUROC = 0.64).ConclusionsIn this study of surgical ICU patients with concern for ongoing bleeding, a prediction model using serial VS and biomarkers outperformed the SI and may help identify those requiring HCI.
Citation: Journal of Intensive Care Medicine
PubDate: 2025-02-10T06:49:36Z
DOI: 10.1177/08850666241312614
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- Anticoagulation Monitoring Strategies During Extracorporeal Membrane
Oxygenation (ECMO) Therapy – Differences Between Simultaneously Obtained
Coagulation Tests: A Retrospective Single-Center Cohort Study-
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Authors: Alexander C. Reisinger, Nikolaus Schneider, Marco Koellinger, Stefan Hatzl, Gerald Hackl, Reinhard Raggam, Dirk von Lewinski, Florian Posch, Philipp Eller; Nikolaus Schneider, Marco Koellinger, Stefan Hatzl, Gerald Hackl, Reinhard Raggam, Dirk von Lewinski, Florian Posch, Philipp Eller
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
IntroductionDuring extracorporeal membrane oxygenation (ECMO) systemic anticoagulation with unfractionated heparin (UFH) is standard-of-care. However, there is uncertainty regarding optimal anticoagulation monitoring strategies.MethodsWe retrospectively investigated venovenous and venoarterial ECMO patients at the medical ICUs at the Medical University of Graz, Austria. We analyzed the correlation and concordance of R-time in thromboelastography (TEG), activated partial thromboplastin time (aPTT), and anti-Xa activity. The proportion within target range, the association of coagulation parameters above or below target range (aPTT 54–72 s; equals 1.5–2× upper limit of normal (ULN), anti-Xa activity 0.2–0.5 U/mL, and R-time in assays without heparinase 675–900 s; equals 1.5–2× ULN) with mortality, bleeding events and thrombotic complications were investigated.ResultsWe analyzed 671 clusters of simultaneously performed coagulation tests in 85 ECMO cases that fulfilled inclusion criteria. Median age of patients was 57 years and 32% were female. There were poor correlations between the three coagulation tests and the proportion of discordance was 46%. Within the target range were 21% of R-time, 15% of aPTT, and 44% of anti-Xa activity measurements. Singular and multiple bleeding events occurred in 25 and 32 patients, respectively. The most common bleeding locations were catheter and cannula insertion sites followed by pulmonary hemorrhage. In VA-ECMO, anti-Xa activity was associated (OR 1.03 [1.01–1.06], p = 0.005) and correlated with bleeding events (spearman rho 0.49, p = 0.002; point biserial 0.49, p = 0.001). aPTT level below target range was associated with reduced mortality (OR 0.98 [0.97–0.99], p = 0.024). Thrombotic events occurred in six patients with no association of coagulation tests.ConclusionThere was a high rate of discordance and poor correlation between aPTT, anti-Xa activity and R-time in TEG in ECMO patients. We found high rates of bleeding events and in VA-ECMO an association with elevated anti-Xa activity levels.
Citation: Journal of Intensive Care Medicine
PubDate: 2025-02-06T08:58:58Z
DOI: 10.1177/08850666241313357
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- Relationship Between the Prognostic Nutritional index and Short-Term
Prognosis among Patients with Community-Acquired Bacterial Pneumonia: A
Retrospective Analysis of the MIMIC-IV-
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Authors: Qingsong Wu, Lianyi Liao, Qingjun Deng; Lianyi Liao, Qingjun Deng1Intensive Care Department, Chongqing Red Cross Hospital (People's Hospital of Jiangbei District), Chongqing, China
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
ObjectivesThe objective of this study was to investigate the association between the prognostic nutritional index (PNI) and the short-term outcomes in patients with community-acquired bacterial pneumonia (CABP).DesignThis study employed a retrospective design, utilizing data from the Medical Information Mart for Intensive Care (MIMIC)-IV database.Participants371 individuals from the MIMIC-IV database who were diagnosed with CABP.Primary and secondary outcomesThe primary endpoint was 28-day all-cause mortality. The secondary endpoint was the length of stay (LOS) in the intensive care unit (ICU) and in hospital.ResultsThe area under the curve of PNI for predicting 28-day all-cause mortality is 0.702 (95% CI 0.630 to 0.775; p
Citation: Journal of Intensive Care Medicine
PubDate: 2025-02-05T08:14:16Z
DOI: 10.1177/08850666251315718
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- Muscle Dysfunction and Physical Recovery After Critical Illness
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Authors: Matthew F. Mart, Joshua I. Gordon, Felipe González-Seguel, Kirby P. Mayer, Nathan Brummel; Joshua I. Gordon, Felipe González-Seguel, Kirby P. Mayer, Nathan Brummel
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
During critical illness, patients experience significant and rapid onsets of muscle wasting and dysfunction with loss of strength, mass, and power. These deficits often persist long after the ICU, leading to impairments in physical function including reduced exercise capacity and increased frailty and disability. While there are numerous studies describing the epidemiology of impaired muscle and physical function in the ICU, there are significantly fewer data investigating mechanisms of prolonged and persistent impairments in ICU survivors. Additionally, while several potential clinical risk factors associated with poor physical recovery have been identified, there remains a dearth of interventions that have effectively improved outcomes long-term among survivors. In this article, we aim to provide a thorough, evidence-based review of the current state of knowledge regarding muscle dysfunction and physical function after critical illness with a focus on post-ICU and post-hospitalization phase of recovery.
Citation: Journal of Intensive Care Medicine
PubDate: 2025-02-05T07:04:41Z
DOI: 10.1177/08850666251317467
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- Survival of Patients with Solid Tumours and Sepsis Admitted to Intensive
Care in a Tertiary Oncology Centre: A Retrospective Analysis-
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Authors: Sam S. Smith, Luke Edwards, Timothy Wigmore, Shaman Jhanji, David B. Antcliffe, Kate C. Tatham; Luke Edwards, Timothy Wigmore, Shaman Jhanji, David B. Antcliffe, Kate C. Tatham
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
IntroductionSepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Patients with cancer are at risk of developing sepsis and requiring intensive care unit (ICU) admission. We aimed to assess survival of patients with a solid tumour admitted to ICU as an emergency with sepsis, and to identify predictors of 90-day survival at admission.Materials and MethodsWe conducted a retrospective cohort survival analysis. We identified adults with a solid tumour admitted to ICU with sepsis between 01/01/2011 and 31/12/2020 at a tertiary oncology centre with two hospitals (London and Surrey, UK). We defined sepsis using the Sepsis-3 definition. The primary outcome was 90-day survival. We used the parametric accelerated failure time model for multivariate analysis to generate acceleration factors (AF).Results625 patients were identified and the 90-day survival rate was 59.5%(353/593).Multivariate analysis identified the presence of localized (AF 0.13, 95% CI 0.06–0.25) or regionalized disease (AF 0.21, 95% CI 0.12–0.36) compared to distant metastatic disease, unplanned surgery on the day of admission (AF 0.15, 95% CI 0.07–0.31), lactate (AF 1.25 95% CI 1.15–1.35), Sequential Organ Failure Assessment Score (AF 1.19, 95% CI 1.12–1.27), previous radiotherapy (AF 1.89, 95% CI 1.14–3.125), previous systemic anti-cancer treatment (excluding hormonal therapy) (AF 1.49, 95% CI 0.93–2.38), bacteraemia (AF 0.47, 95% CI 0.27–0.81) and serum albumin (AF 0.94, 95% CI 0.91–0.98) as independent predictors of 90-day survival.ConclusionsThis study of solid tumour patients admitted to ICU is one of the largest providing survival data to inform clinicians and patients. This data provides information on factors that should be considered when deliberating the possible outcome of ICU admission for a patient with solid malignancy and sepsis and highlights that the presence of cancer itself should not limit ICU admission for sepsis.
Citation: Journal of Intensive Care Medicine
PubDate: 2025-01-28T08:51:53Z
DOI: 10.1177/08850666241312621
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- Systematic Ultrasound Screening for Lower Extremity Deep Vein Thrombosis
in ICU Patients with Severe COVID-19: A Randomized Clinical Trial-
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Authors: Carlos Ernesto Marrero Eligio De La Puente, David Flota Ruiz, Lluis Sánchez Besalduch, Xavier Faner Capó, Daniel Gil Sala, Clara Palmada Ibars, Ivan Bajaña Mindiolaza, Luis Silvestre Chiscano Camon, Adolfo Ruiz Sanmartin, Juan Carlos Ruiz-Rodríguez, Ricard Ferrer, Sergi Bellmunt Montoya; David Flota Ruiz, Lluis Sánchez Besalduch, Xavier Faner Capó, Daniel Gil Sala, Clara Palmada Ibars, Ivan Bajaña Mindiolaza, Luis Silvestre Chiscano Camon, Adolfo Ruiz Sanmartin, Juan Carlos Ruiz-Rodríguez, Ricard Ferrer, Sergi Bellmunt Montoya
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
BackgroundVenous thromboembolism (VTE), whether pulmonary embolism (PE) or deep vein thrombosis (DVT), is common in patients with COVID-19. Recommendations on systematic screening in the intensive care unit (ICU) are lacking.Research questionIs there any clinical benefit of systematic screening for DVT in critically ill patients with severe COVID-19'Study design and methodsSingle-center randomized clinical trial (RCT) of COVID-19 cases admitted to the ICU. Patients were randomized into two groups: a study group that underwent ultrasound (US) screening for DVT Mondays and Thursdays, and a control group that was treated according to the unit protocol. The primary outcome was the presence of DVT. Secondary outcomes were ICU total stay, death within 21-day follow-up and bleeding complications (minor or major). A composite outcome of poor prognosis variables was analyzed. We tested a superiority hypothesis with a confidence level of 95% and an equivalence limit of 20%.Results163 patients (84 screening group, 79 control group) were enrolled between April and July 2021. There were 90 men (55.2%) with a mean ± SD age of 49.8 ± 13.58 years. In screening group 16.7% developed DVT versus 3.8% in control group (p = .007), and 3.6% versus 5.1% developed PE, respectively (p = 0.7). Poor outcome variables were male sex, age, COVID-19 vaccination status, Fibrinogen, Urea, Creatinine and Interleukin 6 (IL6) levels; Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scales. The superiority comparison, with a power of 95%, showed no statistically significant differences for a composite endpoint (p = .123). After adjusting by group, the OR for poor outcome is 1.966 (0.761-5.081) p = 0.163InterpretationAmong these patients, a strategy of systematic US screening for DVT was not associated with any significant improvements to clinical outcomes compared with usual care.Clinical Trial RegistrationClinicaltrials.org registration number: NCT05028244.
Citation: Journal of Intensive Care Medicine
PubDate: 2025-01-22T09:31:13Z
DOI: 10.1177/08850666251313774
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- Takotsubo Cardiomyopathy After Subarachnoid Hemorrhage: Who Is At
Risk'-
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Authors: Alejandro Pando, Roger Cheng, Caryn J. Ha, Gaurav Gupta, Arevik Abramyan, Sourav Mukherjee, Jeffrey Pradeep Raj, James K. Liu, Hai Sun, Kiwon Lee; Roger Cheng, Caryn J. Ha, Gaurav Gupta, Arevik Abramyan, Sourav Mukherjee, Jeffrey Pradeep Raj, James K. Liu, Hai Sun, Kiwon Lee
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
IntroductionTakotsubo Cardiomyopathy (TCM) is a rare but well recognized complication of subarachnoid hemorrhage associated with increased morbidity and poor clinical outcomes. There is a scarcity of literature describing the prevalence and risk factors associated with this complication. The aim of this study was to identify patients who are at risk of developing TCM in non-traumatic subarachnoid hemorrhage.MethodsThe 2016 to 2021 National Inpatient Sample (NIS) was used to identify adult inpatients with a primary diagnosis of non-traumatic subarachnoid hemorrhage. Univariate and multivariable analyses adjusting for patient demographics, comorbidity status, and hemorrhage etiology were used to characterize statistical associations with disease-related complications. Patients with TCM were further divided into those with “good” or “poor” functional outcomes and compared.ResultsA total of 42 141 patients were identified as having a subarachnoid hemorrhage from 2016 to 2021. Of these patients 486 patients (1.2%) were found to have TCM. TCM was associated with increased length of stay (19.15 ± 17.8 days vs 11.72 ± 14.4, P
Citation: Journal of Intensive Care Medicine
PubDate: 2025-01-20T05:25:03Z
DOI: 10.1177/08850666251313759
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- Factors Associated with the Initiation of Renal Replacement Therapy in
Patients on VV-ECMO: A Case-Control Study-
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Authors: Robayo-Amortegui Henry, Quecano-Rosas Cesar, Perez-Garzon Michel, Muñoz-Claros Conny, Poveda-Henao Claudia; Quecano-Rosas Cesar, Perez-Garzon Michel, Muñoz-Claros Conny, Poveda-Henao Claudia
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Summary: Acute Kidney Injury (AKI) is a common complication in patients with Acute Respiratory Distress Syndrome (ARDS) receiving VV-ECMO support, carrying a high risk of progression to Renal Replacement Therapy (RRT). Both AKI and RRT are linked to an increased risk of mortality. This study aims to evaluate the risk factors associated with the need for RRT in patients undergoing VV-ECMO. Methods: This is a retrospective case-control study involving patients on VV-ECMO therapy admitted to the intensive care unit (ICU) between 2019 and 2023. Patients on VV ECMO support, with or without RRT, were included and their severity scores and associated mortality were calculated. A multivariate logistic regression analysis was performed to assess the variable RRT using odds ratios (OR) with their corresponding confidence intervals (CI) for the outcome variables. Results: A total of 192 subjects were included, with a mortality rate of 39.6%. Of these, 68.7% were male, with an average ICU stay of 25.1 days and a need for RRT in 19.7% of cases. The multivariate analysis independently associated the use of vasopressors with RRT norepinephrine OR 5.61 (95% CI, 1.64-19.1) and vasopressin OR 4.64 (95% CI, 2.15-10.0)). An increase in creatinine levels before ECMO support is associated with an increased risk OR 2.21 (95% CI 1.54-3.18), and 24 h after ECMO support, the risk rises further adjusted odds ratio (AOR) 3.32 (95% IC 1.55-7.09). The accuracy of severity scores presented weak discrimination and similar behavior, except for DEOx for the primary outcome, with an AUC of 0.79 (95% CI, 0.72-0.87), and APACHE II with an AUC of 0.68 (95% CI, 0.59-0.78). Conclusions: The prediction of RRT in patients on VV-ECMO support was superior for DEOx, which is influenced by the use of vasopressors, creatinine levels, and platelet transfusion prior to cannulation. This could be useful for predicting early interventions in this patient population.
Citation: Journal of Intensive Care Medicine
PubDate: 2025-01-17T03:36:36Z
DOI: 10.1177/08850666241309852
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- Cardiac Critical Care of the Cardio-Obstetric Patient
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Authors: Amrin Kharawala, Sanjana Nagraj, Gayatri Setia, Deborah Reynolds, Rosy Thachil; Sanjana Nagraj, Gayatri Setia, Deborah Reynolds, Rosy Thachil
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Cardiovascular disease (CVD) is the leading cause of pregnancy-related mortality in the United States, with an incidence that has increased from 7.2 to 32.9 fatalities per 100,000 live births in the last 3 decades. This trend underscores the potential for an increase in the volume of admissions to cardiac intensive care units (CICUs) in the peripartum period. While congestive heart failure remains at the forefront of maternal morbidity, other life-threatening conditions include myocardial infarction (MI), hypertensive emergencies, fatal arrhythmias such as ventricular fibrillation, venous thromboembolism, aortopathies, valvular dysfunction, cardiac arrest, and cardiogenic shock. The lack of standardized guidelines to facilitate management of these conditions highlights the significant gap in medical knowledge while caring for acutely ill pregnant women. Through this comprehensive review, we highlight the most common cardiac pathologies encountered in the obstetric population and their diagnosis and contemporary management in the cardiac intensive care unit.
Citation: Journal of Intensive Care Medicine
PubDate: 2025-01-17T03:35:37Z
DOI: 10.1177/08850666241308207
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- A Review of Emerging Evidence and Clinical Applications of Hyperbaric
Oxygen Therapy-
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Authors: Sakshi Hiren Patel, Juliet Joy Joseph, Tejal R. Gandhi, Anita Mehta, Akshay Shah; Juliet Joy Joseph, Tejal R. Gandhi, Anita Mehta, Akshay Shah175026Anand Pharmacy College, Anand, Gujarat, India
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Background: Hyperbaric Oxygen Therapy (HBOT) is a medical treatment that involves administering 100% oxygen at increased atmospheric pressure to enhance oxygen delivery to tissues. Initially developed for decompression sickness, HBOT has since been utilized for a wide range of medical conditions, including severe infections, non-healing wounds, and, more recently, COVID-19. Objective: This review explores the historical development of HBOT, its principles, its emerging role in the management of and its outcome as treatment in COVID-19, particularly in mitigating inflammation, hypoxemia, and oxidative stress. Methods: A comprehensive review of the literature was conducted, analyzing case reports and case series that examined the effectiveness of HBOT in various clinical scenarios, with a focus on COVID-19. Results: HBOT has been shown to enhance tissue oxygenation, reduce inflammation, and modulate oxidative stress, thereby improving clinical outcomes in patients with severe COVID-19. The therapy's ability to increase dissolved oxygen levels in blood and tissues, independent of hemoglobin, makes it particularly beneficial in conditions like COVID-19, where hypoxemia and inflammation are prominent. Conclusion: HBOT offers a promising adjunctive treatment for severe COVID-19, with the potential to reduce mortality and improve recovery by targeting key pathophysiological processes such as hypoxemia, inflammation, and oxidative stress. Further research is warranted to optimize treatment protocols and confirm long-term benefits.
Citation: Journal of Intensive Care Medicine
PubDate: 2025-01-16T12:35:26Z
DOI: 10.1177/08850666241313136
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- Critical Care Management of Acute Pulmonary Embolism
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Authors: Eugene Yuriditsky, Mads Dam Lyhne, James M. Horowitz, David M. Dudzinski; Mads Dam Lyhne, James M. Horowitz, David M. Dudzinski
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
The unprimed right ventricle is exquisitely sensitive to acute elevations in afterload. High pulmonary vascular tone incurred with acute pulmonary embolism has the potential to induce obstructive shock and circulatory collapse. While emergent pulmonary reperfusion is essential in severe circumstances, an important subset of pulmonary embolism patients may exhibit a less extreme presentation posing a management dilemma. As intensive care therapies have the potential to both salvage and harm the failing right ventricle, a keen understanding of the pathophysiology is requisite in the care of the contemporary patient with hemodynamically significant pulmonary embolism. Here, we review right ventricular pathophysiology, an approach to risk stratification, and offer guidance on the medical and mechanical supportive and therapeutic strategies for the critically ill patient with acute pulmonary embolism.
Citation: Journal of Intensive Care Medicine
PubDate: 2025-01-09T01:15:56Z
DOI: 10.1177/08850666241311512
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- Implementation of a Checklist Tool to Improve Understanding of Rapid
Response Team Protocols-
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Authors: Maria C. Pliakas, Erin F. Carlton, Sarah Brennan, Diane Brown, Laura Getchell, Debra O’Neal, Kayla B. Phelps, Rebekah Shaw, Courtney Strohacker, Anisha K. Coughlin; Erin F. Carlton, Sarah Brennan, Diane Brown, Laura Getchell, Debra O’Neal, Kayla B. Phelps, Rebekah Shaw, Courtney Strohacker, Anisha K. Coughlin
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Background and Objectives: Rapid response teams (RRT) are multidisciplinary teams activated to assess patients outside of the Intensive Care Unit (ICU) and require a shared framework for approaching a deteriorating patient. In this project, we aimed to improve the understanding of RRT protocols through the development and implementation of the RRT Huddle Checklist. Methods: This quality improvement project took place from 2019 to 2022. A multidisciplinary workgroup conducted a current state analysis and defined the ideal RRT process. To improve the RRT process, we developed and implemented an RRT Huddle Checklist based on the SBAR framework, standardized education, and created a process for regular feedback. The primary aim was to improve understanding of RRT protocols among participants. RRT duration was used as a balancing measure. Results: A total of 301 stakeholders completed surveys, including 127 nurses, 101 residents, 45 RRT nurses, 10 Hospital Medicine faculty and fellows, and 18 PICU fellows. After implementation of the RRT Huddle Checklist, the proportion of respondents who agreed with knowing RRT protocols increased from 69% in 2020 to 75% in 2022, with no increase in RRT duration. Conclusions: The implementation of the RRT Huddle Checklist resulted in an increased proportion of key stakeholders that understood RRT protocols without increasing the duration of RRTs. The RRT Huddle Checklist tool utilizes a widely known, validated framework that can be adapted at other institutions to standardize the RRT process and promote ongoing just-in-time education.
Citation: Journal of Intensive Care Medicine
PubDate: 2025-01-09T01:15:26Z
DOI: 10.1177/08850666241309860
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- Machine Learning Approach for Sepsis Risk Assessment in Ischemic Stroke
Patients-
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Authors: Fengkai Mao, Leqing Lin, Dongcheng Liang, Weiling Cheng, Ning Zhang, Ji Li, Siming Wu; Leqing Lin, Dongcheng Liang, Weiling Cheng, Ning Zhang, Ji Li, Siming Wu
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
BackgroundIschemic stroke is a critical neurological condition, with infection representing a significant aspect of its clinical management. Sepsis, a life-threatening organ dysfunction resulting from infection, is among the most dangerous complications in the intensive care unit (ICU). Currently, no model exists to predict the onset of sepsis in ischemic stroke patients. This study aimed to develop the first predictive model for sepsis in ischemic stroke patients using data from the MIMIC-IV database, leveraging machine learning techniques.MethodsA total of 2238 adult patients with a diagnosis of ischemic stroke, admitted to the ICU for the first time, were included from the MIMIC-IV database. The outcome of interest was the development of sepsis. Model development adhered to the TRIPOD guidelines. Feature selection was performed using Least Absolute Shrinkage and Selection Operator (LASSO) regression, identifying 28 key variables. Multiple machine learning algorithms, including logistic regression, k-nearest neighbors, support vector machines, decision trees, and XGBoost, were trained and internally validated. Performance metrics were assessed, and XGBoost was selected as the optimal model. The SHAP method was used to interpret the XGBoost model, revealing the impact of individual features on predictions. The model was also deployed on a user-friendly platform for practical use in clinical settings.ResultsThe XGBoost model demonstrated superior performance in the validation set, achieving an area under the curve (AUC) of 0.863 and offering greater net benefit compared to other models. SHAP analysis identified key factors influencing sepsis risk, including the use of invasive mechanical ventilation on the first day, excessive body weight, a Glasgow Coma Scale verbal score below 3, age, and elevated body temperature (>37.5 °C). A user interface had been developed to enable clinicians to easily access and utilize the model.ConclusionsThis study developed the first machine learning-based model to predict sepsis in ischemic stroke patients. The model exhibited high accuracy and holds potential as a clinical decision support tool, enabling earlier identification of high-risk patients and facilitating preventive measures to reduce sepsis incidence and mortality in this population.
Citation: Journal of Intensive Care Medicine
PubDate: 2025-01-09T01:14:26Z
DOI: 10.1177/08850666241308195
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- Validation of Pediatric Sequential Organ Failure Assessment (pSOFA) Scores
to Predict Critical Events in the Pediatric Intensive Care Unit-
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Authors: Colleen M. Badke, Austin Wang, Latasha A. Daniels, L. Nelson Sanchez-Pinto; Austin Wang, Latasha A. Daniels, L. Nelson Sanchez-Pinto
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
ObjectiveTo determine the prognostic value of the Pediatric Sequential Organ Failure Assessment (pSOFA) to discriminate critical events, including code events and intubations, in the pediatric intensive care unit (PICU).MethodsWe performed an observational cohort study of all critical events in a quaternary care PICU between 5/2020 and 4/2023. Critical events were extracted from our hospital communications platform and from the electronic health record (EHR). The pediatric sequential organ failure assessment (pSOFA) scores were prospectively calculated in real-time in our EHR every 15 min during the study period for data-driven situational awareness and were retrospectively analyzed for this study. Each encounter was divided into 6-h time blocks and we assessed the performance of the highest pSOFA score in each block at discriminating the occurrence of a critical event in the subsequent block.ResultsThere were 5687 unique patient encounters included in the analysis. Critical events were identified in 578 out of 169 486 time blocks (prevalence 0.3%), which included 103 code events and 498 intubation events, in 392 unique PICU encounters. The total pSOFA score in a 6-h time block was significantly associated with a subsequent code event (odds ratio [OR] 1.19, 95% CI 1.13-1.24) or intubation (OR 1.13, 95% CI 1.10-1.15). Several organ-specific pSOFA subscores were also significantly associated with the outcomes. Area under the receiver operating characteristic curve (AUROC) for the total pSOFA score was 0.67 for a code event and 0.65 for intubation. Using a pSOFA score cutoff of ≥8, the positive predictive value was 0.8% and the negative predictive value was 99.7% for any critical event.ConclusionsThe pSOFA score is significantly associated with critical events in the PICU, however, it does not have adequate performance to be used for situational awareness by itself.
Citation: Journal of Intensive Care Medicine
PubDate: 2025-01-09T01:13:56Z
DOI: 10.1177/08850666241307630
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- Oxygen Targets for Mechanically Ventilated Adults with Sepsis: Secondary
Analysis of the PILOT Trial-
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Authors: Jack C. Shapiro, Jonathan D. Casey, Edward T. Qian, Kevin P. Seitz, Li Wang, Bradley D. Lloyd, Joanna L. Stollings, Robert E. Freundlich, Wesley H. Self, Todd W. Rice, Jonathan P. Wanderer, Matthew W. Semler; Jonathan D. Casey, Edward T. Qian, Kevin P. Seitz, Li Wang, Bradley D. Lloyd, Joanna L. Stollings, Robert E. Freundlich, Wesley H. Self, Todd W. Rice, Jonathan P. Wanderer, Matthew W. Semler,
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
BackgroundPatients with sepsis frequently require invasive mechanical ventilation. How oxygenation during mechanical ventilation affects clinical outcomes for patients with sepsis remains uncertain.Research QuestionTo evaluate the effects of different oxygen saturation targets on clinical outcomes for patients with sepsis receiving mechanical ventilation.Study Design and MethodsWe performed a secondary analysis of the Pragmatic Investigation of optimaL Oxygen Targets (PILOT) trial dataset among patients who met criteria for sepsis by the Sepsis-3 definition at the time of enrollment. We compared patients randomized to a lower oxygen saturation target (90%; range, 88–92%), an intermediate target (94%; range, 92–96%), and a higher target (98%; range, 96–100%) with regard to the outcomes of 28-day in-hospital mortality and ventilator-free days to study day 28.ResultsOf 2541 patients in the PILOT dataset, 805 patients with sepsis were included in the current analysis. In-hospital mortality by day 28 did not differ significantly between the lower target group (48%; 95% confidence interval [CI], 42% to 54%), the intermediate target group (50%; 95% CI, 43% to 56%), and the higher target group (51%; 95% CI, 45% to 56%) (P = 0.83). The number of ventilator-free days to day 28 did not significantly differ between the trial groups, with a mean of 9.9 (standard deviation [SD], 11.8) in the lower oxygen saturation target group, 9.5 (SD, 11.2) in the intermediate group, and 9.4 (SD, 11.4) in the higher group (P = 0.65).InterpretationAmong mechanically ventilated patients with sepsis in a large, randomized trial, the incidence of 28-day in-hospital mortality was not statistically significantly different between the use of a lower, intermediate, or higher oxygen target. However, the confidence intervals included treatment effects that would be clinically meaningfully and further randomized trials of oxygen targets in sepsis are required.Referenced trial namePragmatic Investigation of optimaL Oxygen Targets Trial (PILOT)ClinicalTrials.gov number NCT03537937URL: https://clinicaltrials.gov/study/NCT03537937
Citation: Journal of Intensive Care Medicine
PubDate: 2025-01-09T01:13:26Z
DOI: 10.1177/08850666241299378
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- Transtracheal Ultrasound as a Preventive Tool for ETT Related Adverse
Events and Malpositioning in the ICU-
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Authors: David Yamane, Philip Dela Cruz, Mary Heekin Wilby, Sasa Ivanovic, Mark Munoz, Katrina Hawkins, Danielle Davison; Philip Dela Cruz, Mary Heekin Wilby, Sasa Ivanovic, Mark Munoz, Katrina Hawkins, Danielle Davison
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
IntroductionEndotracheal tube (ETT) malpositioning can result in a myriad of complications. Daily chest radiographs (CXR) is the gold standard in monitoring these complications. Point-of-care transtracheal ultrasound (TTUS) is an emerging imaging modality for ETT positioning. We compared ETT malpositioning related adverse events and diagnostic accuracy of ETT malpositioning of a combined TTUS and CXR surveillance protocol to CXR alone.MethodsWe performed a randomized control trial of mechanically ventilated patients in an academic multidisciplinary ICU. In the intervention group, the clinical team was provided the results of the TTUS with CXR results to aid in clinical decision making. In the control group only CXR results were used. Adverse events included bronchial migration, vocal cord herniation, balloon rupture, unplanned extubation, and the development of aspiration pneumonia. Data was analyzed via Fisher's Exact Test. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated.
Citation: Journal of Intensive Care Medicine
PubDate: 2025-01-09T01:12:47Z
DOI: 10.1177/08850666241296523
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- Pathogenic Burden, Antimicrobial Resistance Pattern and Clinical Outcome
of Nosocomial Bloodstream Infections in Intensive Care Unit-
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Authors: Deepak Kumar, Monika Chaudhary, Naresh Kumar Midha, Gopal Krishana Bohra, Durga Shankar Meena, Vibhor Tak, Hembala Rathore, Vishavjeet Rathore, Meruvu Hari Vaishnavi, Neetha TR, Sadik Mohammed, Nikhil Kothari, Pradeep Bhatia; Monika Chaudhary, Naresh Kumar Midha, Gopal Krishana Bohra, Durga Shankar Meena, Vibhor Tak, Hembala Rathore, Vishavjeet Rathore, Meruvu Hari Vaishnavi, Neetha TR, Sadik Mohammed, Nikhil Kothari, Pradeep Bhatia
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Purpose: Nosocomial bloodstream infections with multidrug-resistant microorganisms have become a common health threat in intensive care settings worldwide. Understanding antimicrobial resistance and the outcomes of these infections is crucial for addressing this issue. This study aimed to investigate the burden, antimicrobial resistance, and 28-day outcomes of nosocomial bloodstream infections in the intensive care unit. Materials and Methods: This retrospective study was conducted in a multispecialty intensive care unit at a tertiary care hospital in western India. Adult patients aged ≥18 years with bloodstream infections acquired after 48 h of admission were included in the analysis. Results: A total of 245 patients suspected of having nosocomial infections in the intensive care unit were evaluated, and 179 were included in the study. Gram-negative bacteremia was identified in the majority of cases, affecting 111 (62%) patients. Carbapenem-resistant Acinetobacter baumannii was the most prevalent pathogen, found in 21.2% (38/179) of patients. Candida species were detected in 37 (20.6%) cases, and gram-positive cocci were identified in 31 (17.3%) patients, with vancomycin-sensitive Enterococci being the most common gram-positive cocci isolated from blood. The central venous catheter was the most frequent source of bloodstream infection, identified in 66 (36.9%) patients. Among all patients, 28-day mortality was observed in 102 (57%) patients. Higher quick sepsis-related organ failure (qSOFA) scores at the onset of bloodstream infection, central venous catheters as a source of infection, inability to initiate early appropriate therapy and septic shock at the onset of bloodstream infection were identified as independent predictors of mortality in patients with nosocomial bloodstream infections. Conclusion: An increased burden of gram-negative bacilli and Candida was found to cause nosocomial bloodstream infections, with very high rates of antimicrobial resistance. Early appropriate diagnosis and treatment play a critical role in improving survival. Additionally, enhanced infection prevention and control practices are necessary to mitigate the heavy burden of infections caused by multidrug-resistant organisms in critical care settings.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-12-23T06:57:29Z
DOI: 10.1177/08850666241305043
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- Examination of Risk Factors Affecting the Development of BSI and Mortality
in Critically Ill COVID-19 Patients Hospitalized in Intensive Care Unit
(ICU): A Single-Center Retrospective Study-
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Authors: Çağla Keskin Sarıtaş, Halit Özsüt, Aysun Benli, Seniha Başaran; Halit Özsüt, Aysun Benli, Seniha Başaran
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
BackgroundVarious studies have shown that the incidence of BSI is greater in COVID-19 patients hospitalized in the intensive care unit (ICU).AimsOur study aimed to determine the risk factors for BSI, mortality rates, and factors affecting mortality in adult COVID-19 patients hospitalized in the ICU.MethodsAll COVID-19 patients who met the study criteria and stayed in intensive care for more than 2 days at a tertiary university hospital during the two-year pandemic period were included in the study. Logistic regression analysis was used to determine the risk factors for BSI and mortality.ResultsWe found that respiratory rate (RR) ≥ 30 breaths per minute at the time of admission [OR: 2.342 (95% CI: 1.12-4.897)] and antibiotic use in the month before admission ICU [OR: 3.137 (95% CI: 1.321-7.451)] were independent risk factors for BSI in COVID-19 patients. Subanalysis was also performed according to the doses of immunomodulators such as anakinra, tocilizumab, and corticosteroids, and it was found that they had no effect on the BSI (P > .05). The predominant causative pathogens were K. pneumoniae, A. baumannii and enterococci. The multidrug resistant rate among bacteria was 78%. Although their comorbidities and disease severity at the time of ICU admission were similar, patients with BSIs had a higher mortality rate (58.1 to 81.9%, P = .000). The SAPS-2 score at ICU admission [OR: 3.095 (95% CI: 1.969-4.865)] and mechanical ventilation requirement throughout the ICU admission [OR: 9.314 (95% CI: 3.878-22.37)] were found to be independent risk factors for mortality by multivariate analysis. BSI was not found to be a risk factor for mortality (> .05).ConclusionsAntibiotic use in patients with severe COVID-19 significantly increases the risk of BSI; unnecessary antibiotic use should be avoided.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-12-20T10:29:46Z
DOI: 10.1177/08850666241305347
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- Palliative Care Outcomes for Critically ill Children After Rapid Whole
Genome Sequencing-
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Authors: Katherine Perofsky, Ami Doshi, Zaineb Boulil, Julia Beauchamp Walters, Euyhyun Lee, David Dimmock, Stephen Kingsmore, Nicole G. Coufal; Ami Doshi, Zaineb Boulil, Julia Beauchamp Walters, Euyhyun Lee, David Dimmock, Stephen Kingsmore, Nicole G. Coufal
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
ObjectivesClinical utility of rapid whole genome sequencing (rWGS) has been reported in 30–70% of pediatric ICU patients who receive a molecular diagnosis. Rapid molecular diagnostic techniques have been increasingly integrated into critical care, yet the influence of genetic test results on palliative care related decision making is largely unknown. This study evaluates palliative care related outcomes after rWGS.DesignRetrospective chart reviewSettingTertiary children's hospitalPatientsAcutely ill children [math] 18 years of age who received rWGS due to suspected genetic disease between July 2016 and November 2019InterventionsrWGS with associated precision medicineMeasurements and Main Results536 patients underwent rWGS, of whom 152 (28.4%) received a molecular diagnosis. Diagnostic rWGS was associated with more code status modifications, an increase in palliative care inpatient consultations, and greater enrollment in home-based palliative services. A comparison of diagnostic and nondiagnostic rWGS groups where palliative decisions were made prior to reporting of genomic testing results did not identify differences between the groups. In the subset of patients who had palliative care interventions (n = 57, 53% with diagnostic rWGS), time to palliative care consultation and time to compassionate extubation were shorter for patients with rWGS-based diagnoses (Kaplan-Meier method, P = .008; P = .015). Significantly more patients in this subgroup with diagnostic rWGS received home-based palliative care (Chi-squared, P = .025, 95% CI [−0.47, −0.05]). Univariate Poisson regression indicated that diagnostic rWGS is associated with significantly fewer emergency visits, PICU admissions, and unplanned intubations.ConclusionsDiagnostic rWGS correlates with more rapid engagement of pediatric palliative care services, higher enrollment rates in home-based palliative care, and shorter time to compassionate extubation. Further studies are needed with larger cohort sizes and validated pediatric palliative care outcome measurement tools to accurately determine if this change in care is driven by the underlying condition or knowledge of a molecular diagnosis.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-12-09T07:19:15Z
DOI: 10.1177/08850666241304320
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- Valproic Acid for Hyperactive Delirium and Agitation in Critically Ill
Patients-
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Authors: Olivia Nuti, Cristian Merchan, Tania Ahuja, Serena Arnouk, John Papadopoulos, Alyson Katz; Cristian Merchan, Tania Ahuja, Serena Arnouk, John Papadopoulos, Alyson Katz
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
BackgroundDelirium and agitation are common syndromes in critically ill patients. Valproic acid (VPA) has shown benefit in intensive care unit (ICU)-associated delirium and agitation, but further evaluation is needed.ObjectiveThe purpose of this study was to evaluate the effectiveness and safety of VPA for hyperactive delirium and agitation in critically ill adult patients.MethodsA retrospective cohort study at NYU Langone Health was conducted in critically ill patients treated with VPA for hyperactive delirium or agitation from October 1, 2017 to October 1, 2022. The primary outcome was effectiveness of VPA, defined as a reduction in the total number of any concomitant psychoactive medication by day 3 of VPA treatment. Secondary outcomes included the effect of VPA on the doses of concomitant medications and adverse events.ResultsA total of 87 patients were included in the final analysis. By day 3 of VPA treatment, a 33% reduction (P
Citation: Journal of Intensive Care Medicine
PubDate: 2024-12-09T07:18:35Z
DOI: 10.1177/08850666241302760
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- Ig-M and Ig-A Enriched Ig-G Infusion as Adjuvant Therapy in the Critically
ill Patients Experiencing SARS-CoV-2 Severe Infection-
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Authors: Alberto Corona, Sara Simoncini, Giuseppe Richini, Ivan Gatti, Clemente Santorsola, Andrea Patroni, Giacomina Tomasini, Alice Capone, Elena Zendra, Myriam Shuman; Sara Simoncini, Giuseppe Richini, Ivan Gatti, Clemente Santorsola, Andrea Patroni, Giacomina Tomasini, Alice Capone, Elena Zendra, Myriam Shuman
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
IntroductionSARS-CoV-2 in patients who need Intensive Care (ICU) is associated with a mortality rate ranging from 10 to 40%-45%, with an increase in morbidity and mortality in presence of sepsis.MethodsWe assumed that immunoglobulin (Ig) M and IgA enriched IgG (IGAM) therapy may support SARS COV-2 sepsis-related phase improving patient outcome. We conducted a retrospective case-control study on all the patients admitted to our ICU during the three pandemic waves between February 2020 and April 2021. Upon ICU admission, patients received anticoagulants with the standard supportive treatment (ST) ± IGAM therapy. After matching for the baseline characteristics and treatments, the patients receiving IGAM therapy too (group A), were compared with those undergoing ST (group B) only.Results85 patients were enrolled in group A, whereas 111 in group B. The mortality resulted lower in group A [37.6% versus 55.8%, OR: 0.7 (02-08), P = .01)]. A logistic regression analysis identified IGAM treatment as a survival predictor [OR: 0.35 (95%CI, 0.2-0.8)], whereas experiencing a super-infection [OR: 1.88 (95%CI, 1.5-4.9)] and a septic shock [OR: 1.92 (95%CI, 1.4-4.3)] as predictors of death. On day 7, the probability of dying was 3 times higher in patients treated with ST only. Variable life adjustment display (VLAD) was equal to 2.4 in group A, while – 2.2 group B (in terms of lives saved in relation with those expected, in according with Simplified Acute Physiology Score II (SAPS II) score.ConclusionThe treatment based on IGAM infusion seems to give an advantage chance of survival in SARS-CoV-2 severe infection. Further prospective studies are warranted.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-12-09T07:17:58Z
DOI: 10.1177/08850666241301689
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- Cardiooncology in the ICU – Cardiac Urgencies in Cancer Care
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Authors: Stephanie Wu, Faizi Jamal; Faizi Jamal1Department of Medicine, 20220City of Hope Comprehensive Cancer Center, Duarte, California, USA
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Cardiovascular disease is an increasing risk of morbidity and mortality in cancer patients, related to an growing number of aging survivors with pre-existing cardiovascular disease and the use of traditional and novel cancer therapies with cardiotoxic effects. While many cardiac complications are chronic processes that develop over time, there are many acute processes that may arise in hospitalized patients. It is important for hospitalists and critical care physicians to be familiar with the recognition and management of these conditions in this unique population. This article reviews the presentation and management of common cardiac urgencies in critically ill cancer patients including acute decompensated heart failure, acute coronary syndromes, arrhythmias, hypertensive crises, pulmonary embolism, pericardial tamponade and myocarditis.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-12-05T08:36:34Z
DOI: 10.1177/08850666241303461
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- Prognostic Factors of Hospital Mortality After Near Hanging: A
Retrospective two-Center French Study-
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Authors: Yanis Gueddoum, Antoine Goury, Vincent Legros, Thierry Floch, Bruno Mourvillier, Guillaume Thery; Antoine Goury, Vincent Legros, Thierry Floch, Bruno Mourvillier, Guillaume Thery
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Introductionsuicide is a global public health issue, with over 800 000 people taking their own lives every year. However, most suicide attempts do not result in death. Hanging is the most common method used in France, often leading to post-hanging coma (PHC). The prognosis for patients admitted in intensive care unit (ICU) following PHC is poor, yet predictive criteria of mortality have been poorly evaluated.Methodswe retrospectively collected prehospital and in-hospital data from 65 patients hospitalized in 2 French ICU for PHC, between first March 2010 and first August 2023, and compared characteristics between patients alive and dead.Resultshospital mortality was 52%. Among baseline characteristics, SAPSII and pre-hospital cardiac arrest were associated with mortality, respectively 47 versus 62 (P = .005) and 32% versus 85% (P = .001). Concerning neuroprognostication, abnormal pupillary light reflex (PLR) was more frequent in patients who died (14% vs 56%, P = .002), as abnormal EEG (0% vs 32%, P = .002) and abnormal transcranial doppler (10% vs 35%, P = .031).Conclusionwe identified several poor prognostic factors associated with hospital mortality after PHC. Further larger-scale studies are needed to supplement these findings.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-12-05T07:18:43Z
DOI: 10.1177/08850666241303881
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- Reducing Chest Compression Pauses During Pediatric ECPR
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Authors: Elena M. Insley, Andrew S. Geneslaw, Tarif A. Choudhury, Anita I. Sen; Andrew S. Geneslaw, Tarif A. Choudhury, Anita I. Sen1Department of Pediatrics, 21611Columbia University Irving Medical Center, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Objective: To quantify chest compression (CC) pauses during pediatric ECPR (CPR incorporating ECMO) and implement sustainable quality improvement (QI) initiatives to reduce CC pauses during ECMO cannulation. Methods: We retrospectively identified baseline CC pause characteristics during pediatric ECPR events (pre-intervention), deployed QI interventions to reduce CC pause length, and then prospectively quantified CC pause metrics post-QI interventions (post-intervention). Data were gathered from a single center review of CC-pause characteristics in children less than 18 years old with a PICU ECPR arrest. QI Interventions included: (1) sharing baseline CC data with ECPR stakeholders, (2) establishing consensus among providers regarding areas for improvement, and (3) creating a communication aid to encourage counting CC pauses out loud. Multidisciplinary ECPR simulations allowed for practice of these skills. Using telemetry data, CC pause metrics were analyzed in the medical (CPR before cannulation) and surgical (CPR during ECMO cannulation, demarcated by the sterile draping of the patient) phases of ECPR, pre- and post-intervention. Results: Pre-intervention, 11 ECPR events (5 central cannulation, 6 peripheral cannulation) met inclusion criteria compared with 14 ECPR events (2 central, 12 peripheral) post-intervention. Pre-intervention analysis identified longer CC pauses and lower chest compression fraction (CCF) during the surgical versus medical phase of ECPR. Compared to pre-intervention data, CCF during the surgical phase of ECPR improved from 66% to 81% (73-85%) post-intervention (P = .02). Median CC pause length was significantly reduced from 20 s pre-intervention to 10.5 (9-13) seconds post-intervention (P = .01). There was no change in the surgical phase of ECPR duration (44 min pre- vs 41 min post-intervention, P = .8) or survival to hospital discharge (45% vs 21%, P = .4). Conclusion: Simple and feasible communication interventions during ECPR can minimize CC pauses, increase CCF and improve CPR quality without prolonging the time needed for ECMO cannulation.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-12-05T07:18:25Z
DOI: 10.1177/08850666241301023
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- Exploring Rapid Response Team Activation Impact in Patients with Cirrhosis
with Acute Decompensation-
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Authors: Joelle N. Friesen, Mackenzie Maberry, Jody C. Olson, Alice Gallo de Moraes; Mackenzie Maberry, Jody C. Olson, Alice Gallo de Moraes
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
BackgroundCirrhosis is associated with significant healthcare utilization, yet data about in-hospital decompensations remain sparse. Additionally, the impact of liver transplant candidacy status on resuscitation and outcomes is largely unknown.AimsWe aimed to evaluate the characteristics of resuscitation events for patients with cirrhosis with acute decompensation, analyzing liver transplant candidacy and intensive care unit (ICU) transfer parameters.MethodsRetrospective single-center review of adult patients with liver cirrhosis who had a rapid response team (RRT) activation during hospitalization and no prior liver transplantation.ResultsPatients with cirrhosis who were liver transplant candidates were more likely to be younger (p = .003), have a higher serum total bilirubin (p = .015), higher INR (p
Citation: Journal of Intensive Care Medicine
PubDate: 2024-11-25T12:55:17Z
DOI: 10.1177/08850666241302024
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- Methylene Blue for Septic Shock: A Systematic Review and Meta-analysis of
Randomized and Prospective Observational Studies-
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Authors: Afrah Alkazemi, Sayed Abdulmotaleb Almoosawy, Anwar Murad, Abdulrahman Alfares; Sayed Abdulmotaleb Almoosawy, Anwar Murad, Abdulrahman Alfares
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
BackgroundThe impact of methylene blue (MB) on critical patient outcomes, including overall mortality, hemodynamic stability, and organ function has been inconsistently described across studies. This study aims to evaluate the efficacy of MB therapy in adult patients with septic shock in the intensive care unit (ICU).MethodsThe systematic search of PubMed/MEDLINE, EMBASE and Cochrane Library databases up to February 2024 included randomized controlled trials and prospective observational studies involving adult septic shock patients who received intravenous MB therapy. The primary outcome was all-cause mortality, with secondary outcomes on hemodynamics and ICU length of stay.ResultsFifteen studies (5 randomized, 10 non-randomized) involving a total of 441 patients, met the inclusion criteria. The meta-analysis showed statistically significant reduction in mortality rates among septic shock patients treated with MB (mortality rate 0.52; 95% CI 0.38 to 0.66; P
Citation: Journal of Intensive Care Medicine
PubDate: 2024-11-22T08:16:09Z
DOI: 10.1177/08850666241300312
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- High-dose Intravenous N-Acetylcysteine in Mechanically Ventilated Patients
with COVID-19 Pneumonia: A Propensity-Score Matched Cohort Study-
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Authors: Ka Man Fong, George Wing Yiu Ng, Anne Kit Hung Leung, Kang Yiu Lai; George Wing Yiu Ng, Anne Kit Hung Leung, Kang Yiu Lai1Intensive Care Unit, 36682Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
BackgroundCurrent therapies for severe COVID-19, such as steroids and immunomodulators are associated with various side effects. N-acetylcysteine (NAC) has emerged as a potential adjunctive therapy with minimal side effects for patients with cytokine storm due to COVID-19. However, evidence supporting high-dose intravenous NAC in severe COVID-19 pneumonia requiring mechanical ventilation is limited.MethodsWe conducted a retrospective analysis of consecutive patients aged ≥ 18 who were admitted for acute respiratory failure (PaO2/FiO2 ratio
Citation: Journal of Intensive Care Medicine
PubDate: 2024-11-22T08:15:30Z
DOI: 10.1177/08850666241299391
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- Bacterial Superinfections in Critically Ill Patients With SARS-CoV-2
Infection: A Retrospective Cohort Study-
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Authors: Anfal Y. Al-Ali, Abdul Salam, Osama Almuslim, Maha Alayouny, Mohammed Alhabib, Nada AlQadheeb; Abdul Salam, Osama Almuslim, Maha Alayouny, Mohammed Alhabib, Nada AlQadheeb
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
BackgroundThere is a considerable gap in the current evidence concerning the prevalence of superinfections among critically ill patients with SARS-CoV-2 infection in Saudi Arabia.ObjectivesWe sought to determine the prevalence of bacterial superinfections following the initiation of antibiotic therapy in critically ill patients with SARS-CoV-2 infection.MethodsA retrospective observational study that included patients with SARS-CoV-2 infection admitted to the intensive care unit (ICU) for at least 24 hours and received empirical antibiotic therapy. The primary outcome was the rate of bacterial superinfections occurring at least 48 hours after the initiation of antibiotics. ICU-related outcomes and complications were compared between subgroups with and without superinfections and amongst the two most frequently used antibiotic regimens.ResultsA total of 230 patients were included in our study. Superinfections developed in 40 (17.4%) patients, with the median time from the first dose of antibiotic to the emergence of superinfection of 17.6 days (IQR 9.8-29.2). Patients with superinfections had longer median ICU stays [ 27.1 days(IQR 15.2-43.3) versus 7.1 days(IQR 3.8-11.8); P
Citation: Journal of Intensive Care Medicine
PubDate: 2024-11-14T08:30:22Z
DOI: 10.1177/08850666241298229
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- Assessing the Role of Blood Gas Analysis in COVID-19 Patients for Early
Warning and Clinical Guidance-
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Authors: Youji Wang, Tielian Liu, Hualongyue Du, Yongliang Wang, Gang Xiao, Xiaoming Lyu; Tielian Liu, Hualongyue Du, Yongliang Wang, Gang Xiao, Xiaoming Lyu
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
ObjectiveTo assess the role of blood gas analysis as an auxiliary tool for detecting and predicting the progression of COVID-19 in patients.Research Methodology/DesignA consecutive cohort study was conducted of 106 patients diagnosed with the novel coronavirus. Patients were divided into two groups based on age and the course of the disease (mild to moderate and severe). Blood gas analysis parameters were measured for all participants and results were compared between groups.SettingThis study was conducted in the Department of Laboratory Medicine, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China.Main Outcome MeasuresArterial/alveolar oxygen partial pressure ratio, reduced hemoglobin fraction, sodium ion, lactic acid, oxygen saturation, oxygen partial pressure, and oxyhemoglobin fraction.ResultsFindings indicated statistically significant differences between the two groups in the measured parameters.ConclusionBlood gas analysis has the potential to more accurately assess the progression of COVID-19 in elderly patients, specifically related to respiratory and acid-base balance issues.Implications for Clinical PracticeThis study underscores the importance for bedside nurses to pay close attention to acid-base balance, lung ventilation/ventilation function, and hypoxia status in elderly critically ill patients with COVID-19, in order to more effectively diagnose and predict the progression of the disease.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-11-14T08:29:44Z
DOI: 10.1177/08850666241297081
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- Adult Code Sepsis: A Narrative Review of its Implementation and Impact
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Authors: Andrés Giglio, María Aranda, Andres Ferre, Marcio Borges; María Aranda, Andres Ferre, Marcio Borges
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
This narrative review explores the implementation and impact of sepsis code protocols, an urgent intervention strategy designed to improve clinical outcomes in patients with sepsis. We examined the degree of implementation, activation criteria, areas of implementation, personnel involved, responses after activation, goals and targets, impact on clinical indicators, and challenges in implementation. The reviewed evidence suggests that sepsis codes can significantly reduce sepsis-related mortality and enhance early administration of treatments. However, variability in activation criteria and inconsistent application present ongoing challenges. The review considers the incorporation of newer scoring systems, such as NEWS and MEWS, and the potential integration of machine learning tools for early sepsis detection. It highlights the importance of tailoring implementation to specific healthcare contexts and the value of ongoing training to optimize sepsis response. Limitations include the ongoing controversy surrounding sepsis definitions and the need for standardized, feasible quality indicators. Future research should focus on standardizing activation criteria, improving protocol adherence, and exploring emerging technologies to enhance early sepsis detection and management. Despite challenges, sepsis codes show promise in improving patient outcomes when implemented thoughtfully and consistently across healthcare settings.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-11-04T07:52:56Z
DOI: 10.1177/08850666241293034
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- Cognitive and Functional Capacity Assessment of Individuals Who Were
Admitted to the Intensive Care Unit Due to COVID-19: A Prospective Cohort
Study-
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Authors: Juliana Cristina Fogaça Carneiro, Mayco Biasibetti, Folly Rodrigues, Gustavo de Castro Barroso, Fernanda Cechetti; Mayco Biasibetti, Folly Rodrigues, Gustavo de Castro Barroso, Fernanda Cechetti
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
AimThe goal of this study was to identify changes in cognitive and functional capacity after hospital discharge in those infected with COVID-19 who were admitted to the ICU.MethodsThis is a prospective cohort study carried out with individuals who were admitted to a hospital, from July 2021 to May 2022. The evaluations happened in three moments: at hospital discharge, 30 days after discharge and 90 days after discharge. The instruments applied are the following: handgrip dynamometer, Montreal Cognitive Assessment Basic questionnaire (MoCA-B), Barthel Index (BI), timed up and go test (TUG), hospital anxiety and depressive scale (HADS) and 36-Item Short Form Health Survey questionary (SF-36).Results74 individuals were eligible to participate in the study, 25 of which were followed for 90 days. Based on the results of the MoCA-b, there were no relevant cognitive changes after 3 months. According to the Barthel Index applied to each of the evaluations, the percentage of subjects that were classified as independent or minimally dependent was 48%, 92% then 96%, respectively, demonstrating that individuals can achieve a good degree of functional independence after 3 months. Despite that, the SF-36 demonstrated a score below the South Brazilian normal in some domains.ConclusionThe individuals studied did not present persistent cognitive changes after 3 months and functional capacity showed significant improvement during this period. However, when the assessment is about the self-perceived quality of life, the majority of domain values are still below expectations, deserving attention by the health professionals involved.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-10-29T08:49:34Z
DOI: 10.1177/08850666241291513
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- Extubation Advisor: Implementation and Evaluation of A Novel Extubation
Clinical Decision Support Tool-
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Authors: Brett N. Hryciw, Natasha Hudek, Jamie C. Brehaut, Christophe Herry, Nathan Scales, Emma Lee, Aimee J. Sarti, Karen E.A. Burns, Andrew J.E. Seely; Natasha Hudek, Jamie C. Brehaut, Christophe Herry, Nathan Scales, Emma Lee, Aimee J. Sarti, Karen E.A. Burns, Andrew J.E. Seely
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
ImportanceExtubation Advisor (EA) is a novel software tool that generates a synoptic report for each Spontaneous Breathing Trial (SBT) conducted to inform extubation decision-making.ObjectivesTo assess bedside EA implementation, perceptions of utility, and identify barriers and facilitators of use.Design, Setting and ParticipantsWe conducted a phase I mixed-methods interventional study in three mixed intensive care unit (ICUs) in two academic hospitals. We interviewed critical care physicians (MDs) and respiratory therapists (RTs) regarding user-centered design principles and usability.AnalysisWe evaluated our ability to consent participants (feasibility threshold 50%), capture complete data (threshold 90%), generate and review EA reports in real-time (thresholds 75% and 80%, respectively), and MD perception of tool usefulness (6-point Likert scale). We analyzed interview transcripts using inductive coding to identify facilitators and barriers to EA implementation and perceived benefit of tool use.ResultsWe enrolled 31 patients who underwent 70 SBTs. Although consent rates [31/31 (100%], complete data capture [68/68 (100%)], and EA report generation [68/70 (97.1%)] exceeded feasibility thresholds, reports were reviewed by MDs for [55/70 (78.6%)] SBTs. Mean MD usefulness score was 4.0/6. Based on feedback obtained from 36 interviews (15 MDs, 21 RTs), we revised the EA report twice and identified facilitators (ability to track patient progress, enhance extubation decision-making, and provide support in resource-limited settings) and barriers (resource constraints, need for education) to tool implementation. Half of respondents (9 MDs, 9 RTs; combined 50%) perceived definite or potential benefit to EA tool use.ConclusionThis is the first study of a waveform-based variability-derived, predictive clinical decision support tool evaluated in adult ICUs. Our findings support the feasibility of integrating the EA tool into bedside workflow. Clinical trials are needed to assess the utility of the EA tool in practice and its impact on extubation decision-making and outcomes.Trial RegistrationNCT04708509
Citation: Journal of Intensive Care Medicine
PubDate: 2024-10-24T07:47:43Z
DOI: 10.1177/08850666241291524
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- A Retrospective Closed Cohort Study on Distribution of Multidrug-Resistant
Bacteria in Ventilator-Associated Pneumonia and its Impact on Patient
Outcome-
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Authors: Tushar Mantri, Jyoti Burad, Safiya Al Hashmi, Said Salim Abood AL Jaadi, Badriya Aladawi, Wijdan Abdullah Said Balushi; Jyoti Burad, Safiya Al Hashmi, Said Salim Abood AL Jaadi, Badriya Aladawi, Wijdan Abdullah Said Balushi
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
ObjectivesVentilator-associated pneumonia (VAP) is a common and serious nosocomial infection affecting critically ill patients undergoing mechanical ventilation. This study investigated the prevalence of multidrug-resistant (MDR) organisms in VAP, the VAP rate, and the outcomes associated with MDR-VAP.MethodsThis retrospective single-center study, conducted in 2022, included adult ICU cases from April 2021 to March 2022, receiving mechanical ventilation for more than 48 h. Patient data were analyzed for demographics, comorbidities, empirical antibiotic use, and outcomes. MDR organisms were identified in respiratory cultures.ResultsAmong 447 patients, 133 developed VAP, with 96 cases being MDR-VAP. The mean age of the overall VAP population was 52 years, 70% of which were males. The incidence of VAP was 30.0% (95% CI: 25.7%–34.5%), while that of MDR-VAP was 21.6% (95% CI: 17.9%–25.8%). The most prevalent MDR organisms were Acinetobacter species (50%) and Klebsiella pneumoniae (46.9%). Empirical antibiotics were administered in 96% of VAP cases. The overall VAP rate was 38.03/1000 ventilator days. No single antimicrobial agent seemed to offer an empirical cover, as the susceptibility rate for most tested antimicrobials was less than 85%. Patients with MDR-VAP had a low survival rate (64.6%) and were less likely to be extubated at 13.5% compared to non-MDR-VAP (survival rate of 62.2%). COVID-19 patients had a high incidence of MDR VAP, especially with Acinetobacter. Overall, VAP mortality was 57.1%. The median ventilator days were 16 for VAP and only four for non-VAP.ConclusionGram-negative organisms, particularly Klebsiella and Acinetobacter, were the main MDR VAP culprits. MDR-VAP exhibited higher morbidity and mortality. A study focused on developing resistance by microorganisms is warranted for further understanding.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-10-24T07:47:04Z
DOI: 10.1177/08850666241290468
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- Implementing a Bedside Percutaneous Tracheostomy and Ultrasound
Gastrostomy Team Reduces Length of Stay and Hospital Costs Across Multiple
Critical Care Units in a 1500 Bed Tertiary Care Center-
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Authors: Douglas Houghton, Samarth Patel, Sergey Gerasim, Yaroslav Buryk, Nina Massad, Ayham Alkhachroum, Hany Y. Atallah, Kristine O'Phelan; Samarth Patel, Sergey Gerasim, Yaroslav Buryk, Nina Massad, Ayham Alkhachroum, Hany Y. Atallah, Kristine O'Phelan
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
BackgroundThousands of critically ill patients every year in the United States receive tracheostomy and gastrostomy procedures. Recent research has investigated the benefits of a combined team approach to these procedures, with associated decreases in length of stay (LOS) and hospital costs. This study's objective was to determine if implementing a bedside percutaneous tracheostomy and percutaneous ultrasound gastrostomy (PUG) team would reduce LOS and hospital costs. Design and Methods: This retrospective chart review compares the impact of implementing an ICU bedside percutaneous tracheostomy and PUG service team to the hospital's previous workflow (ie, pre-implementation). Inclusion criteria were adult patients with Ventilator Dependent Respiratory Failure (VDRF), a clinical indication for both procedures while admitted to the ICU and received both tracheostomy and gastrostomy procedures while admitted to the hospital. Pre- and post-implementation groups were compared across patients’ demographics, clinical characteristics, and outcomes. ICU LOS, hospital LOS and total hospital costs were the primary outcome measures. Results: A total of 101 adult critically ill patients were included in the analysis; 49 patients were in the pre-implementation group and 52 patients in the post-implementation group (ie, PUG group). Patients in the PUG group had a significantly shorter mean ICU LOS and hospital LOS, 10.9- and 14.7-day reductions respectively (p = 0.010, p = 0.006). PUG group patients also had a significant reduction in total hospital costs, a per patient cost savings of $34 778 (p = 0.043). Conclusions: This study supports implementing a bedside percutaneous tracheostomy and PUG team to reduce LOS and total hospital costs in patients with VDRF.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-10-22T01:17:48Z
DOI: 10.1177/08850666241289115
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- Outcomes Associated with the use of High Dose Corticosteroids and IL-6
Inhibitors for the Treatment of Acute Respiratory Distress Syndrome
Secondary to SARS COV-2-
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Authors: Tessa Milic, Kieran Shah, Anish Mitra, Sarah Stabler; Kieran Shah, Anish Mitra, Sarah Stabler
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
BackgroundDuring the COVID-19 pandemic, treatment strategies evolved rapidly. The RECOVERY trial established corticosteroids as the standard care for reducing mortality in COVID-19 patients. However, some critical care clinicians began using doses higher than those recommended in RECOVERY.ObjectiveTo characterize the use of high-dose corticosteroids and IL-6 inhibitors in critically ill COVID-19 patients and examine their association with adverse drug events (ADEs).MethodsA retrospective cohort study of 320 electronic health records (January 1, 2020 - June 30, 2022) was conducted on COVID-19 patients requiring high-flow oxygen or mechanical ventilation. Patients were categorized based on corticosteroid dose: “high dose dexamethasone” (daily dose greater than 12 mg and/or for longer than 10 days), “low dose dexamethasone” (daily dose 12 mg or less for 10 days or less), and “no dexamethasone” (no corticosteroid therapy). Subgroups were created based on IL-6 inhibitor use.ResultsHigh-dose dexamethasone was associated with increased odds of ADEs compared to low dose (OR 2.55, 95% CI 1.45 to 4.49) and no dexamethasone (OR 6.29, 95% CI 2.08 to 19.03). No additional efficacy benefit was observed in patients receiving high dose corticosteroids when compared to low dose corticosteroids. Patients receiving both an IL-6 inhibitor and high-dose dexamethasone had further increased odds of ADEs. High-dose dexamethasone was also associated with increased mortality compared to low dose (OR 3.78, 95% CI 1.97-7.25) and no dexamethasone (OR 15.22, 95% CI 3.27-70.74).ConclusionsAcknowledging the risk for residual confounding, higher doses of dexamethasone were associated with increased ADEs and mortality. These findings highlight the need for careful consideration of the use of high-dose dexamethasone.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-10-21T08:16:04Z
DOI: 10.1177/08850666241287514
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- Utilization of NIRS Monitor to Compare the Regional Cerebral Oxygen
Saturation Between Dexmedetomidine and Propofol Sedation in Mechanically
Ventilated Critically ill Patients with Sepsis- A Prospective Randomized
Control Trial-
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Authors: Atul Kumar Patidar, Puneet Khanna, Lokesh Kashyap, Bikash R. Ray, Souvik Maitra; Puneet Khanna, Lokesh Kashyap, Bikash R. Ray, Souvik Maitra1Department of Anesthesiology, Critical Care & Pain Medicine, 28730All India Institute of Medical Sciences, Delhi, India
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Aim & BackgroundDelirium frequently occurs in the acute phase of sepsis and is associated with increased ICU and hospital length of stay, duration of mechanical ventilation, and higher mortality rates. We utilized the Near-Infrared Spectroscopy monitor to measure and compare the regional cerebral oxygen saturation in mechanically ventilated patients of sepsis receiving either dexmedetomidine or propofol sedation and assessed the association between delirium and regional cerebral oxygen saturation.MethodsA single center prospective randomized control trial conducted over a period of two years, 54 patients were included, equally divided between propofol and dexmedetomidine groups. Patients received a blinded study drug, propofol (10 mg/mL) or dexmedetomidine (5 mcg/mL) via infusion pump according to randomization. Infusion rates were adjusted every 10 min based on weight-based titration tables, aiming for target sedation (RASS −2 to 0). Management components included pain monitoring using the CPOT score and delirium assessment using CAM-ICU score.ResultsDexmedetomidine group showed higher mean regional cerebral oxygen saturation as compared to propofol group (P = .036). No significant differences were found in mechanical ventilation or ICU stay durations, delirium-free days, or sedation cessation reasons. Delirium occurred in 36 patients, with lower mean regional cerebral oxygen saturation as compared to non-delirious patients.ConclusionThe dexmedetomidine group had higher regional cerebral oxygen saturation compared to the propofol group. Delirious patients showed lower cerebral oxygen saturation than non-delirious patients, suggesting a link between sedation type, cerebral oxygenation, and delirium.CTRI registration: REF/2021/11/048655 N
Citation: Journal of Intensive Care Medicine
PubDate: 2024-10-07T08:05:27Z
DOI: 10.1177/08850666241288141
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- Development of an Extended Cardiovascular SOFA Score Component Reflecting
Cardiac Dysfunction with Improved Survival Prediction in Sepsis: An
Exploratory Analysis in the Sepsis and Elevated Troponin (SET) Study-
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Authors: S. Lörstad, Y. Wang, S. Tehrani, S. Shekarestan, P. Åstrand, P. Gille-Johnson, T. Jernberg, J. Persson; Y. Wang, S. Tehrani, S. Shekarestan, P. Åstrand, P. Gille-Johnson, T. Jernberg, J. Persson
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
IntroductionThe cardiovascular component of the Sequential Organ Failure Assessment (SOFA) score does not correspond with contemporary clinical practice in sepsis or identify impaired cardiac function. Our aim was to develop a modified cardiovascular SOFA component that reflects cardiac dysfunction and improves the SOFA score's 30-day mortality discrimination.MethodsA cohort of sepsis patients from a previous study was divided into a training (n = 250) and test cohort (n = 253). Nine widely available measures of cardiovascular function were screened for association with 30-day mortality using natural cubic spline. High-sensitivity cardiac troponin T (hs-cTnT), N-terminal pro B-type natriuretic peptide (NT-proBNP) and heart rate (HR) were transformed into ordinal variables (0-4 points). The presence of atrial fibrillation (AF) was assigned two points. The SOFA score was extended by adding the variable points in different weights and combinations. The best-performing cardiac-extended model (CE-SOFA) was evaluated in the test cohort. Improved prognostic discrimination and calibration were assessed using logistic regression, area under receiver operating characteristic curves (AUC), Net Reclassification Improvement (NRI) index, and DeLong and Hoshmer-Lemeshow tests.ResultsIn the training cohort, all differently weighted and combined models using hs-cTnT, NT-proBNP and AF points added to the SOFA score showed improved discriminative ability (AUC 0.67-0.75) compared to the SOFA score (AUC 0.62; NRI P
Citation: Journal of Intensive Care Medicine
PubDate: 2024-10-01T07:03:43Z
DOI: 10.1177/08850666241282294
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- Myoclonus After Cardiac Arrest did not Correlate with Cortical Response on
Somatosensory Evoked Potentials-
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Authors: Adriana Y. Koek, Kyle A. Darpel, Temenuzhka Mihaylova, Wesley T. Kerr; Kyle A. Darpel, Temenuzhka Mihaylova, Wesley T. Kerr
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
PurposeMyoclonus after anoxic brain injury is a marker of significant cerebral injury. Absent cortical signal (N20) on somatosensory evoked potentials (SSEPs) after cardiac arrest is a reliable predictor of poor neurological recovery when combined with an overall clinical picture consistent with severe widespread neurological injury. We evaluated a clinical question of if SSEP result could be predicted from other clinical and neurodiagnostic testing results in patients with post-anoxic myoclonus.MethodsRetrospective chart review of all adult patients with post-cardiac arrest myoclonus who underwent both electroencephalographic (EEG) monitoring and SSEPs for neuroprognostication. Myoclonus was categorized as “non-myoclonic movements,” “myoclonus not captured on EEG,” “myoclonus without EEG correlate,” “myoclonus with EEG correlate,” and “status myoclonus.” SSEP results were categorized as all absent, all present, N18 and N20 absent bilaterally, and N20 only absent bilaterally. Cox proportional hazards with censoring was used to evaluate the association of myoclonus category, SSEP results, and confounding factors with survival.ResultsIn 56 patients, median time from arrest to either confirmed death or last follow up was 9 days. The category of myoclonus was not associated with SSEP result or length of survival. Absence of N20 s or N18 s was associated with shorter survival (N20 hazard ratio [HR] 4.4, p = 0.0014; N18 HR 5.5, p
Citation: Journal of Intensive Care Medicine
PubDate: 2024-09-30T08:12:33Z
DOI: 10.1177/08850666241287154
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- Predicting Parental Post-Traumatic Stress Symptoms Following their Child's
Stay in a Pediatric Intensive Care Unit, Prior to Discharge-
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Authors: Mekela M. Whyte-Nesfield, Eduardo A. Trujillo Rivera, Daniel Kaplan, Simon Li, Pamela S. Hinds, Murray M. Pollack; Eduardo A. Trujillo Rivera, Daniel Kaplan, Simon Li, Pamela S. Hinds, Murray M. Pollack
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Objective: Develop an inpatient predictive model of parental post-traumatic stress (PTS) following their child's care in the Pediatric Intensive Care Unit (PICU). Design: Prospective observational cohort. Setting: Two tertiary care children's hospitals with mixed medical/surgical/cardiac PICUs. Subjects: Parents of patients admitted to the PICU. Interventions: None. Measurements and Main Results: Preadmission and admission data from 169 parents of 129 children who completed follow up screening for parental post-traumatic stress symptoms at 3-9 months post PICU discharge were utilized to develop a predictive model estimating the risk of parental PTS 3-9 months after hospital discharge. The parent cohort was predominantly female (63%), partnered (75%), and working (70%). Child median age was 3 years (IQR 0.36-9.04), and more than half had chronic illnesses (56%) or previous ICU admissions (64%). Thirty-five percent (60/169) of parents met criteria for PTS (>9 on the Post-traumatic Stress Disorder Symptom Scale-Interview). The machine learning model (XGBoost) predicted subjects with parental PTS with 76.7% accuracy, had a sensitivity of 0.83 (95% CI 0.586, 0.964), a specificity of 0.72 (95% CI 0.506, 0.879), a precision of 0.682 (95% CI 0.451, 0.861) and number needed to evaluate of 1.47 (95% CI 1.16, 1.98). The area under the receiver operating curve was 0.78 (95% CI 0.64, 0.92). The most important predictive pre-admission and admission variables were determined using the Local Interpretable Model-Agnostic Explanation, which identified seven variables used 100% of the time. Composite variables of parental history of mental illness and traumatic experiences were most important. Conclusion: A machine learning model using parent risk factors predicted subsequent PTS at 3-9 months following their child's PICU discharge with an accuracy of 76.7% and number needed to evaluate of 1.47. This performance is sufficient to identify parents who are at risk during hospitalization, making inpatient and acute post admission mitigation initiatives possible.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-09-30T07:45:16Z
DOI: 10.1177/08850666241287442
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- Intubation and Mechanical Ventilation in Patients with Acute Pulmonary
Embolism: A Scoping Review-
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Authors: Eun Sang Lee, Cecilie Dahl Baltsen, William B. Stubblefield, Asger Granfeldt, Asger Andersen, Karsten Stannek, David M. Dudzinski, Christopher Kabrhel, Mads Dam Lyhne; Cecilie Dahl Baltsen, William B. Stubblefield, Asger Granfeldt, Asger Andersen, Karsten Stannek, David M. Dudzinski, Christopher Kabrhel, Mads Dam Lyhne
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
ObjectivesHigh-risk acute pulmonary embolism (PE) is associated with significant mortality and may require emergency endotracheal intubation and mechanical ventilation. Intubation and ventilation are thought to exacerbate cardiorespiratory instability. Our purpose was to conduct a systematic literature review to identify studies investigating peri-intubation events in acute PE.MethodsA systematic search of Medline, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library was performed. Results were screened by two independent observers. Studies reporting on intubation and positive pressure ventilation in acute PE patients were included. The primary outcome was adverse events during the peri-intubation period. Data was synthesized and an assessment of risk of bias was conducted. The review was registered on PROSPERO (CRD42023444483).Results4100 unique articles were screened. Three retrospective studies comprising 104 patients with acute PE met criteria and were included. Peri-intubation, hemodynamic collapse was observed in 19%-28% of cases. Patients with hemodynamic collapse exhibited higher rates of echocardiographic RV dysfunction.ConclusionsPeri-intubation adverse events are common in patients with acute PE. Current evidence is limited and highlights the need for further research to optimize management of respiratory failure in acute PE and patient selection for intubation to improve patient outcomes.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-09-25T08:10:10Z
DOI: 10.1177/08850666241285862
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- Effect of Extended Prone Positioning in Intubated COVID-19 Patients with
Acute Respiratory Distress Syndrome, a Revision Letter-
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Authors: Santiago Ferrière-Steinert, Maximiliano Acevedo de la Barra, Alexandra Neman, Tamara Vergara Cerón, Rodrigo A. Cornejo, Abraham I.vn J. Gajardo; Maximiliano Acevedo de la Barra, Alexandra Neman, Tamara Vergara Cerón, Rodrigo A. Cornejo, Abraham I.vn J. Gajardo
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
The systematic review and meta-analysis performed by Kang et al about the effect of extended prone positioning in intubated COVID-19 patients with ARDS presents valuable findings on the effectiveness and safety of extended prone positioning, but also raises several concerns which require clarifications. The inclusion of observational studies without any control group, the use of crude rather than adjusted estimates in key variables from observational studies, an error in data extraction from randomized clinical trials, and the employment of odds ratios rather than risk ratios, may mislead interpretations of the aforementioned intervention.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-09-19T07:45:08Z
DOI: 10.1177/08850666241286484
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- When Fulfilling a Professional Obligation Causes Moral Distress: A New
Evaluative Approach-
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Authors: Daniel T. Kim, Wayne Shelton, Linda Breslin, Megan K. Applewhite; Wayne Shelton, Linda Breslin, Megan K. Applewhite
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
PurposeThe term ‘moral distress’ was coined by Andrew Jameton to name the anguish that clinicians feel when they cannot pursue what they judge to be right because of institutional constraints. We argue that moral distress in critical care should also be addressed as a function of the constraints of ethics and propose an evaluative approach to the experience considering its implications for professional identity.MethodWe build on a selective review of the literature and analyze a paradigmatic example of moral distress, namely, clinicians who feel compelled to perform procedures on patients that seem futile. Such cases are commonly cited by clinicians as among the most morally distressing.ResultsOur analysis shows that (1) physicians’ experiences of moral distress can stem not only from toxic workplace cultures and institutional constraints on their time and resources for patient care but also from the limits of ethical reasoning and (2) an emotion-based evaluative approach to analyzing moral distress is needed to address its hazards for professional identity.ConclusionWe propose a new evaluative approach to moral distress with implications for professional identity and the need for institutional education and support.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-09-19T07:44:40Z
DOI: 10.1177/08850666241285861
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- Standardized Temporary Atrial Epicardial Wire Locations Lead to Enhanced
Atrial Signal Identification-
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Authors: Nir Atlas, Xiao Zhang, Jenna N. Torgeson, Joshua Hermsen, William J. Gibson, Adam M. Harmon, Nicholas H. Von Bergen; Xiao Zhang, Jenna N. Torgeson, Joshua Hermsen, William J. Gibson, Adam M. Harmon, Nicholas H. Von Bergen
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Background: Arrhythmias, common after pediatric cardiac surgery, are associated with increased morbidity and mortality. Atrial epicardial wires (AEW) improve diagnostic accuracy but have variable pacing and sensing properties based on their location. Even so, there are no longitudinal prospective pediatric studies examining ideal placement of AEW. Methods: This multicenter study compared atrial amplitudes, pacing sensitivities and thresholds via AEW placed at Bachmann's Bundle (BB) and the interatrial groove near the right pulmonary veins (IGRPV) versus the surgeons’ standard locations. An AtriAmp system was used to obtain an atrial ECG to calculate atrial and ventricular amplitude from atrial electrograms on the bedside monitor. Sensitivities and thresholds via a temporary pacemaker were documented. ANOVA tests with repeated measures and post-hoc pairwise comparisons were performed to compare variables within the first 24-h postoperative hours. Mixed effects linear regression models were employed to examine daily trends. Results: In the first 24-h following cardiac surgery, AEW at BB and IGRPV showed significantly larger atrial amplitudes than the surgeons’ standard locations. In addition, there was a negative trend in atrial ECG amplitude in all AEW from postoperative days 0 to 1; however, subsequent days showed a positive mean change in atrial amplitude with largest increase seen at BB. Atrial sensing as measured by the temporary pacemaker had statistically greater atrial signal amplitude from the BB-IGRPV set in both polarities (ie, with the BB as the – or + electrode pair) as compared to the surgeons’ standard locations. No difference in atrial thresholds (mA) were noted in the immediate postoperative period or over time, with a relatively low atrial threshold at all sites. Conclusion: Standardization of AEW at Bachmann's Bundle can yield largest atrial amplitudes by atrial ECG and highest atrial sensing parameters without compromising atrial thresholds.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-09-19T07:44:27Z
DOI: 10.1177/08850666241279229
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- Plasma Adsorption with the MTx.100 Column in Critically Ill COVID-19
Patients: A Prospective Study and Propensity Score Analysis-
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Authors: Christopher Choi, Nicole De Simone, Christopher B. Webb, Peiman Lahsaei, Sean G. Yates, Jay S. Raval, Michelle S. Harkins, Donald J. Hillebrand, Antonio Belli, Nicolas A. Schlapobersky, Tina S. Ipe, Grace C. Banez-Sese, Vikramjit S. Khangoora, Steven D. Nathan, Trudy M. Demko, David C. Young, Sigalit Caron, Ravi Sarode; Nicole De Simone, Christopher B. Webb, Peiman Lahsaei, Sean G. Yates, Jay S. Raval, Michelle S. Harkins, Donald J. Hillebrand, Antonio Belli, Nicolas A. Schlapobersky, Tina S. Ipe, Grace C. Banez-Sese, Vikramjit S. Khangoora, Steven D. Nathan, Trudy M. Demko, David C. Young, Sigalit Caron, Ravi Sarode
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
BackgroundEarly in the COVID-19 pandemic, patients with severe disease admitted to the intensive care unit (ICU) had a high incidence of mortality. We aimed to investigate whether plasma adsorption with the MTx.100 Column could improve survival.MethodsWe performed a prospective, single-arm, multicenter, Emergency Use Authorization (EUA) trial in patients admitted to the ICU with severe COVID-19 who were worsening despite standard therapy. The primary outcome was all-cause mortality on day 28. Outcomes were analyzed using both a pre-specified performance goal (PG), and a propensity score-matched (PSM) analysis from the highest enrolling center, in which patients treated with the standard of care (SOC) plus the MTx.100 Column (n = 70) were compared to a contemporaneous cohort treated at the same center with SOC only (n = 244).FindingsBetween May 21, 2020, and November 2, 2021, 107 patients with severe COVID-19 (mean age 58.1) at 7 US centers were enrolled and had at least one plasma adsorption treatment initiated. All-cause mortality on day 28 was 37.4% (40/107), an improvement over the prespecified PG (88.1%, p
Citation: Journal of Intensive Care Medicine
PubDate: 2024-09-13T06:32:11Z
DOI: 10.1177/08850666241280031
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- N-acetyl-cysteine in Intensive Care Unit Patients with Acute Respiratory
Distress Syndrome due to COVID-19: A Retrospective Cohort Study-
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Authors: Diego González-Guzmán, Carlos A. Andrade-Castellanos, Marco A. Ponce-Gallegos, Ignacio Mesina-Estarrón, José G. Mora-Almanza, Hugo E. Ruelas-Moreno, Daniel Rodríguez-González, Omar Eguia-Ortega, Luis Enrique Colunga-Lozano; Carlos A. Andrade-Castellanos, Marco A. Ponce-Gallegos, Ignacio Mesina-Estarrón, José G. Mora-Almanza, Hugo E. Ruelas-Moreno, Daniel Rodríguez-González, Omar Eguia-Ortega, Luis Enrique Colunga-Lozano
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
COVID-19-related acute respiratory distress syndrome (ARDS) is linked to mortality, primarily due to a cytokine storm, oxidative stress imbalance, and pro-thrombotic state.PurposeWe assessed the potential association between N-acetyl-cysteine (NAC) and clinical outcomes in critically ill subjects with COVID-19-related ARDS.Material and MethodsWe included subjects with confirmed COVID-19 who were admitted to our ICU between March 1, 2020, and January 31, 2021, due to ARDS and necessitating invasive mechanical ventilation (IMV). Subjects who received standard of care (SOC) were compared with subjects who additionally received NAC 600 mg bid orally.ResultsA total of 243 subjects were included in this study. The results indicate significantly improved survival rates in the NAC plus SOC group, both in the unadjusted analysis and after adjusting for confounding factors such as ARDS severity (HR 0.48, 95% CI 0.32-0.70).ConclusionsWe found that oral administration of NAC was associated with reduced mortality in critically ill patients with COVID-19 related ARDS.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-09-12T06:47:09Z
DOI: 10.1177/08850666241281281
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- A Nomogram for Predicting Postoperative Pulmonary Complications in
Critical Patients Transferred to ICU After Abdominal Surgery-
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Authors: Bin Wang, Han Sheng Liang, Jia Wei Shen, You Zhong An, Yi Feng; Han Sheng Liang, Jia Wei Shen, You Zhong An, Yi Feng
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
ObjectiveThe purpose of this study was to investigate the risk factors associated with postoperative pulmonary complications(PPCs) in critically ill patients transferred to intensive care unit(ICU) after abdominal surgery and develop a predictive model for this disease.MethodsData for 3716 patients who were admitted to ICU after abdominal surgery in Peking University People's Hospital between January 2015 and December 2020 were retrospectively collected and analyzed to identify the risk factors and develop a nomogram prediction model. Data for patients admitted to ICU following abdominal surgery at Peking University People's Hospital from March 2021 to December 2022 were prospectively collected as a validation set to validate and assess the model.Results10 independent risk factors for PPCs in critically ill patients transferred to ICU after abdominal surgery were identified. A nomogram prediction model was constructed for PPCs in this group patients, the area under ROC curve was 0.771[95%CI: 0.756,0.786] and 0.759[95%CI: 0.726,0.792] in the training set and validation set, respectively.ConclusionsIn this study, independent risk factors for PPCs in critically ill patients transferred to ICU after abdominal surgery were identified. A nomogram prediction model for PPCs in critically ill surgical population was constructed using these factors, demonstrating a good predictive value.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-09-12T06:46:40Z
DOI: 10.1177/08850666241280900
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- Barriers and Strategies to Effective Serious Illness Communication for
Patients with End-Stage Liver Disease in the Intensive Care Setting-
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Authors: Cristal Brown, Saif Khan, Trisha M. Parekh, Andrew J Muir, Rebecca L. Sudore; Saif Khan, Trisha M. Parekh, Andrew J Muir, Rebecca L. Sudore
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Background: Patients with end-stage liver disease (ESLD) often require Intensive Care Unit (ICU) admission during the disease trajectory, but aggressive medical treatment has not resulted in increased quality of life for patients or caregivers. Methods: This narrative review synthesizes relevant data thematically exploring the current state of serious illness communication in the ICU with identification of barriers and potential strategies to improve performance. We provide a conceptual model underscoring the importance of providing comprehensible disease and prognosis knowledge, eliciting patient values and aligning these values with available goals of care options through a series of discussions. Achieving effective serious illness communication supports the delivery of goal concordant care (care aligned with the patient's stated values) and improved quality of life. Results: General barriers to effective serious illness communication include lack of outpatient serious illness communication discussions; formalized provider training, literacy and culturally appropriate patient-directed serious illness communication tools; and unoptimized electronic health records. ESLD-specific barriers to effective serious illness communication include stigma, discussing the uncertainty of prognosis and provider discomfort with serious illness communication. Evidence-based strategies to address general barriers include using the Ask-Tell-Ask communication framework; clinician training to discuss patients’ goals and expectations; PREPARE for Your Care literacy and culturally appropriate written and online tools for patients, caregivers, and clinicians; and standardization of documentation in the electronic health record. Evidence-based strategies to address ESLD-specific barriers include practicing with empathy; using the “Best-Case, Worst Case” prognostic framework; and developing interdisciplinary solutions in the ICU. Conclusion: Improving clinician training, providing patients and caregivers easy-to-understand communication tools, standardizing EHR documentation, and improving interdisciplinary communication, including palliative care, may increase goal concordant care and quality of life for critically ill patients with ESLD.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-09-09T09:17:25Z
DOI: 10.1177/08850666241280892
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- Predicting Mortality in Sepsis-Associated Acute Respiratory Distress
Syndrome: A Machine Learning Approach Using the MIMIC-III Database-
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Authors: Shengtian Mu, Dongli Yan, Jie Tang, Zhen Zheng; Dongli Yan, Jie Tang, Zhen Zheng1Department of Intensive Care Unit, Cancer Hospital of China Medical University, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & Institute, Shenyang, China
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
BackgroundTo develop and validate a mortality prediction model for patients with sepsis-associated Acute Respiratory Distress Syndrome (ARDS).MethodsThis retrospective cohort study included 2466 patients diagnosed with sepsis and ARDS within 24 h of ICU admission. Demographic, clinical, and laboratory parameters were extracted from Medical Information Mart for Intensive Care III (MIMIC-III) database. Feature selection was performed using the Boruta algorithm, followed by the construction of seven ML models: logistic regression, Naive Bayes, k-nearest neighbor, support vector machine, decision tree, Random Forest, and extreme gradient boosting. Model performance was evaluated using the area under the receiver operating characteristic curve, accuracy, sensitivity, specificity, positive predictive value, and negative predictive value.ResultsThe study identified 24 variables significantly associated with mortality. The optimal ML model, a Random Forest model, demonstrated an AUC of 0.8015 in the test set, with high accuracy and specificity. The model highlighted the importance of blood urea nitrogen, age, urine output, Simplified Acute Physiology Score II, and albumin levels in predicting mortality.ConclusionsThe model's superior predictive performance underscores the potential for integrating advanced analytics into clinical decision-making processes, potentially improving patient outcomes and resource allocation in critical care settings.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-09-05T09:16:29Z
DOI: 10.1177/08850666241281060
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- Evaluation of Sepsis-Related Medical Emergency Team (MET) Calls with
Pharmacist Involvement and Time to Antimicrobial Administration-
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Authors: Li Xian Simon Du, Gail Emily Edwards, Zohal Rashidzada, Harvey Newnham, Steve McGloughlin, Judit Orosz, Erica Y. Tong; Gail Emily Edwards, Zohal Rashidzada, Harvey Newnham, Steve McGloughlin, Judit Orosz, Erica Y. Tong
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Objective: To evaluate the difference in proportion of patients receiving antimicrobials within one hour of sepsis recognition at sepsis-related Medical Emergency Team (MET) calls, without or with a sepsis-credentialed pharmacist. Design: Retrospective pre and post-intervention study. Setting: Single centre tertiary referral hospital. Participants: Patients admitted to the General Medicine Unit who had a sepsis-related MET call 24 hrs per day, and all other units from 17:00-08:00 hrs from August 2019 to Jan 2020 in the pre-intervention cohort and Aug 2020 to Jan 2021 for the post-intervention cohort. Interventions: Pharmacists attended MET calls to assist selection of antimicrobials, collaboratively prescribe with the medical officers, ensure supply, provide advice on dosing calculations, reconstitution, and administration. The pre-intervention cohort (Aug 2019-Jan 2020) did not have credentialed pharmacists’ involvement at MET calls. Outcome Measures: Proportion of patients who received antimicrobials within one hours of MET call. Results: There were 97 sepsis-related MET calls in the pre-intervention cohort and 110 sepsis-related MET calls in the post-intervention cohort. A significantly higher proportion of patients received antimicrobials within one hour with pharmacist involvement, compared to control (81.3% vs 59.7%, P = .0006). A reduction in median time to antimicrobial administration (43 min vs 54 min, P = .017) was observed. Conclusion: Sepsis-related MET calls with pharmacist involvement experienced a greater proportion of patients receiving antimicrobials within one hour of sepsis recognition, and a reduction in median time to antimicrobial administration. These results provide support for routine pharmacist involvement at MET calls to assist patients receiving medications in a timely and efficient manner.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-09-05T07:40:19Z
DOI: 10.1177/08850666241277507
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- Clinical characteristics and prognosis of patients with early
sepsis-related liver injury in Northeast China-
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Authors: Yan Song, Al-Mogahed Maged Abdulsalam Mohammed Ali, Weiying Yang, Lichao Sun; Al-Mogahed Maged Abdulsalam Mohammed Ali, Weiying Yang, Lichao Sun1Department of Emergency Medicine, 117971First Hospital of Jilin University, Changchun, China
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Background: Sepsis-associated liver injury (SALI) occurs in about a third of septic patients, and it is often a poor prognostic factor. However, there are few studies on early SALI and its impact on the clinical course of sepsis. Here we explored the clinical characteristics, risk factors, and prognosis of early SALI. Methods: Two hundred and one patients with confirmed sepsis were divided into those with and without early SALI (on admission) based on liver function. The clinical characteristics and prognosis were compared between groups and associated factors identified by multivariable regression analysis. Results: Sepsis-related liver injury was present in 18.9% of septic patients on admission. High aspartate transaminase (AST), high direct bilirubin, and low plasma thromboplastin antecedent (PTA, factor XI) were risk factors for sepsis with SALI: the area under the AST curve was 0.825, corresponding to a sensitivity of 0.67 and a specificity of 0.93 (cutoff 91.6 U/L), the area under the direct bilirubin curve was 0.86, corresponding to a sensitivity of 0.83 and a specificity of 0.71 (cutoff 8.35 μmol/L), and the area under the PTA curve was 0.678, corresponding to a sensitivity of 0.47 and a specificity of 0.93 (cutoff 54.0). Conclusion: Septic patients with early SALI have early-onset coagulation disorders that must be recognized to instigate early intervention and halt sepsis progression. Elevated AST, PTA, and direct bilirubin may be independent risk markers of sepsis-related liver injury, and extra clinical vigilance is required when these factors are noted in patients with sepsis.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-08-23T07:38:40Z
DOI: 10.1177/08850666241277512
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- Oncology Intensive Care Units: Distinguishing Features and Clinical
Considerations-
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Authors: Hugh Davis, Steve Tseng, Weijia Chua; Steve Tseng, Weijia Chua
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
The rapidly advancing field of cancer therapeutics has led to increased longevity among cancer patients as well as increasing complexity of cancer-related illness and associated comorbid conditions. As a result, institutions and organizations that specialize in the in-patient care of cancer patients have similarly evolved to meet the constantly changing needs of this unique patient population. Within these institutions, the intensive care units that specialize in the care of critically ill cancer patients represent an especially unique clinical resource. This article explores some of the defining and distinguishing characteristics associated with oncology ICUs.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-08-23T07:38:04Z
DOI: 10.1177/08850666241268857
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- “The Psychiatric Domain of Post-Intensive Care Syndrome: A Review
for the Intensivist”-
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Authors: Allison Rhodes, Christopher Wilson, Dimitar Zelenkov, Kathryne Adams, Janelle O. Poyant, Xuan Han, Anthony Faugno, Cristina Montalvo; Christopher Wilson, Dimitar Zelenkov, Kathryne Adams, Janelle O. Poyant, Xuan Han, Anthony Faugno, Cristina Montalvo
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Post-intensive care syndrome (PICS) is a clinical syndrome characterized by new or worsening changes in mental health, cognition, or physical function that persist following critical illness. The psychiatric domain of PICS encompasses new or worsened psychiatric burdens following critical illness, including post-traumatic stress disorder (PTSD), depression, and anxiety. Many of the established predisposing and precipitating factors for the psychiatric domain of PICS are commonly found in the setting of critical illness, including mechanical ventilation (MV), exposure to sedating medications, and physical restraint. Importantly, previous psychiatric history is a strong risk factor for the development of the psychiatric domain of PICS and should be considered when screening patients to diagnose psychiatric impairment and interventions. Delirium has been associated with psychiatric symptoms following ICU admission, therefore prevention warrants careful consideration. Dexmedetomidine has been shown to have the lowest risk for development of delirium when compared to other sedatives and has been the only sedative studied in relation to the psychiatric domain of PICS. Nocturnal dexmedetomidine and intensive care unit (ICU) diaries have been associated with decreased psychiatric burden after ICU discharge. Studies evaluating the impact of other intra-ICU practices on the development of the psychiatric domain of PICS, including the ABCDEF bundle, depth of sedation, and daily spontaneous awakening trials, have been limited and inconclusive. The psychiatric domain of PICS is difficult to treat and may be less responsive to multidisciplinary post-discharge programs and targeted interventions than the cognitive and physical domains of PICS. Given the high morbidity associated with the psychiatric domain of PICS, intensivists should familiarize themselves with the risk factors and intra-ICU interventions that can mitigate this important and under-recognized condition.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-08-22T08:07:03Z
DOI: 10.1177/08850666241275582
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- Artificial Intelligence-Based Models for Prediction of Mortality in ICU
Patients: A Scoping Review-
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Authors: Orkideh Olang, Sana Mohseni, Ali Shahabinezhad, Yasaman Hamidianshirazi, Amireza Goli, Mansour Abolghasemian, Mohammad Ali Shafiee, Mehdi Aarabi, Mohammad Alavinia, Pouyan Shaker; Sana Mohseni, Ali Shahabinezhad, Yasaman Hamidianshirazi, Amireza Goli, Mansour Abolghasemian, Mohammad Ali Shafiee, Mehdi Aarabi, Mohammad Alavinia, Pouyan Shaker
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Background and ObjectiveHealthcare professionals may be able to anticipate more accurately a patient's timing of death and assess their possibility of recovery by implementing a real-time clinical decision support system. Using such a tool, the healthcare system can better understand a patient's condition and make more informed judgements about distributing limited resources. This scoping review aimed to analyze various death prediction AI (Artificial Intelligence) algorithms that have been used in ICU (Intensive Care Unit) patient populations.MethodsThe search strategy of this study involved keyword combinations of outcome and patient setting such as mortality, survival, ICU, terminal care. These terms were used to perform database searches in MEDLINE, Embase, and PubMed up to July 2022. The variables, characteristics, and performance of the identified predictive models were summarized. The accuracy of the models was compared using their Area Under the Curve (AUC) values.ResultsDatabases search yielded an initial pool of 8271 articles. A two-step screening process was then applied: first, titles and abstracts were reviewed for relevance, reducing the pool to 429 articles. Next, a full-text review was conducted, further narrowing down the selection to 400 key studies. Out of 400 studies on different tools or models for prediction of mortality in ICUs, 16 papers focused on AI-based models which were ultimately included in this study that have deployed different AI-based and machine learning models to make a prediction about negative patient outcome. The accuracy and performance of the different models varied depending on the patient populations and medical conditions. It was found that AI models compared with traditional tools like SAP3 or APACHE IV score were more accurate in death prediction, with some models achieving an AUC of up to 92.9%. The overall mortality rate ranged from 5% to more than 60% in different studies.ConclusionWe found that AI-based models exhibit varying performance across different patient populations. To enhance the accuracy of mortality prediction, we recommend customizing models for specific patient groups and medical contexts. By doing so, healthcare professionals may more effectively assess mortality risk and tailor treatments accordingly. Additionally, incorporating additional variables—such as genetic information—into new models can further improve their accuracy.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-08-16T04:15:15Z
DOI: 10.1177/08850666241277134
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- Outcomes and Practices of Endotracheal Intubation Using the Glasgow Coma
Scale in Acute Non-Traumatic Poisoning: A Systematic Review and
Meta-Analysis of Proportions-
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Authors: Abdelrahman Nanah, Fatima Abdeljaleel, Júlio Ken Matsubara, Marcos Vinicius Fernandes Garcia; Fatima Abdeljaleel, Júlio Ken Matsubara, Marcos Vinicius Fernandes Garcia
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
BackgroundAcute poisoning often results in decreased consciousness, necessitating airway assessment and management. Existing literature in the trauma setting suggests the importance of airway protection in unconscious patients to prevent complications, including aspiration. Practices for endotracheal intubation in non-traumatic acute poisoning are poorly described and variable, particularly regarding the use of a Glasgow Coma Scale (GCS) ≤ 8 threshold for intubation.MethodsA systematic review and meta-analysis of proportions was conducted to evaluate intubation rates and outcomes in patients presenting for acute non-traumatic poisoning. Studies were excluded if the primary indication for intubation was not airway protection. We analyzed rates of intubation, mortality, and aspiration by subgrouping patients into GCS ≤ 8, GCS 9–15, or mixed GCS. Common and random-effects analysis were used, supplemented by subgroup analyses.Results39 studies were included in the analysis, involving 15,959 patients. Random-effects pooled intubation rates varied significantly across GCS categories: GCS ≤ 8 (30.0%, I2 = 92%, p
Citation: Journal of Intensive Care Medicine
PubDate: 2024-08-16T01:13:44Z
DOI: 10.1177/08850666241275041
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- Prevalence and Risk Factors of Intensive Care Unit-acquired Weakness in
Patients With COVID-19: A Systematic Review and Meta-analysis-
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Authors: Ya-Chi Chuang, Sz-Iuan Shiu, Yu-Chun Lee, Yu-Lin Tsai, Yuan-Yang Cheng; Sz-Iuan Shiu, Yu-Chun Lee, Yu-Lin Tsai, Yuan-Yang Cheng
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
BackgroundIntensive care unit acquired weakness (ICUAW) is a common neuromuscular complication of critical illness, impacting patients’ recovery and long-term outcomes. However, limited evidence is available on pooled prevalence and risk factors of ICUAW specifically in the COVID-19-infected population.MethodsWe searched on PubMed, Embase, Cochrane Library, Web of Science, PEDro, and EBSCOhost/CINAHL up to January 31, 2024. Data synthesis was conducted using the Freeman-Tukey double-arcsine transformation model for the pooled prevalence rate and odds ratios with corresponding 95% confidence intervals was used to identify risk factors.ResultsThe pooled prevalence of ICUAW in COVID-19 patients was 55% in eight studies on 868 patients. Risk factors for developing ICUAW in these patients were: old age (WMD 4.78, 95% CI, 1.06-8.49), pre-existing hypertension (OR = 1.63, 95% CI, 1.02-2.61), medical intervention of prone position (OR = 5.21, 95% CI, 2.72-9.98), use of neuromuscular blocking agents (NMBA) (OR = 12.04, 95% CI, 6.20-23.39), needed tracheostomy (OR = 18.07, 95% CI, 5.64-57.92) and renal replacement therapy (RRT) (OR = 5.24, 95% CI = 2.36-11.63).ConclusionsThe prevalence of ICUAW in patients with COVID-19 was considered relatively high. Older age, pre-existing hypertension, medical intervention of prone position, NMBA use, needed tracheostomy and RRT were likely risk factors. In the future, interdisciplinary medical team should pay attention to high-risk groups for ICUAW prevention and early treatments.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-08-14T11:11:34Z
DOI: 10.1177/08850666241268437
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- Venoarterial Extracorporeal Membrane Oxygenation Therapy in Patients with
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Authors: Alison Grazioli, Joseph Rabin, Raymond P. Rector, Zhongjun J. Wu, Allen P. Burke, Nima Sharifai, Aakash Shah, Bradley S. Taylor, Mark T. Gladwin; Joseph Rabin, Raymond P. Rector, Zhongjun J. Wu, Allen P. Burke, Nima Sharifai, Aakash Shah, Bradley S. Taylor, Mark T. Gladwin
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Sickle cell disease (SCD) is associated with substantial morbidity and early mortality in afflicted adults. Cardiopulmonary complications that occur at increased frequency in SCD such as pulmonary embolism, pulmonary arterial hypertension, and acute chest syndrome can acutely worsen right ventricular function and lead to cardiogenic shock. Mechanical circulatory support including venoarterial extracorporeal membrane oxygenation (VA ECMO) is being increasingly utilized to treat hemodynamic collapse in various patient populations. However, a paucity of literature exists to guide the use of mechanical circulatory support in adults with SCD where disease-related sequela and unique hematologic aspects of this disorder may complicate extracorporeal therapy and must be understood. Here, we review the literature and describe three cases of adult patients with SCD who developed cardiogenic shock from acute decompensated right heart failure and were treated clinically with VA ECMO. Using an in vitro ECMO system, we investigate a potential increased risk of systemic fat emboli in patients with SCD who may be experiencing vaso-occlusive events with bone marrow involvement given the high-volume shunting of blood from venous to arterial systems with VA ECMO. The purpose of this study is to describe available extracorporeal life support experiences, review potential complications, and discuss the special considerations needed to further our understanding of the utility of VA ECMO in those with SCD.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-08-14T11:11:02Z
DOI: 10.1177/08850666241260605
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- Graft Versus Host Disease: Management Issues in the Intensive Care Unit
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Authors: Amandeep Salhotra, Dat Ngo, Waasil Kareem; Dat Ngo, Waasil Kareem
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Graft versus host disease (GVHD) in acute and chronic forms is a frequent post-transplant complication and seen in 50% of patients in acute and up to 70% cases in chronic GVHD setting. Patients with multiorgan involvement and those who are steroid refractory, frequently present with complications arising from this post-transplant complication. These GVHD patients are frequently managed in the Intensive care unit for treatment of air leaks, effusions, management of hypoxemia due to lung GVHD or infections. Close coordination between hematologists and Pulmonary medicine specialists is critical for timely management of these complications to improve patient outcomes.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-08-07T11:15:42Z
DOI: 10.1177/08850666241271431
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- Droxidopa for Vasopressor Weaning in Critically Ill Patients with
Persistent Hypotension: A Multicenter, Retrospective, Single-Arm
Observational Study-
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Authors: Andrew J Webb, Gianna LH Casal, Kelly A Newman, Justin R Culshaw, Kalynn A Northam, Edmond J Solomon, Sarah M Beargie, Riley B Johnson, Natasha D Lopez, Bryan D. Hayes, Russel J. Roberts; Gianna LH Casal, Kelly A Newman, Justin R Culshaw, Kalynn A Northam, Edmond J Solomon, Sarah M Beargie, Riley B Johnson, Natasha D Lopez, Bryan D. Hayes, Russel J. Roberts
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
BackgroundPersistent vasopressor requirements are a common reason for delayed liberation from the intensive care unit (ICU) and adjunct oral agents are sometimes used to hasten time to vasopressor discontinuation. We sought to describe the use of droxidopa for vasopressor weaning in critically ill patients with prolonged hypotension.Materials and MethodsThis retrospective, single-arm, observational study included adult patients admitted to an ICU at two academic centers between 06/2016–07/2023 who received droxidopa for vasopressor weaning. Patients who received droxidopa prior to admission or for another indication were excluded. The primary outcome was time to vasopressor discontinuation, defined as when vasopressors were stopped and remained off for at least 24 h. Secondary outcomes included rates of tachycardia and hypotension post-initiation, norepinephrine equivalents pre- and post-initiation, concomitant oral agent use, and dosing. A subgroup analysis was conducted in patients receiving droxidopa via feeding tubes.ResultsA total of 30 patients met inclusion criteria. Median age was 62 years old, 12 (40%) were female, and 73% were in a cardiac/cardiac surgical ICU. Patients were on vasopressors for a median of 16 days prior to droxidopa initiation. Median (IQR) time to vasopressor discontinuation was 70 h (23-192) and norepinephrine equivalents decreased immediately after initiation (0.08 vs 0.02 mcg/kg/min, p
Citation: Journal of Intensive Care Medicine
PubDate: 2024-08-07T03:10:57Z
DOI: 10.1177/08850666241270089
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- Approaches to Cholecystitis: Surgical, Endoscopic, and Percutaneous
Management-
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Authors: Nicole Cherng, Ikechukwu Achebe, Mason Winkie, Julie Thomann, Eric Then, Neil B. Marya; Ikechukwu Achebe, Mason Winkie, Julie Thomann, Eric Then, Neil B. Marya
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Acute cholecystitis (AC) is associated with significant morbidity and mortality. Minimally invasive laparoscopic cholecystectomy remains the gold standard of treatment. Therapeutic endoscopy for management of AC continues to emerge as a favorable alternative to percutaneous gallbladder drainage in patients with prohibitive operative risk. Endoscopic management of AC includes transpapillary and transmural stenting. When patient-specific factors prevent both surgical and endoscopic treatment, percutaneous cholecystostomy tube (PCT) placement is an option. Early studies show PCT to have worse outcomes when compared against all other described treatment options for the management of AC.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-08-02T10:51:49Z
DOI: 10.1177/08850666241267262
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- Diagnostic Value of Hepcidin in Sepsis: A Systematic Review and
Meta-Analysis-
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Authors: Jingxiao Zhang, Zhifang Zheng, Lei Ren, Chenhong Wang, Yue Li, Xidan Hu, Jie Zhang, Xiaoqing Jing, Yuzi Jin; Zhifang Zheng, Lei Ren, Chenhong Wang, Yue Li, Xidan Hu, Jie Zhang, Xiaoqing Jing, Yuzi JinPaediatric Internal Medicine, Affiliated Hospital of Chengde Medical University, Chengde, Hebei Province, China
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Objectives: To investigate the diagnostic value of hepcidin for sepsis diagnosis. Methods: The relevant literature on hepcidin for sepsis diagnosis published up to October 20, 2023, was systematically searched in the Web of Science, PubMed, Embase, and China Knowledge Network databases. Two researchers screened the literature and extracted relevant data according to the inclusion and exclusion criteria. Study quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Meta-analysis and calculation of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were performed using State16 and Review Manager 5.3 software. Furthermore, receiver operating characteristic curve (ROC) was plotted, and the respective area under the curve (AUC) was calculated to assess the accuracy of hepcidin. Publication bias was evaluated using Deeks’ funnel plot asymmetry test. Results: Overall, 1047 patients from 8 studies were included (625 patients with sepsis and 422 controls). The quality of the literature was relatively moderate. Meta-analysis demonstrated the presence of heterogeneity in the data (I2 > 50%, P
Citation: Journal of Intensive Care Medicine
PubDate: 2024-08-02T10:51:30Z
DOI: 10.1177/08850666241267261
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- Fluid Resuscitation Dilemma in End-stage Renal Disease Patients Presenting
with Sepsis: A Systematic Review and Meta-analysis-
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Authors: Georges Khattar, Khalil El Gharib, Ngowari Pokima, Juliet Kotys, Vineeth Kandala, Jonathan Mina, Fadi Haddadin, Saif Abu Baker, Samer Asmar, Taqi Rizvi, Matthew Flamenbaum, Dany Elsayegh, Michel Chalhoub, Halim El Hage, Suzanne El Sayegh; Khalil El Gharib, Ngowari Pokima, Juliet Kotys, Vineeth Kandala, Jonathan Mina, Fadi Haddadin, Saif Abu Baker, Samer Asmar, Taqi Rizvi, Matthew Flamenbaum, Dany Elsayegh, Michel Chalhoub, Halim El Hage, Suzanne El Sayegh
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Background: This study aims to investigate the safety and efficacy of guideline-directed fluid resuscitation (GDFR) compared with conservative fluid management in end-stage renal disease (ESRD) patients with sepsis by evaluating 90-day mortality and intubation rate. Methods: Following PRISMA guidelines, a systematic review was conducted across multiple databases using specific keywords and controlled vocabulary. The search strategy, implemented until October 1, 2023, aimed to identify studies examining fluid resuscitation in ESRD patients with sepsis. The review process was streamlined using Covidence software. A fourth reviewer resolved discrepancies in study inclusion. A random-effects model with the generic Mantel–Haenszel method was preferred for integrating odds ratios (ORs). Sensitivity analysis and publication bias analysis were performed. Results: Of the 1274 identified studies, 10 were selected for inclusion, examining 1184 patients, 593 of whom received GDFR. Four studies were selected to investigate the intubation rate, including 304 patients. No significant mortality or intubation rate difference was spotted between both groups [OR = 1.23; confidence interval (CI) = 0.92-1.65; I2 = 0% and OR = 1.91; CI = 0.91-4.04]. In most studies, sensitivity analysis using the leave-one-out approach revealed higher mortality and intubation rates. The Egger test results indicated no statistically significant publication bias across the included studies. Conclusion: Our research contradicts the common assumption about the effectiveness of GDFR for sepsis patients with ESRD. It suggests that this approach, while not superior to the conservative strategy, may potentially be harmful.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-07-25T10:14:19Z
DOI: 10.1177/08850666241261673
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- Part 1: Current Concepts in Radiologic Imaging and Intervention in Acute
Cholecystitis-
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Authors: Easton Neitzel, Julia Laskus, Peter R Mueller, Avinash Kambadakone, Shravya Srinivas-Rao, Eric vanSonnenberg; Julia Laskus, Peter R Mueller, Avinash Kambadakone, Shravya Srinivas-Rao, Eric vanSonnenberg
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Acute calculous cholecystitis and acute acalculous cholecystitis are encountered commonly among critically ill, often elderly, patients. Multidisciplinary management of these conditions is essential, with intensivists, surgeons, diagnostic radiologists, interventional radiologists, infectious disease physicians, gastroenterologists, and endoscopists able to contribute to patient care. In this article intended predominantly for intensivists, we will review the imaging findings and radiologic treatment of critically ill patients with acute calculous cholecystitis and acute acalculous cholecystitis.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-06-06T12:57:44Z
DOI: 10.1177/08850666241259421
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- Part 2: Current Concepts in Radiologic Imaging & Intervention in Acute
Biliary Tract Diseases-
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Authors: Easton Neitzel, Owais Salahudeen, Peter R. Mueller, Avinash Kambadakone, Shravya Srinivas-Rao, Eric vanSonnenberg; Owais Salahudeen, Peter R. Mueller, Avinash Kambadakone, Shravya Srinivas-Rao, Eric vanSonnenberg
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Acute cholangitis is encountered commonly in critically ill, often elderly, patients. The most common causes of cholangitis include choledocholithiasis, biliary strictures, and infection from previous endoscopic, percutaneous, or surgical intervention of the biliary tract. Rare causes of acute cholangitis in the United States include sclerosing cholangitis and recurrent pyogenic cholangitis, the latter predominantly occurring in immigrants of Asian descent. Multidisciplinary management of these conditions is essential, with intensivists, surgeons, diagnostic radiologists, interventional radiologists, gastroenterologists, endoscopists, and infectious disease physicians typically involved in the care of these patients. In this paper intended for intensivists predominantly, we will review the imaging findings and radiologic interventional management of critically ill patients with acute cholangitis, primary and secondary sclerosing cholangitis, and recurrent pyogenic cholangitis.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-06-06T12:57:25Z
DOI: 10.1177/08850666241259420
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- Antibiotic Stewardship in the Neonatal Intensive Care Unit
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Authors: Dustin D Flannery, Sarah A Coggins, Alexandra K Medoro; Sarah A Coggins, Alexandra K Medoro
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Antibiotic stewardship is a multidisciplinary, evidence-based approach to optimize antibiotic use and mitigate development of antibiotic resistance. Neonates have high rates of antibiotic exposure, particularly those born preterm and admitted to the NICU, and mounting evidence describes the adverse consequences of such exposures in the absence of infection. Here, we review the general principles of antibiotic stewardship and how they can be applied in NICUs. The unique characteristics of NICUs and patients cared for in this setting, which warrant unique implementation strategies and special considerations are discussed. We summarize current antibiotic use metrics for assessment of responses to stewardship interventions and changes over time, and review evidence-based infection prevention practices in the NICU. Current recommendations for empiric antibiotic use in the NICU and the utility of infection biomarkers are summarized. Lastly, given the growing global threat of increasing antibiotic resistance, specific threats in the NICU are highlighted.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-06-05T07:09:37Z
DOI: 10.1177/08850666241258386
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- Sepsis as a Potential Risk Factor for Upper Gastrointestinal Bleeding in
Critically Ill Patients: A Systematic Review and Meta-analysis-
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Authors: Yanfen Yao, Tejin Ba, Bagenna Bao, Shuanglin Zhang, Li Kong; Tejin Ba, Bagenna Bao, Shuanglin Zhang, Li Kong
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Purpose: Sepsis is a common and critical condition in intensive care units (ICUs) known to complicate patient outcomes. Previous studies have indicated an association between sepsis and various ICU morbidities, including upper gastrointestinal bleeding (UGIB). However, the extent of this relationship and its implications in ICU settings remain inadequately quantified. This study aims to elucidate the association between sepsis and the risk of UGIB in ICU patients. Methods: A comprehensive meta-analysis was conducted, encompassing nine studies with a total of nearly 9000 participants. These studies reported events for both sepsis and nonsepsis patients separately. Pooled odds ratios (ORs) were calculated to assess the risk of UGIB in septic versus nonseptic ICU patients. Subgroup analyses were conducted based on age and study design, and both unadjusted and adjusted ORs were examined. Results: The pooled OR indicated a significant association between sepsis and UGIB (OR = 3.276, 95% CI: 1.931 to 5.557). Moderate heterogeneity was observed (I² = 43.9%). The association was significant in adults (pooled OR = 4.083) but not in children. No difference in association was found based on the study design. Unadjusted and adjusted ORs differed slightly, indicating the influence of confounding factors. Conclusion: This meta-analysis reveals a significant association between sepsis and an increased risk of UGIB in ICU patients, particularly in adults. These findings highlight the need for vigilant monitoring and proactive management of septic ICU patients to mitigate the risk of UGIB. Future research should focus on understanding the underlying mechanisms and developing tailored preventive strategies.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-05-30T09:34:58Z
DOI: 10.1177/08850666241252048
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- Healthcare-associated infections in Iranian pediatric and adult intensive
care units: A comprehensive review of risk factors, etiology, molecular
epidemiology, antimicrobial sensitivity, and prevention strategies during
the COVID-19 pandemic-
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Authors: Mehdi Safarabadi, Tahereh Motallebirad, Davood Azadi, Ali Jadidi; Tahereh Motallebirad, Davood Azadi, Ali Jadidi
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
The current review article provides a comprehensive analysis of nosocomial infections in pediatric and adult intensive care units (ICUs) in Iran. We examine the risk factors and etiology of nosocomial infections, with a particular focus on molecular epidemiology and antimicrobial sensitivity. In this article, we explore a range of prevention strategies, including hand hygiene, personal protective equipment, environmental cleaning, antibiotic stewardship, education, and training. Moreover, we discuss the impact of the COVID-19 pandemic on infection control measures in ICUs and provide valuable insights for healthcare professionals and policymakers seeking to address this critical public health issue. In conclusion, this review article can serve as a valuable resource for those interested in understanding and improving infection control in ICUs and beyond.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-05-07T05:46:27Z
DOI: 10.1177/08850666241249162
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- A Narrative Review of Aconite Poisoning and Management
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Authors: Christine Lawson, Daniel J. McCabe, Ryan Feldman; Daniel J. McCabe, Ryan Feldman
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Aconite poisoning refers to toxicity resulting from plants belonging to the Aconitum genus, which comprises over 350 different species of perennial flowering plants that grow in temperate mountainous areas of the northern hemisphere (North America, Europe, Asia). These plants contain a group of toxins known as aconite alkaloids, which encompass numerous closely related toxic compounds. Conventional teaching from toxicology textbooks has broadly classified these alkaloids based on their mechanism of action, often simplifying them as substances that prevent sodium channel inactivation. However, this is an oversimplified and sometimes inaccurate description, as some aconite alkaloids can act as sodium channel blockers. Aconite alkaloids have a long history of use as poisonous substances and have been historically employed for hunting, assassinations, traditional medicine, and self-inflicted harm. Toxicity can occur due to the consumption of traditional medicines derived from aconitum plants or the ingestion of aconite plants and their derivatives. The clinical manifestations of aconite poisoning may encompass gastrointestinal symptoms, sensory alterations, seizures, and life-threatening dysrhythmias that may not respond to standard treatments. Treatment is primarily supportive however evaluation and management of these patients should be personalized and carried out in collaboration with a toxicologist.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-04-13T09:30:20Z
DOI: 10.1177/08850666241245703
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- A Guide to the Use of Vasopressors and Inotropes for Patients in Shock
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Authors: Anaas Moncef Mergoum, Abigail Rebecca Rhone, Nicholas James Larson, David J Dries, Benoit Blondeau, Frederick Bolles Rogers; Abigail Rebecca Rhone, Nicholas James Larson, David J Dries, Benoit Blondeau, Frederick Bolles Rogers1Department of Surgery, 7031Regions Hospital, Saint Paul, MN, USA
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Shock is a life-threatening circulatory failure that results in inadequate tissue perfusion and oxygenation. Vasopressors and inotropes are vasoactive medications that are vital in increasing systemic vascular resistance and cardiac contractility, respectively, in patients presenting with shock. To be well versed in using these agents is an important skill to have in the critical care setting where patients can frequently exhibit symptoms of shock. In this review, we will discuss the pathophysiological mechanisms of shock and evaluate the current evidence behind the management of shock with an emphasis on vasopressors and inotropes.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-04-13T09:30:12Z
DOI: 10.1177/08850666241246230
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- Parenteral Nutrition in the Critically Ill Adult: A Narrative Review
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Authors: Christopher Nguyen, Gaurav Singh, Karen Rubio, Karen Mclemore, Ware Kuschner; Gaurav Singh, Karen Rubio, Karen Mclemore, Ware Kuschner
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Malnutrition in adult intensive care unit patients is associated with poor clinical outcomes. Providing adequate nutritional support to the critically ill adult should be an important goal for the intensivist. This narrative review aims to delineate the role of parenteral nutrition (PN) in meeting nutritional goals. We examined the data regarding the safety and efficacy of PN compared to enteral nutrition. In addition, we describe practical considerations for the use of PN in the ICU including patient nutritional risk stratification, nutrient composition selection for PN, route of PN administration, and biochemical monitoring.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-04-11T09:25:38Z
DOI: 10.1177/08850666241246748
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- Intravenous Antibiotics in the Management of H. pylori Infection: A
Systematic Review-
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Authors: Yau-Lam Alex Chau, Tessa Milic, Jerrold Perrott; Tessa Milic, Jerrold Perrott
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Background: Helicobacter pylori is implicated in the development of gastritis, ulcers, and various gastric cancers, representing significant morbidity, mortality, and healthcare spending. Patients with H. pylori infection have traditionally been treated with oral antibiotics, however, oral therapy is not feasible in all clinical situations. We examined the available evidence supporting the use of intravenous (IV) antibiotics in H. pylori. Methods: This systematic review was carried out by reviewing multiple electronic databases: MEDLINE, CENTRAL, EMBASE, CINAHL, Clinicaltrials.org, and the World Health Organization (WHO) database of clinical trials. Articles published from database inception until February 12, 2023 that discussed the use of IV antibiotics in H. pylori management were included. Results: The search strategy identified 978 studies, with 11 meeting the inclusion criteria. The results demonstrate that there is a lack of robust trials examining the use of IV antibiotics in H. pylori management. Many trials demonstrated that IV antibiotics were safe and efficacious but the results are limited by inconsistencies in the year and geographic location trials were conducted, the IV and oral antibiotic regimens, and the duration of therapy. Conclusions: IV antibiotics appear to be a feasible therapeutic alternative in the management of H. pylori and can be considered, especially in patient populations where oral therapy is contraindicated.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-04-11T09:25:27Z
DOI: 10.1177/08850666241245364
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- Noninvasive Ventilation in the Cardiac Intensive Care Unit
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Authors: Christopher S. Schenck, Fouad Chouairi, David M. Dudzinski, P. Elliott Miller; Fouad Chouairi, David M. Dudzinski, P. Elliott Miller
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Over the last several decades, the cardiac intensive care unit (CICU) has seen an increase in the complexity of the patient population and etiologies requiring CICU admission. Currently, respiratory failure is the most common reason for admission to the contemporary CICU. As a result, noninvasive ventilation (NIV), including noninvasive positive-pressure ventilation and high-flow nasal cannula, has been increasingly utilized in the management of patients admitted to the CICU. In this review, we detail the different NIV modalities and summarize the evidence supporting their use in conditions frequently encountered in the CICU. We describe the unique pathophysiologic interactions between positive pressure ventilation and left and/or right ventricular dysfunction. Additionally, we discuss the evidence and strategies for utilization of NIV as a method to reduce extubation failure in patients who required invasive mechanical ventilation. Lastly, we examine unique considerations for managing respiratory failure in certain, high-risk patient populations such as those with right ventricular failure, severe valvular disease, and adult congenital heart disease. Overall, it is critical for clinicians who practice in the CICU to be experts with the application, risks, benefits, and modalities of NIV in cardiac patients with respiratory failure.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-04-04T07:07:28Z
DOI: 10.1177/08850666241243261
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- When Our Best Friend Becomes Our Worst Enemy: The Mitochondrion in Trauma,
Surgery, and Critical Illness-
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Authors: May-Kristin Torp, Kåre-Olav Stensløkken, Jarle Vaage; Kåre-Olav Stensløkken, Jarle Vaage
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Common for major surgery, multitrauma, sepsis, and critical illness, is a whole-body inflammation. Tissue injury is able to trigger a generalized inflammatory reaction. Cell death causes release of endogenous structures termed damage associated molecular patterns (DAMPs) that initiate a sterile inflammation. Mitochondria are evolutionary endosymbionts originating from bacteria, containing molecular patterns similar to bacteria. These molecular patterns are termed mitochondrial DAMPs (mDAMPs). Mitochondrial debris released into the extracellular space or into the circulation is immunogenic and damaging secondary to activation of the innate immune system. In the circulation, released mDAMPS are either free or exist in extracellular vesicles, being able to act on every organ and cell in the body. However, the role of mDAMPs in trauma and critical care is not fully clarified. There is a complete lack of knowledge how they may be counteracted in patients. Among mDAMPs are mitochondrial DNA, cardiolipin, N-formyl peptides, cytochrome C, adenosine triphosphate, reactive oxygen species, succinate, and mitochondrial transcription factor A. In this overview, we present the different mDAMPs, their function, release, targets, and inflammatory potential. In light of present knowledge, the role of mDAMPs in the pathophysiology of major surgery and trauma as well as sepsis, and critical care is discussed.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-03-20T08:14:09Z
DOI: 10.1177/08850666241237715
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- Updated Review of Radiologic Imaging and Intervention for Acute
Pancreatitis and Its Complications-
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Authors: Joshua Willis, Eric vanSonnenberg; Eric vanSonnenberg142283University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
This is a current update on radiologic imaging and intervention of acute pancreatitis and its complications. In this review, we define the various complications of acute pancreatitis, discuss the imaging findings, as well as the timing of when these complications occur. The various classification and scoring systems of acute pancreatitis are summarized. Advantages and disadvantages of the 3 primary radiologic imaging modalities are compared. We then discuss radiologic interventions for acute pancreatitis. These include diagnostic aspiration as well as percutaneous catheter drainage of fluid collections, abscesses, pseudocysts, and necrosis. Recommendations for when these interventions should be considered, as well as situations in which they are contraindicated are discussed. Fortunately, acute pancreatitis usually is mild; however, serious complications occur in 20%, and admission of patients to the intensive care unit (ICU) occurs in over 10%. In this paper, we will focus on the imaging and interventional radiologic aspects for the serious complications and patients admitted to the ICU.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-02-28T08:16:40Z
DOI: 10.1177/08850666241234596
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- Ten Influential Point-of-Care Ultrasound Papers: 2023 in Review
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Authors: Scott J. Millington, Mangala Narasimhan, Paul H. Mayo, Antoine Vieillard-Baron; Mangala Narasimhan, Paul H. Mayo, Antoine Vieillard-Baron
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
In an effort to help keep busy clinicians up to date with the latest ultrasound research, our group of experts has selected 10 influential papers from the past 12 months and provided a short summary of each. We hope to provide emergency physicians, intensivists, and other acute care providers with a succinct update concerning some key areas of ultrasound interest.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-02-20T06:20:32Z
DOI: 10.1177/08850666241233556
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- Cardiogenic Shock and Utilization of Mechanical Circulatory Support in
Pregnancy-
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Authors: Anna C. O’Kelly, Amy Sarma, Emily Naoum, Sarah Rae Easter, Katherine Economy, Jonathan Ludmir; Amy Sarma, Emily Naoum, Sarah Rae Easter, Katherine Economy, Jonathan Ludmir
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Maternal mortality rates are rising in the United States, a trend which is in contrast to that seen in other high-income nations. Cardiovascular disease and hypertensive disorders of pregnancy are consistently the leading causes of maternal mortality both in the United States and globally, accounting for about one-quarter to one-third of maternal and peripartum deaths. A large proportion of cardiovascular morbidity and mortality stems from acquired disease in the context of cardiovascular risk factors, which include obesity, pre-existing diabetes and hypertension, and inequities in care from maternal care deserts and structural racism. Patients may also become pregnant with preexisting structural heart disease, or acquire disease throughout pregnancy (ex: spontaneous coronary artery dissection, peripartum cardiomyopathy), and be at higher risk of pregnancy-related cardiovascular complications. While risk-stratification tools including the modified World Health Organization (mWHO) classification, Cardiac Disease in Pregnancy (CARPREG II) and Zwangerschap bij Aangeboren HARtAfwijking/Pregnancy in Women with Congenital Heart Disease (ZAHARA) have been designed to help physicians identify patients at increased risk for adverse pregnancy outcomes and who may therefore benefit from referral to a tertiary care center, the limitation of these scores is their predominant focus on patients with known preexisting heart disease. As such, identifying patients at risk for pregnancy complications presents a significant challenge, and it is often patients with high-risk cardiovascular substrates prior to or during pregnancy who are at a highest risk for adverse pregnancy outcomes including cardiogenic shock.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-01-11T06:49:31Z
DOI: 10.1177/08850666231225606
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- POCUS in the PICU: A Narrative Review of Evidence-Based Bedside Ultrasound
Techniques Ready for Prime-Time in Pediatric Critical Care-
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Authors: Catherine E. Naber, Michael D. Salt; Michael D. Salt
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
Point-of-care ultrasound (POCUS) is an accessible technology that can identify and treat life-threatening pathology in real time without exposing children to ionizing radiation. We aim to review current evidence supporting the use of POCUS by pediatric intensivists with novice-level experience with bedside ultrasound. Current evidence supports the universal adoption of POCUS-guided internal jugular venous catheter placement and arterial line placement by pediatric critical care physicians. Focused cardiac ultrasound performed by PICU physicians who have completed appropriate training with quality assurance measures in place can identify life-threatening cardiac pathology in most children and important physiological changes in children with septic shock. POCUS of the lungs, pleural space, and diaphragm have great potential to provide valuable information at the bedside after validation of these techniques for use in the PICU with additional research. Based on currently available evidence, a generalizable and attainable POCUS educational platform for pediatric intensivists should include training in vascular access techniques and focused cardiac examination. A POCUS educational program should strive to establish credentialing and quality assurance programs that can be expanded when additional research validates the adoption of additional POCUS techniques by pediatric intensive care physicians.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-01-09T09:04:39Z
DOI: 10.1177/08850666231224391
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- High Respiratory and Cardiac Drive Exacerbate Secondary Lung Injury in
Patients With Critical Illness-
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Authors: Shiyi Gong, Hui Lian, Xin Ding, Xiaoting Wang; Hui Lian, Xin Ding, Xiaoting Wang,
Abstract: Journal of Intensive Care Medicine, Ahead of Print.
The high respiratory and cardiac drive is essential to the host-organ unregulated response. When a primary disease and an unregulated secondary response are uncontrolled, the patient may present in a high respiratory and cardiac drive state. High respiratory drive can cause damage to the lungs, pulmonary circulation, and diaphragm, while high cardiac drive can lead to fluid leakage and infiltration as well as pulmonary interstitial edema. A “respiratory and cardiac dual high drive” state may be a sign of an unregulated response and can lead to secondary lung injury through the increase of transvascular pressure and pulmonary microcirculation injury. Ultrasound examination of the lung, heart, and diaphragm is important when evaluating the phenotype of high respiratory drive in critically ill patients. Ultrasound assessment can guide sedation, analgesia, and antistress treatment and reduce the risk of high respiratory and cardiac drive-induced lung injury in these patients.
Citation: Journal of Intensive Care Medicine
PubDate: 2024-01-04T07:35:53Z
DOI: 10.1177/08850666231222220
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