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EMERGENCY AND INTENSIVE CRITICAL CARE (121 journals)                     

Showing 1 - 123 of 123 Journals sorted alphabetically
AACN Advanced Critical Care     Full-text available via subscription   (Followers: 36)
Academic Emergency Medicine     Hybrid Journal   (Followers: 100)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 2)
Acute and Critical Care     Open Access   (Followers: 10)
Acute Cardiac Care     Hybrid Journal   (Followers: 12)
Acute Medicine     Full-text available via subscription   (Followers: 7)
Advances in Emergency Medicine     Open Access   (Followers: 21)
Advances in Neonatal Care     Hybrid Journal   (Followers: 44)
African Journal of Anaesthesia and Intensive Care     Full-text available via subscription   (Followers: 8)
African Journal of Emergency Medicine     Open Access   (Followers: 6)
AINS - Anasthesiologie - Intensivmedizin - Notfallmedizin - Schmerztherapie     Hybrid Journal   (Followers: 5)
American Journal of Emergency Medicine     Hybrid Journal   (Followers: 57)
Annals of Emergency Medicine     Hybrid Journal   (Followers: 150)
Annals of Intensive Care     Open Access   (Followers: 39)
Annals of the American Thoracic Society     Full-text available via subscription   (Followers: 16)
Archives of Academic Emergency Medicine     Open Access   (Followers: 6)
Archives of Trauma Research     Open Access   (Followers: 5)
ASAIO Journal     Hybrid Journal   (Followers: 2)
Australasian Journal of Paramedicine     Open Access   (Followers: 9)
Australian Critical Care     Full-text available via subscription   (Followers: 21)
Bangladesh Critical Care Journal     Open Access   (Followers: 1)
BMC Emergency Medicine     Open Access   (Followers: 29)
BMJ Quality & Safety     Hybrid Journal   (Followers: 66)
Burns Open     Open Access   (Followers: 1)
Canadian Journal of Respiratory, Critical Care, and Sleep Medicine     Hybrid Journal   (Followers: 2)
Case Reports in Acute Medicine     Open Access   (Followers: 4)
Case Reports in Critical Care     Open Access   (Followers: 14)
Case Reports in Emergency Medicine     Open Access   (Followers: 23)
Chronic Wound Care Management and Research     Open Access   (Followers: 8)
Clinical and Applied Thrombosis/Hemostasis     Open Access   (Followers: 28)
Clinical Medicine Insights : Trauma and Intensive Medicine     Open Access   (Followers: 3)
Clinical Risk     Hybrid Journal   (Followers: 6)
Crisis: The Journal of Crisis Intervention and Suicide Prevention     Hybrid Journal   (Followers: 17)
Critical Care     Open Access   (Followers: 78)
Critical Care and Resuscitation     Full-text available via subscription   (Followers: 29)
Critical Care Clinics     Full-text available via subscription   (Followers: 35)
Critical Care Explorations     Open Access   (Followers: 3)
Critical Care Medicine     Hybrid Journal   (Followers: 324)
Critical Care Research and Practice     Open Access   (Followers: 13)
Current Emergency and Hospital Medicine Reports     Hybrid Journal   (Followers: 6)
Current Opinion in Critical Care     Hybrid Journal   (Followers: 74)
Disaster and Emergency Medicine Journal     Open Access   (Followers: 12)
Egyptian Journal of Critical Care Medicine     Open Access   (Followers: 2)
EMC - Urgenze     Full-text available via subscription  
Emergency Care Journal     Open Access   (Followers: 8)
Emergency Medicine (Medicina neotložnyh sostoânij)     Open Access  
Emergency Medicine Australasia     Hybrid Journal   (Followers: 18)
Emergency Medicine Clinics of North America     Full-text available via subscription   (Followers: 19)
Emergency Medicine International     Open Access   (Followers: 8)
Emergency Medicine Journal     Hybrid Journal   (Followers: 56)
Emergency Medicine News     Full-text available via subscription   (Followers: 7)
Emergency Nurse     Full-text available via subscription   (Followers: 16)
Enfermería Intensiva (English ed.)     Full-text available via subscription   (Followers: 2)
European Burn Journal     Open Access   (Followers: 8)
European Journal of Emergency Medicine     Hybrid Journal   (Followers: 25)
Frontiers in Emergency Medicine     Open Access   (Followers: 8)
Global Journal of Transfusion Medicine     Open Access   (Followers: 1)
Hong Kong Journal of Emergency Medicine     Full-text available via subscription   (Followers: 5)
Indian Journal of Burns     Open Access   (Followers: 3)
Injury     Hybrid Journal   (Followers: 21)
Intensive Care Medicine     Hybrid Journal   (Followers: 87)
Intensive Care Medicine Experimental     Open Access   (Followers: 2)
Intensivmedizin up2date     Hybrid Journal   (Followers: 4)
International Journal of Critical Illness and Injury Science     Open Access   (Followers: 1)
International Journal of Emergency Medicine     Open Access   (Followers: 9)
International Journal of Emergency Mental Health and Human Resilience     Open Access   (Followers: 2)
International Paramedic Practice     Full-text available via subscription   (Followers: 17)
Iranian Journal of Emergency Medicine     Open Access  
Irish Journal of Paramedicine     Open Access   (Followers: 3)
Journal Européen des Urgences et de Réanimation     Hybrid Journal   (Followers: 1)
Journal of Acute Care Physical Therapy     Hybrid Journal   (Followers: 4)
Journal of Cardiac Critical Care TSS     Open Access   (Followers: 1)
Journal Of Cardiovascular Emergencies     Open Access  
Journal of Concussion     Open Access  
Journal of Critical Care     Hybrid Journal   (Followers: 51)
Journal of Critical Care Medicine     Open Access   (Followers: 18)
Journal of Education and Teaching in Emergency Medicine     Open Access   (Followers: 1)
Journal of Emergencies, Trauma and Shock     Open Access   (Followers: 13)
Journal of Emergency Medical Services     Full-text available via subscription   (Followers: 12)
Journal of Emergency Medicine     Hybrid Journal   (Followers: 53)
Journal of Emergency Medicine, Trauma and Acute Care     Open Access   (Followers: 26)
Journal of Emergency Practice and Trauma     Open Access   (Followers: 6)
Journal of Intensive Care     Open Access   (Followers: 9)
Journal of Intensive Care Medicine     Hybrid Journal   (Followers: 23)
Journal of Intensive Medicine     Open Access   (Followers: 1)
Journal of Neuroanaesthesiology and Critical Care     Open Access   (Followers: 4)
Journal of Stroke Medicine     Hybrid Journal   (Followers: 3)
Journal of the American College of Emergency Physicians Open     Open Access   (Followers: 2)
Journal of the Intensive Care Society     Hybrid Journal   (Followers: 5)
Journal of the Royal Army Medical Corps     Hybrid Journal   (Followers: 7)
Journal of Thrombosis and Haemostasis     Hybrid Journal   (Followers: 52)
Journal of Translational Critical Care Medicine     Open Access   (Followers: 3)
Journal of Trauma and Acute Care Surgery, The     Hybrid Journal   (Followers: 36)
La Presse Médicale Open     Open Access  
Médecine de Catastrophe - Urgences Collectives     Hybrid Journal  
Medicina Intensiva     Open Access   (Followers: 3)
Medicina Intensiva (English Edition)     Hybrid Journal   (Followers: 1)
Mediterranean Journal of Emergency Medicine & Acute Care : MedJEM     Open Access  
Notfall + Rettungsmedizin     Hybrid Journal   (Followers: 4)
OA Critical Care     Open Access   (Followers: 3)
OA Emergency Medicine     Open Access   (Followers: 2)
Open Access Emergency Medicine     Open Access   (Followers: 6)
Open Journal of Emergency Medicine     Open Access   (Followers: 2)
Palliative Care : Research and Treatment     Open Access   (Followers: 25)
Palliative Medicine     Hybrid Journal   (Followers: 58)
Prehospital Emergency Care     Hybrid Journal   (Followers: 20)
Regulatory Toxicology and Pharmacology     Hybrid Journal   (Followers: 26)
Research and Opinion in Anesthesia and Intensive Care     Open Access   (Followers: 3)
Resuscitation     Hybrid Journal   (Followers: 59)
Resuscitation Plus     Open Access   (Followers: 2)
Saudi Critical Care Journal     Open Access   (Followers: 2)
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine     Open Access   (Followers: 12)
Seminars in Thrombosis and Hemostasis     Hybrid Journal   (Followers: 28)
Shock : Injury, Inflammation, and Sepsis : Laboratory and Clinical Approaches     Hybrid Journal   (Followers: 12)
Sklifosovsky Journal Emergency Medical Care     Open Access  
The Journal of Trauma Injury Infection and Critical Care     Full-text available via subscription   (Followers: 23)
Therapeutics and Clinical Risk Management     Open Access   (Followers: 1)
Transplant Research and Risk Management     Open Access   (Followers: 1)
Trauma Case Reports     Open Access   (Followers: 1)
Trauma Monthly     Open Access   (Followers: 4)
Visual Journal of Emergency Medicine     Full-text available via subscription   (Followers: 1)
Western Journal of Emergency Medicine     Open Access   (Followers: 11)
 AEM Education and Training : A Global Journal of Emergency Care     Open Access   (Followers: 1)

           

Similar Journals
Journal Cover
Journal of Intensive Care Medicine
Journal Prestige (SJR): 0.82
Citation Impact (citeScore): 2
Number of Followers: 23  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0885-0666 - ISSN (Online) 1525-1489
Published by Sage Publications Homepage  [1176 journals]
  • Tight Versus Liberal Blood Glucose Control in Patients With Diabetes in
           the ICU: A Meta-Analysis of Randomized Controlled Trials

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      Authors: Maria L. R. Defante, Beatriz Ximenes Mendes, Mariana de Moura de Souza, Beatriz Austregésilo de Athayde De Hollanda Morais, Otávio Cosendey Martins, Vitória Martins Prizão, Salma Ali El Chab Parolin
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Introduction: Glycemia is an important factor among critically ill patients in the intensive care unit (ICU). There is conflicting evidence on the preferred strategy of blood glucose control among patients with diabetes in the ICU. We aimed to conduct a meta-analysis comparing tight with liberal blood glucose in critically ill patients with diabetes in the ICU. Methods: We systematically searched PubMed, Embase, and Cochrane Central for randomized controlled trials (RCTs) comparing tight versus liberal blood glucose control in critically ill patients with diabetes from inception to December 2023. We pooled odds-ratios (OR) and 95% confidence intervals (CI) with a random-effects model for binary endpoints. We used the Review Manager 5.17 and R version 4.3.2 for statistical analyses. Risk of bias assessment was performed with the Cochrane tool for randomized trials (RoB2). Results: Eight RCTs with 4474 patients were included. There was no statistically significant difference in all-cause mortality (OR 1.11; 95% CI 0.95-1.28; P = .18; I² = 0%) between a tight and liberal blood glucose control. RoB2 identified all studies at low risk of bias and funnel plot suggested no evidence of publication bias. Conclusion: In patients with diabetes in the ICU, there was no statistically significant difference in all-cause mortality between a tight and liberal blood glucose control. PROSPERO registration: CRD42023485032.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-05-16T07:21:31Z
      DOI: 10.1177/08850666241255671
       
  • Evaluation of Gram Stain-Guided Antibiotic Therapy for
           Methicillin-Resistant Staphylococcus aureus Pneumonia in Intensive Care
           Unit Patients

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      Authors: Johanna Van Epps, Alexander J. Lepak, Lucas T. Schulz, Jeffrey Fish
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Background: Despite high negative predictive values (NPVs) seen with methicillin-resistant Staphylococcus aureus (MRSA) nares polymerase chain reaction (PCR) assays, utilization of both respiratory sample Gram stain and MRSA nares PCR in patients with pneumonia may contribute to overuse of laboratory resources. The purpose of this study was to evaluate if a Gram stain demonstrating no Gram-positive organisms from a respiratory sample is sufficient to allow for de-escalation of vancomycin therapy. Methods: This single center study retrospectively identified intensive care unit (ICU) patients started on vancomycin for presumed pneumonia at University of Wisconsin (UW) Health in Madison, WI between August 2022 and March 2023. Patients with respiratory sample demonstrating no Gram-positives on Gram stain met inclusion criteria if the sample was ordered within 24 h of vancomycin initiation. The primary outcome was NPV of respiratory sample Gram stain demonstrating no Gram-positive organisms with respect to MRSA detection of the respiratory culture. Secondary outcomes included the NPV of combined MRSA nares PCR plus respiratory sample Gram stain, and difference in time to event in patients that had both a respiratory sample and MRSA nares PCR ordered. Results: A total of 370 patients were screened for study eligibility; of which 99 patients met inclusion criteria. NPV of respiratory sample Gram stain was 99% for MRSA culture. The combined NPV of respiratory sample Gram stain plus MRSA nares PCR was 98.9% for MRSA culture (n = 88). Respiratory sample was ordered 2.3 h faster compared to MRSA nares PCR (4.3 vs 6.6 h, P = .036). Respiratory sample Gram stain resulted 4.5 h faster compared to MRSA nares PCR (10.7 vs 15.2 h, P = .002). Conclusion: Respiratory sample Gram stains demonstrating no Gram-positive organisms may be used to de-escalate vancomycin and deprioritize the use of MRSA nares PCR.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-05-16T07:20:33Z
      DOI: 10.1177/08850666241254736
       
  • The Role of the Tissue Perfusion Index in Predicting Disease Severity and
           Prognosis in Patients with Severe and Critical COVID-19

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      Authors: Wan-Ting Lin, Yan-Jie Zhang, Ming-Kun Yan, Xiao-Tian Cai, Xin-Er Cai, Jingyuan Xu
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      ObjectivesThe study investigated whether percutaneous partial pressure of oxygen (PtcO2), percutaneous partial pressure of carbon dioxide (PtcCO2), and the derived tissue perfusion index (TPI) can predict the severity and short-term outcomes of severe and critical COVID-19.DesignProspective observational study conducted from January 1, 2023 to February 10, 2023.SettingA teaching hospital specializing in tertiary care in Nanjing City, Jiangsu Province, China.ParticipantsAdults (≥18 years) with severe and critical COVID-19.InterventionsNot applicable.Main outcome measuresThe general information and vital signs of the patients were collected. The PtcO2 and PtcCO2 were monitored in the left dorsal volar. The ratio of TPI was defined as the ratio of PtcO2/fraction of inspired oxygen (FiO2) to PtcCO2. Mortality at 28 was recorded. The ability of the TPI to assess disease severity and predict prognosis was determined.EndpointSeverity of the disease on the enrollment and mortality at 28.ResultsA total of 71 patients with severe and critical COVID-19, including 40 severe and 31 critical cases, according to the COVID-19 treatment guidelines published by WHO, were recruited. Their median age was 70 years, with 56 (79%) males. The median SpO2/FiO2, PtcO2, PtcCO2, PtcO2/ FiO2, and TPI values were 237, 61, 42, 143, and 3.6 mm Hg, respectively. Compared with those for severe COVID-19, the TPI, PtcO2/ FiO2, SpO2/FiO2, and PtcO2 were significantly lower in critical COVID-19, while the PtcCO2 was significantly higher. After 28 days, 26 (37%) patients had died. TPI values 
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-05-15T04:25:10Z
      DOI: 10.1177/08850666241253162
       
  • Prognostic Value of Sublingual Microcirculation in Sepsis: A Systematic
           Review and Meta-analysis

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      Authors: Aling Tang, Yi Shi, Qingqing Dong, Sihui Wang, Yao Ge, Chenyan Wang, Zhimin Gong, Weizhen Zhang, Wei Chen
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Objectives: To investigate the relationship between sublingual microcirculation and the prognosis of sepsis. Data sources: The PubMed, Web of Science, Embase, and China National Knowledge Infrastructure (CNKI) databases were searched to identify studies published from January 2003 to November 2023. Study selection: Clinical studies examining sublingual microcirculation and the prognosis of sepsis were included. Data extraction: Sublingual microcirculation indices included the microvascular blood index (MFI), total vascular density (TVD), perfusion vascular density (PVD), perfusion vascular vessel (PPV), and heterogeneity index (HI). Prognostic outcomes included mortality and severity. Funnel plots and Egger's test were used to detect publication bias. The ability of the small vessel PPV (PPVs) to predict sepsis-related mortality was analyzed based on the summary receiver operating characteristic (SROC) curve, pooled sensitivity, and pooled specificity. Data synthesis: Twenty-five studies involving 1750 subjects were included. The TVD (95% CI 0.11-0.39), PVD (95% CI 0.42-0.88), PPV (95% CI 6.63-13.83), and MFI (95% CI 0.13-0.6) of the survival group were greater than those of the nonsurvival group. The HI in the survival group was lower than that in the nonsurvival group (95% CI −0.49 to −0.03). The TVD (95% CI 0.41-0.83), PVD (95% CI 0.83-1.17), PPV (95% CI 14.49-24.9), and MFI (95% CI 0.25-0.66) of the nonsevere group were greater than those of the severe group. Subgroup analysis revealed no significant difference in TVD between the survival group and the nonsurvival group in the small vessel subgroup. The area under the SROC curve (AUC) was 0.88. Conclusions: Sublingual microcirculation was worse among patients who died and patients with severe sepsis than among patients who survived and patients with nonsevere sepsis. PPV has a good predictive value for the mortality of sepsis patients. This study was recorded in PROSPERO (registration number: CRD42023486349).
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-05-15T04:24:38Z
      DOI: 10.1177/08850666241253800
       
  • Prospective Evaluation of the Peripheral Perfusion Index in Assessing the
           Organ Dysfunction and Prognosis of Adult Patients With Sepsis in the ICU

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      Authors: Qirui Guo, Hui Lian, Guangjian Wang, Hongmin Zhang, Xiaoting Wang
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Background: The peripheral perfusion index (PI) reflects microcirculatory blood flow perfusion and indicates the severity and prognosis of sepsis. Method: The cohort comprised 208 patients admitted to the intensive care unit (ICU) with infection, among which 117 had sepsis. Demographics, medication history, ICU variables, and laboratory indexes were collected. Primary endpoints were in-hospital mortality and 28-day mortality. Secondary endpoints included organ function variables (coagulation function, liver function, renal function, and myocardial injury), lactate concentration, mechanical ventilation time, and length of ICU stay. Univariate and multivariate analyses were conducted to assess the associations between the PI and clinical outcomes. Sensitivity analyses were performed to explore the associations between the PI and organ functions in the sepsis and nonsepsis groups. Result: The PI was negatively associated with in-hospital mortality (odds ratio [OR] 0.29, 95% confidence interval [CI] 0.15 to 0.55), but was not associated with 28-day mortality. The PI was negatively associated with the coagulation markers prothrombin time (PT) (β −0.36, 95% CI −0.59 to 0.13) and activated partial thromboplastin time (APTT) (β −1.08, 95% CI −1.86 to 0.31), and the myocardial injury marker cardiac troponin I (cTnI) (β −2085.48, 95% CI −3892.35 to 278.61) in univariate analysis, and with the PT (β −0.36, 95% CI −0.60 to 0.13) in multivariate analysis. The PI was negatively associated with the lactate concentration (β −0.57, 95% CI −0.95 to 0.19), mechanical ventilation time (β −23.11, 95% CI −36.54 to 9.69), and length of ICU stay (β −1.28, 95% CI −2.01 to 0.55). Sensitivity analyses showed that the PI was significantly associated with coagulation markers (PT and APTT) and a myocardial injury marker (cTnI) in patients with sepsis, suggesting that the associations between the PI and organ function were stronger in the sepsis group than the nonsepsis group. Conclusion: The PI provides new insights for assessing the disease severity, short-term prognosis, and organ function damage in ICU patients with sepsis, laying a theoretical foundation for future research.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-05-15T04:24:21Z
      DOI: 10.1177/08850666241252758
       
  • Ferritin Levels on Hospital Admission Predict Hypoxic-Ischemic
           Encephalopathy in Patients After Out-of-Hospital Cardiac Arrest: A
           Prospective Observational Single-Center Study

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      Authors: Swantje Nickelsen, Eleonore Grosse Darrelmann, Lea Seidlmayer, Katrin Fink, Simone Britsch, Daniel Duerschmied, Ruediger E. Scharf, Albrecht Elsaesser, Thomas Helbing
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      AimOut-of-hospital cardiac arrest (OHCA) is a major health concern in Western societies. Poor outcome after OHCA is determined by the extent of hypoxic-ischemic encephalopathy (HIE). Dysregulation of iron metabolism has prognostic relevance in patients with ischemic stroke and sepsis. The aim of this study was to determine whether serum iron parameters help to estimate outcomes after OHCA.MethodsIn this prospective single-center study, 70 adult OHCA patients were analyzed. Serum ferritin, iron, transferrin (TRF), and TRF saturation (TRFS) were measured in blood samples drawn on day 0 (admission), day 2, day 4, and 6 months after the return of spontaneous circulation (ROSC). The association of 4 iron parameters with in-hospital mortality, neurological outcome (cerebral performance category [CPC]), and HIE was investigated by receiver operating characteristics and multivariate regression analyses.ResultsOHCA subjects displayed significantly increased serum ferritin levels on day 0 and lowered iron, TRF, and TRFS on days 2 and 4 after ROSC, as compared to concentrations measured at a 6-month follow-up. Iron parameters were not associated with in-hospital mortality or neurological outcomes according to the CPC. Ferritin on admission was an independent predictor of features of HIE on cranial computed tomography and death due to HIE.ConclusionOHCA is associated with alterations in iron metabolism that persist for several days after ROSC. Ferritin on admission can help to predict HIE.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-05-15T04:24:11Z
      DOI: 10.1177/08850666241252602
       
  • Epidemiology and Outcomes of Hospitalized Chimeric Antigen Receptor T-Cell
           (CAR-T) Therapy Patients Who Developed Acute Respiratory Failure

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      Authors: Daniel Kurtz, Aditya Sharma, Aditi Sharma, Ayman O. Soubani
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Objectives:The aim of the study was to examine the incidence, baseline characteristics, and outcomes of Chimeric Antigen Receptor T-cell (CAR-T) therapy admissions in individuals who developed acute respiratory failure (ARF). The study utilized the National Inpatient Sample (NIS) database for the years 2017 to 2020. Methods: The study identified CAR-T cell therapy hospitalizations through the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) codes. Patients with acute respiratory failure (ARF) were further classified using specific International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Descriptive statistics were performed to analyze baseline characteristics, comorbidities, complications, and outcomes. Results: Analysis of the NIS Database identified 5545 CAR-T therapy admissions between 2017 and 2020, revealing a rising trend over time. In our study, we found that hypertension (39%), dyslipidemia (21.7%), and venous thromboembolism (13%) were the most frequently observed comorbidities in CAR-T cell therapy admissions. Acute respiratory failure (ARF) was reported in 7.1% of admissions, and they had higher all-cause in-hospital mortality than CAR-T cell therapy admissions without ARF (32.9% vs 1.3%, P 
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-05-10T06:03:37Z
      DOI: 10.1177/08850666241253537
       
  • Tracheostomy in Patients with Acute Myocardial Infarction and Respiratory
           Failure

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      Authors: Megan Grammatico, Soumya Banna, Andi Shahu, Maria Gabriela Gastanadui, Jose Victor Jimenez, Cory Heck, Abner Arias-Olson, Alexander Thomas, Tariq Ali, P. Elliott Miller
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      ObjectivePatients with acute myocardial infarction (AMI) complicated by respiratory failure require antiplatelet regimens which often cannot be stopped and may increase bleeding from tracheostomy. However, there is limited available data on both the proportion of patients undergoing tracheostomy and the impact on antiplatelet regimens on outcomes.MethodsUtilizing the Vizient® Clinical Data Base, we identified patients ≥18 years admitted from 2015 to 2019 with a primary diagnosis of AMI and requiring invasive mechanical ventilation (IMV). We assessed for the incidence of patients undergoing tracheostomy, outcomes stratified by the timing of tracheostomy (≤10 vs>10 days), and the association between dual antiplatelet therapy (DAPT) use and in-hospital mortality.ResultsWe identified 26 435 patients presenting with AMI requiring IMV. The mean (SD) age was 66.8 (12.3) years and 33.4% were women. The incidence of tracheostomy was 6.0% (n = 1573), and the median IMV time to tracheostomy was 12 days, 55.6% of which underwent percutaneous and 44.4% underwent open tracheostomy. Over 90% (n = 1424) underwent tracheostomy (>10 days) and had a similar mortality when compared to early (≤10 days) tracheostomy (22.5% vs 22.8%, P = 0.94). On the day of tracheostomy, only 24.7% were given DAPT, which was associated with a lower mortality than those not on DAPT (17.4% vs 23.7%, P = 0.01). After multivariable adjustment, DAPT use on the day of tracheostomy remained associated with lower in-hospital mortality (odds ratio 0.68; 95% confidence interval: 0.49-0.94, P = 0.02). Tracheostomy complications were not different between groups (P > 0.05), but more patients in the DAPT group required post-tracheostomy blood transfusions (5.6% vs 2.7%, P = 0.01).ConclusionApproximately 1 in 20 intubated AMI patients requires tracheostomy. The lack of DAPT interruption on the day of tracheostomy but not the timing of tracheostomy was associated with a lower in-hospital mortality. Our results suggest that DAPT should not be a barrier to tracheostomy for patients with AMI.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-05-08T06:19:23Z
      DOI: 10.1177/08850666241253202
       
  • Vitamin K Prescribing Trends Among Critically Ill Children Hospitalized
           for Sepsis: A Multicenter Observational Cohort Study

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      Authors: Corey A. Fowler, Meghan Roddy, Elizabeth Havlicek, Anthony A. Sochet
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Objective: Vitamin K (VK) is commonly prescribed for pediatric sepsis-induced coagulopathy without trial-derived evidence to support its use for this indication. The purpose of this study was to characterize national prescribing trends for VK in this population. Patients and Methods: This is a multicenter retrospective cohort study using the Pediatric Health Information System registry including children 0 to 17 years of age hospitalized for sepsis in the pediatric intensive care unit from January 2016 through December 2022. The primary outcome was overall, annual, and center-specific VK prescribing rates. Descriptive data included demographics, length of stay, and rates of VK deficiency, hepatic insufficiency, red blood cell (RBC) transfusion, venous thromboembolism (VTE), and mortality. VK prescribing trends were assessed using Joinpoint regression. Descriptive statistics employed included Wilcoxon rank-sum, student's t, and chi-square tests. Results: Of the 31 221 encounters studied, 4539 (14.6%) were prescribed VK (median center-specific rate: 14.2%; interquartile range [IQR]: 8.8-21%) with a linear annual trend decreasing from 17.3% in 2016 to 13.3% in 2022 (−0.6%/year, r2 = .661). Those prescribed VK had greater rates of hepatic dysfunction (20.5% vs 3.1%), RBC transfusion (26.5% vs 11.2%), VTE (12.5% vs 4.6%), mortality (17.1% vs 4.4%), and median length of stay (16 [IQR: 8-33] vs 8 [4-15] days) (all P 
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-05-07T06:18:58Z
      DOI: 10.1177/08850666241252419
       
  • Blood RNA Biomarkers Identify Bacterial and Biofilm Coinfections in
           COVID-19 Intensive Care Patients

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      Authors: Philip Dela Cruz, Richard Wargowsky, Alberto Gonzalez-Almada, Erick Perez Sifontes, Eduard Shaykhinurov, Kevin Jaatinen, Tisha Jepson, John E. Lafleur, David Yamane, John Perkins, Mary Pasquale, Brian Giang, Matthew McHarg, Zach Falk, Timothy A. McCaffrey
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Purpose: Secondary opportunistic coinfections are a significant contributor to morbidity and mortality in intensive care unit (ICU) patients, but can be difficult to identify. Presently, new blood RNA biomarkers were tested in ICU patients to diagnose viral, bacterial, and biofilm coinfections. Methods: COVID-19 ICU patients had whole blood drawn in RNA preservative and stored at −80°C. Controls and subclinical infections were also studied. Droplet digital polymerase chain reaction (ddPCR) quantified 6 RNA biomarkers of host neutrophil activation to bacterial (DEFA1), biofilm (alkaline phosphatase [ALPL], IL8RB/CXCR2), and viral infections (IFI27, RSAD2). Viral titer in blood was measured by ddPCR for SARS-CoV2 (SCV2). Results: RNA biomarkers were elevated in ICU patients relative to controls. DEFA1 and ALPL RNA were significantly higher in severe versus incidental/moderate cases. SOFA score was correlated with white blood cell count (0.42), platelet count (−0.41), creatinine (0.38), and lactate dehydrogenase (0.31). ALPL RNA (0.59) showed the best correlation with SOFA score. IFI27 (0.52) and RSAD2 (0.38) were positively correlated with SCV2 viral titer. Overall, 57.8% of COVID-19 patients had a positive RNA biomarker for bacterial or biofilm infection. Conclusions: RNA biomarkers of host neutrophil activation indicate the presence of bacterial and biofilm coinfections in most COVID-19 patients. Recognizing coinfections may help to guide the treatment of ICU patients.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-05-07T05:47:47Z
      DOI: 10.1177/08850666241251743
       
  • 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
      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
       
  • Individualized Autoregulation-Derived Cerebral Perfusion Targets in
           Aneurysmal Subarachnoid Hemorrhage: A New Therapeutic Avenue'

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      Authors: Teodor Mikael Svedung Wettervik, Anders Hånell, Timothy Howells, Elisabeth Ronne-Engström, Anders Lewén, Per Enblad
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Background: Cerebral perfusion pressure (CPP) is an important target in aneurysmal subarachnoid hemorrhage (aSAH), but it does not take into account autoregulatory disturbances. The pressure reactivity index (PRx) and the CPP with the optimal PRx (CPPopt) are new variables that may capture these pathomechanisms. In this study, we investigated the effect on the outcome of certain combinations of CPP or ΔCPPopt (actual CPP-CPPopt) with the concurrent autoregulatory status (PRx) after aSAH. Methods: This observational study included 432 aSAH patients, treated in the neurointensive care unit, at Uppsala University Hospital, Sweden. Functional outcome (GOS-E) was assessed 1-year postictus. Heatmaps of the percentage of good monitoring time (%GMT) of PRx/CPP and PRx/ΔCPPopt combinations in relation to GOS-E were created to visualize the association between these variables and outcome. Results: In the heatmap of the %GMT of PRx/CPP, the combination of lower CPP with higher PRx values was more strongly associated with lower GOS-E. The tolerance for lower CPP values increased with lower PRx values until a threshold of −0.50. However, for decreasing PRx below −0.50, there was a gradual reduction in the tolerance for lower CPP. In the heatmap of the %GMT of PRx/ΔCPPopt, the combination of negative ΔCPPopt with higher PRx values was strongly associated with lower GOS-E. In particular, negative ΔCPPopt together with PRx above +0.50 correlated with worse outcomes. In addition, there was a transition toward an unfavorable outcome when PRx went below −0.50, particularly if ΔCPPopt was negative. Conclusions: The PRx levels influenced the association between CPP/ΔCPPopt and outcome. Thus, this variable could be used to individualize a safe CPP-/ΔCPPopt-range.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-05-06T05:52:45Z
      DOI: 10.1177/08850666241252415
       
  • Long-term Risk of Stroke After New-Onset Atrial Fibrillation in Sepsis
           Survivors: A 2-Year Follow-Up Study

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      Authors: Ahmed Ayaz, Muhammad Ibrahim, Ainan Arshad
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      BackgroundCardiovascular complications such as new-onset atrial fibrillation (NOAF) are common in sepsis and are known to increase the risk of in-hospital mortality and stroke. However, only a handful of studies have evaluated the long-term risk of stroke after NOAF in sepsis survivors. As part of our efforts to address this issue, we conducted the first-ever follow-up study in a developing country evaluating the long-term risk of stroke for sepsis survivors following NOAF. Methods: This retrospective study evaluated all adult patients admitted at the Aga Khan University Hospital between July 2019 and December 2019 with the diagnosis of sepsis. Data was collected from medical records of the included patients. Outcome measures included in-hospital mortality and ischemic stroke within 2 years. Results: Seven hundred thirty patients were included in the study; 415 (57%) were males and 315 (43%) females; mean age was 59.4 ± 18 years. 59 (8%) patients developed NOAF. The risk of stroke within 2 years in sepsis survivors was 3.5%. Six out of 30 (20%) patients in the atrial fibrillation (AF) group developed stroke, whereas 11 out of 448 (2%) patients in the non-AF group developed stroke. NOAF was associated with an increased risk of ischemic stroke within 2 years (OR = 6.6; 95% CI, 2.3-12.8; P = 
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-05-06T05:00:24Z
      DOI: 10.1177/08850666241251755
       
  • Outcomes of High-Dose Versus Low-Dose Vitamin D on Prognosis of Sepsis
           Requiring Mechanical Ventilation: A Randomized Controlled Trial

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      Authors: Tarek Mohamed Ashoor, Abd Elmoniem Hassan Abd Elazim, Zakaria Abd Elaziz Mustafa, Maha Ahmad Anwar, Ihab Ahmad Gad, Ibrahim Mamdouh Esmat
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Background: Critically ill patients with sepsis have a high incidence of vitamin D deficiency. Vitamin D promotes the synthesis of human cathelicidin antimicrobial peptide, a precursor of LL-37, which is a part of the innate immune system. This study investigated the effectiveness and safety of the early administration of high-dose enteral vitamin D3 in comparison with low-dose vitamin D3 in patients with sepsis requiring mechanical ventilation (MV). Methods: Eighty adult patients with sepsis requiring MV with known vitamin D deficiency were randomly assigned to receive either an enteral 50 000 IU (Group I) or 5000 IU (Group II) vitamin D supplementation. Clinical and laboratory parameters were evaluated at baseline and on days 4 and 7 between the study groups. The change in serum procalcitonin (PCT) levels on day 7 was the primary outcome, while the change in serum LL-37 levels on day 7, changes in sequential organ failure assessment (SOFA) score, and clinical pulmonary infection score on day 7, MV duration, and hospital length of stay (LOS) were the secondary outcomes. Results: The (day 7-day 0) change in serum PCT and LL-37 levels and SOFA score were significantly different in Group I (P = .010, P 
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-05-06T05:00:09Z
      DOI: 10.1177/08850666241250319
       
  • Delirium Associated with COVID-19 in Critically ill Children: An
           Observational Cohort Study

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      Authors: Meghan C. Gray, Chani Traube, Taylor B. Sewell, Andrew S. Geneslaw
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      ObjectiveDelirium is an under-recognized problem in critically ill children. Although delirium is common in adults hospitalized with COVID-19, the relationship between pediatric COVID-19 and delirium has not been described. To address this gap, we characterized delirium in critically ill children with different manifestations of COVID-19 and investigated associations among demographic, disease, and treatment factors. We hypothesized that multisystem inflammatory syndrome in children (MIS-C) would be associated with a higher incidence of delirium given its underlying pathophysiology of hyperinflammation.DesignRetrospective, single-center cohort study.SettingQuaternary-care pediatric intensive care unit (PICU).PatientsChildren less than 18 years of age hospitalized in the PICU between March 2020 and March 2023 with either active SARS-CoV-2 infection or serological evidence of prior infection.Measurements and main resultsThe cohort included 149 PICU hospitalizations among children with evidence of COVID-19. Patients were categorized by reason for PICU admission: 75 (50%) for COVID-19 respiratory disease, 36 (24%) MIS-C, and 38 (26%) any other primary reason with positive COVID-19 testing. Delirium was diagnosed in 43 (29%) patients. Delirium incidence was highest in patients requiring invasive mechanical ventilation (IMV) (56% vs 7.5% in patients who did not require IMV, p 
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-05-01T05:31:08Z
      DOI: 10.1177/08850666241249169
       
  • Hospital Outcomes in Patients Who Developed Acute Respiratory Distress
           Syndrome After Community-Acquired Pneumonia

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      Authors: George Kasotakis, Praruj Pant, Akash D. Patel, Yousef Ahmed, Karthik Raghunathan, Vijay Krishnamoorthy, Tetsu Ohnuma
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Purpose: To identify risk factors for and outcomes in acute respiratory distress syndrome (ARDS) in patients hospitalized with community-acquired pneumonia (CAP). Methods: This is a retrospective study using the Premier Healthcare Database between 2016 and 2020. Patients diagnosed with pneumonia, requiring mechanical ventilation (MV), antimicrobial therapy, and hospital admission ≥2 days were included. Multivariable regression models were used for outcomes including in-hospital mortality, hospital length of stay (LOS), intensive care unit (ICU) LOS, and days on MV. Results: 1924 (2.7%) of 72 107 patients with CAP developed ARDS. ARDS was associated with higher mortality (33.7% vs 18.9%; adjusted odds ratio 2.4; 95% confidence interval [CI] 2.16-2.66), longer hospital LOS (13 vs 9 days; adjusted incidence risk ratio (aIRR) 1.24; 95% CI 1.20-1.27), ICU LOS (9 vs 5 days; aIRR 1.51; 95% CI 1.46-1.56), more MV days (8 vs 5; aIRR 1.54; 95% CI 1.48-1.59), and increased hospitalization cost ($46 459 vs $29 441; aIRR 1.50; 95% CI 1.45-1.55). Conclusion: In CAP, ARDS was associated with worse in-patient outcomes in terms of mortality, LOS, and hospitalization cost. Future studies are needed to explore outcomes in patients with CAP with ARDS and explore risk factors for development of ARDS after CAP.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-04-25T07:00:28Z
      DOI: 10.1177/08850666241248568
       
  • Transbronchial Lung Cryobiopsies, Transbronchial Forceps Lung Biopsies,
           and Surgical Lung Biopsies in Mechanically Ventilated Patients with Acute
           Hypoxemic Respiratory Failure: A Retrospective Cohort Study

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      Authors: Qi Li, Dominique Lafrance, Moishe Liberman, Charles Leduc, Emmanuel Charbonney, Polina Titova, Hélène Manganas, Michaël Chassé
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      ImportanceLung biopsies are sometimes performed in mechanically ventilated patients with acute hypoxemic respiratory failure (AHRF) of unknown etiology to guide patient management. While surgical lung biopsies (SLB) offer high diagnostic rates, they may also cause significant complications. Transbronchial forceps lung biopsies (TBLB) are less invasive but often produce non-contributive specimens. Transbronchial lung cryobiopsies (TBLC) yield specimens of potentially better quality than TBLB, but due to their novel implementation in the intensive care unit (ICU), their accuracy and safety are still unclear.ObjectivesOur main objective was to evaluate the risk of adverse events in patients with AHRF following the three biopsy techniques. Our secondary objectives were to assess the diagnostic yield and associated modifications of patient management of each technique.Design, Settings and ParticipantsWe conducted a retrospective cohort study comparing TBLC, TBLB, and SLB in mechanically ventilated patients with AHRF.Main Outcomes and MeasuresThe primary outcome was the proportion of patients with at least one complication, and secondary outcomes included complication rates, diagnostic yields, treatment modifications, and mortality.ResultsOf the 26 patients who underwent lung biopsies from 2018 to 2022, all TBLC and SLB patients and 60% of TBLB patients had at least one complication. TBLC patients had higher unadjusted numbers of total and severe complications, but also worse Sequential Organ Failure Assessment scores and P/F ratios. A total of 25 biopsies (25/26, 96%) provided histopathological diagnoses, 88% (22/25) of which contributed to patient management. ICU mortality was high for all modalities (63% for TBLC, 60% for TBLB and 50% for SLB).Conclusions and RelevanceAll biopsy methods had high diagnostic yields and the great majority contributed to patient management; however, complication rates were elevated. Further research is needed to determine which patients may benefit from lung biopsies and to determine the best biopsy modality.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-04-22T08:37:56Z
      DOI: 10.1177/08850666241247145
       
  • Impact of Humidification Modality on Incidence of Endotracheal Tube
           Occlusion in COVID-19 Patients

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      Authors: James Richard Mattson, Kunal Dhiren Gada, Randeep Jawa, Xiaoyue Zhang, Sahar Ahmad
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Background: Endotracheal tube (ETT) occlusion is reported at a higher frequency among coronavirus disease-2019 (COVID-19) patients. Prior to the COVID-19 pandemic, literature examining patient and ventilator characteristics, including humidification, as etiologies of ETT occlusion yielded mixed results. Our study examines the relationship of humidification modality with ETT occlusion in COVID-19 patients undergoing invasive mechanical ventilation (IMV). Methods: We conducted a retrospective chart review of COVID-19 patients requiring IMV at a tertiary care center in New York from April 2020 to April 2021. Teleflex Neptune heated wire heated humidification (HH) and hygroscopic Intersurgical FiltaTherm and Sunmed Ballard 1500 heat and moisture exchangers (HME) were used. Episodes of ETT occlusion were recorded. Univariate and multivariable logistic regression models were used to investigate the relationship between humidification modality and the occurrence of ETT occlusion. Findings: A total of 201 eligible patients were identified. Teleflex HH was utilized in 50.2% of the population and the others Intersurgical and Sunmed HME devices. Median age was 62 years and 78.6% of patients had at least one medical comorbidity. Precisely, 24% of patients experienced an ETT occlusion after a median of 12 days. The HME group was younger (58.5 vs 64 years), predominantly male (75% vs 59.4%), and experienced more total ventilator days than the HH group (24 vs 12). Those using the studied HME devices had significantly higher odds of ETT occlusion (OR 4.4, 95% CI 1.8-10.6, P = .0011). Three patients (6.1%) experienced cardiac arrest as a consequence of their occlusion. There were no deaths directly attributed to ETT occlusion. Conclusions: The studied HME devices were significantly associated with higher odds of ETT occlusion in COVID-19 patients requiring invasive mechanical ventilation. These events are not without significant clinical consequences. Prolonged use of under-performing HME devices remains suspect in the occurrence of ETT occlusions.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-04-18T08:07:52Z
      DOI: 10.1177/08850666241246969
       
  • Association Between Arterial Pulse Waveform Analysis and Mortality in
           Patients With Septic Shock: A Retrospective Cohort Study Using Japanese
           Diagnosis Procedure Combination Data

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      Authors: Koji Endo, Kayoko Mizuno, Satomi Yoshida, Koji Kawakami
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Purpose: Specialized pressure transducers for arterial pulse waveform analysis (S-APWA) devices are dedicated kits connected to an arterial pressure catheter that monitors hemodynamic parameters, such as cardiac output, pulse pressure variation, and stroke volume variation, less invasively. While the association between the use of S-APWA devices and clinical outcomes in perioperative patients has been previously evaluated, its assessment in patients with septic shock remains inadequate. Materials and Methods: This retrospective cohort study utilized a nationwide Diagnosis Procedure Combination database in Japan. Adult patients with septic shock admitted to the intensive care unit (ICU) with arterial pressure catheter placement on the admission day from August 2012 to February 2021 were included. Hospitalizations meeting the eligibility criteria were categorized into groups based on S-APWA device usage. The primary outcome, evaluated using Cox regression analysis, was 30-day all-cause mortality in the propensity score overlap-weighted population. Secondary outcomes included in-hospital mortality, ICU duration, and overall hospital stay. Results: Among 5130 eligible hospitalizations, 643 were in the S-APWA group and 4487 were in the conventional pressure transducer group. Cox regression analysis within the propensity score overlap-weighted population showed no significant difference in 30-day mortality (adjusted hazard ratio: 0.94; 95% confidence interval: 0.9-1.38; P = .58). Logistic regression analysis indicated no significant differences in the in-hospital mortality. While the S-APWA group had prolonged ICU stays, no significant difference in the overall hospital stay was observed according to linear regression analyses. Conclusions: Our study found no significant association between S-APWA use and 30-day mortality in patients with septic shock. These findings offer insights into optimizing monitoring systems in ICUs.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-04-18T08:07:12Z
      DOI: 10.1177/08850666241246215
       
  • A Proof-of-Concept Model for Implementing a “Smart-NICU” to
           Improve Infant Mortality

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      Authors: Sidney Hilker, Amundam Mancho, Geetanjali Srivatsava, Dileep Raman, Sitarah Mathias, Ryan Brewster, Carl Britto
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Low- and middle-income countries face limited critical care capacity due to constraints in staffing, resources, and technology. “Smart ICUs” that integrate telehealth to augment care delivery, communication, and data integration have the potential to bridge these gaps and reduce preventable morbidity and mortality. While their efficacy has been well validated in adult populations, applications of Smart-ICU services in the neonatal population have not been studied. Neonatal intensive care units (NICUs) in India using a common Smart-NICU platform, developed by CloudPhysician, utilize a hub-and-spokes framework along with locally designed technology to facilitate remote patient care in collaboration with local health systems. In this article, we investigate the operational characteristics and performance outcomes for Smart-NICU deployment from the 18 NICUs and 214 beds deployed to date. These findings highlight the potential impact of Smart-NICUs and establish generalizable principles for implementation in low-resource settings.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-04-18T07:25:12Z
      DOI: 10.1177/08850666241247532
       
  • Impact of Delirium Onset and Duration on Mortality in Patients With Cancer
           Admitted to the ICU

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      Authors: Jing Tao, Kenneth P. Seier, Sanjay Chawla, Kay See Tan, Amanda Wheeler, Joanna Sanzone, Carina B. Marasigan-Stone, Justina-Sheila S. Simondac, Analin V. Pascual, Natalie T. Kostelecky, Louis P. Voigt
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      BackgroundLittle is known on the effects of delirium onset and duration on outcome in critically ill patients with cancer.ObjectivesTo determine the impact of delirium onset and duration on intensive care unit (ICU) and hospital mortality and length of stay (LOS) in patients with cancer.MethodsOf the 915 ICU patients admitted in 2018, 371 were included for analysis after excluding for terminal disease,
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-04-17T10:27:35Z
      DOI: 10.1177/08850666241244733
       
  • Quantitative SARS-CoV-2 RT-PCR and Bronchoalveolar Cytokine Concentrations
           Redefine the COVID-19 Phenotypes in Critically Ill Patients

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      Authors: M. Cristina Vazquez Guillamet, Rodrigo Vazquez Guillamet, Ashraf Rjob, Daniel Reynolds, Bijal Parikh, Vladimir Despotovic, Derek E. Byers, Ali H. Ellebedy, Marin H. Kollef, Philip A. Mudd
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      RationaleRecent studies suggest that both hypo- and hyperinflammatory acute respiratory distress syndrome (ARDS) phenotypes characterize severe COVID-19-related pneumonia. The role of lung Severe Acute Respiratory Syndrome – Coronavirus 2 (SARS-CoV-2) viral load in contributing to these phenotypes remains unknown.ObjectivesTo redefine COVID-19 ARDS phenotypes when considering quantitative SARS-CoV-2 RT-PCR in the bronchoalveolar lavage of intubated patients. To compare the relevance of deep respiratory samples versus plasma in linking the immune response and the quantitative viral loads.MethodsEligible subjects were adults diagnosed with COVID-19 ARDS who required mechanical ventilation and underwent bronchoscopy. We recorded the immune response in the bronchoalveolar lavage and plasma and the quantitative SARS-CoV-2 RT-PCR in the bronchoalveolar lavage. Hierarchical clustering on principal components was applied separately on the 2 compartments’ datasets. Baseline characteristics were compared between clusters.Measurements and ResultsTwenty subjects were enrolled between August 2020 and March 2021. Subjects underwent bronchoscopy on average 3.6 days after intubation. All subjects were treated with dexamethasone prior to bronchoscopy, 11 of 20 (55.6%) received remdesivir and 1 of 20 (5%) received tocilizumab. Adding viral load information to the classic 2-cluster model of ARDS revealed a new cluster characterized by hypoinflammatory responses and high viral load in 23.1% of the cohort. Hyperinflammatory ARDS was noted in 15.4% of subjects. Bronchoalveolar lavage clusters were more stable compared to plasma.ConclusionsWe identified a unique group of critically ill subjects with COVID-19 ARDS who exhibit hypoinflammatory responses but high viral loads in the lower airways. These clusters may warrant different treatment approaches to improve clinical outcomes.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-04-17T10:26:36Z
      DOI: 10.1177/08850666231217707
       
  • Pilot Study on the Impact of Early Subcutaneous Basal Insulin
           Administration in Diabetic Ketoacidosis

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      Authors: Danielle S. Murray, Brian W. Gilbert, Tessa R. Cox
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Purpose/Background: Recent studies have shown improved outcomes with the initiation of earlier subcutaneous (SQ) basal insulin. The purpose of this study was to examine the effects of early SQ basal insulin administration on hospital length of stay in patients with mild to moderate diabetic ketoacidosis (DKA). Methods: This was a retrospective, single-center study from a large community teaching hospital that included patients 18 years or older with mild to moderate DKA, identified using ICD-10 codes, who received intravenous (IV) insulin. Patients who received SQ basal insulin prior to a documented anion gap ≤12 mmol/L were considered to have received early SQ basal insulin and were compared to patients who received SQ basal insulin after closure of their anion gap (AG). The primary outcome was hospital length of stay. Secondary outcomes included intensive care unit length of stay, duration of IV insulin, time to anion gap closure, and incidences of rebound hyperglycemia. Safety outcomes included incidences of hypoglycemia, and hypokalemia. Results: Of 301 patients screened, 108 patients were included in the final analysis. Forty patients received early SQ basal insulin and 68 did not. Median hospital length of stay in the nonearly group was 71 h, compared to 62 h in the early group (P = .57). Secondary and safety outcomes were similar between groups. Conclusions: In this study, there was no statistically significant difference in length of stay in patients that received early SQ basal insulin. Larger trials are needed to determine the significance of earlier SQ basal insulin in DKA.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-04-17T08:05:30Z
      DOI: 10.1177/08850666241247516
       
  • A Narrative Review of Aconite Poisoning and Management

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      Authors: Christine Lawson, 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
       
  • 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
      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
       
  • 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
      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
       
  • 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
      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
       
  • What Are the Real Issues in Providing Extracorporeal Membrane Oxygenation
           (ECMO) Support: A Survey

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      Authors: Shahla Siddiqui, Lovkesh Arora, Monica I. Lupei, S. Veena Satyapriya, Michael Wall, Miguel Cobas, Samuel Justice, Raquel R. Bartz
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      IntroductionBy using a novel survey our study aimed to assess the challenges ECMO and Critical Care (CC) teams face when initiating and managing patient's ECMO support.MethodsA qualitative survey-based observational study was performed of members of 2 Critical Care Medicine organizations involved in decision-making around the practice of Extracorporeal Membrane Oxygenation (ECMO). The range of exploratory questions covered ethical principles of informed consent, autonomy and goals of care discussions, beneficence, non-maleficence (offering life-sustaining treatments in end-of-life care), and justice (insurance-related limitations of treatment). Questions also covered pragmatic practice and quality improvement areas, such as exploring whether palliative care or ethics teams were involved in such decision-making.Results305 members received the survey links, and a total of 61 completed surveys were received, for an overall response rate of 20% among all eligible members. Only 70% of the participants who manage ECMO patients are involved in the ECMO initiation decision process. The majority do not involve Ethics or Palliative care at the initial ECMO initiation decision step. Of the ethical and moral dilemmas reported, the majority revolved around 1. Prognostication of patients receiving VV and VA ECMO support, 2. Lack of knowledge of patient's wishes and goals, 3. Disconnect between expectations of families and outcomes and 4. Staff moral distress around when to stop ECMO in case of futility.ConclusionOur survey highlights areas of distress and dilemma which have been stressed before in the initiation, management, and outcomes of ECMO patients, however with the increasing use of this modality of cardiopulmonary mechanical support being offered, the survey results can offer a guidance using sound ethical principles.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-04-04T07:07:46Z
      DOI: 10.1177/08850666241245933
       
  • Noninvasive Ventilation in the Cardiac Intensive Care Unit

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      Authors: Christopher S. Schenck, 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
       
  • Association Between In-hospital Mortality and the Institutional Factors of
           Intensive Care Units with a Focus on the Intensivist- to-bed Ratio: A
           Retrospective Cohort Study

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      Authors: Hideki Endo, Hiroshi Okamoto, Satoru Hashimoto, Hiroaki Miyata
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Purpose: To elucidate the relationship between in-hospital mortality and the institutional factors of intensive care units (ICUs), with a focus on the intensivist-to-bed ratio. Methods: A retrospective cohort study was conducted using a Japanese ICU database, including adult patients admitted between April 1, 2020 and March 31, 2021. We used a multilevel logistic regression model to investigate the associations between in-hospital mortality and the following institutional factors: the intensivist-to-bed ratios on weekdays or over weekends/holidays, different work shifts, hospital-to-ICU-bed ratio, annual-ICU-admission-to-bed ratio, type of hospital, and the presence of other medical staff. Results: The study population comprised 46 503 patients admitted to 65 ICUs. The in-hospital mortality rate was 8.1%. The median numbers of ICU beds and intensivists were 12 (interquartile range [IQR] 8-14) and 4 (IQR 2-9), respectively. In-hospital mortality decreased significantly as the intensivist-to-bed ratio at 10 am on weekdays increased: the average contrast indicated a 20% (95% confidence interval [CI]: 1%-38%) reduction when the ratio increased from 0 to 0.5, and a 38% (95% CI: 9%-67%) reduction when the ratio increased from 0 to 1. The other institutional factors did not present a significant effect. Conclusions: The intensivist-to-bed ratio at 10 am on weekdays had a significant effect on in-hospital mortality. Further investigation is needed to understand the processes leading to improved outcomes.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-04-03T08:10:48Z
      DOI: 10.1177/08850666241245645
       
  • Improving 1-Year Mortality Following Intensive Care Unit Admission in
           Adults with HIV: A 20-Year Observational Study

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      Authors: Tanmay Kanitkar, Nicholas Bakewell, Oshani Dissanayake, Maggie Symonds, Stephanie Rimmer, Amit Adlakha, Marc C. I. Lipman, Sanjay Bhagani, Banwari Agarwal, Caroline A. Sabin, Robert F. Miller
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      BackgroundDespite widespread use of combination antiretroviral therapy, people with HIV (PWH) continue to have an increased risk of admission to and mortality in the intensive care unit (ICU). Mortality risk after hospital discharge is not well described. Using retrospective data on adult PWH (≥18 years) admitted to ICU from 2000-2019 in an HIV-referral centre, we describe trends in 1-year mortality after ICU admission.MethodsOne-year mortality was calculated from index ICU admission to date of death; with follow-up right-censored at day 365 for people remaining alive at 1 year, or day 7 after ICU discharge if lost-to-follow-up after hospital discharge. Cox regression was used to describe the association with calendar year before and after adjustment for patient characteristics (age, sex, Acute Physiology and Chronic Health Evaluation II [APACHE II] score, CD4+ T-cell count, and recent HIV diagnosis) at ICU admission. Analyses were additionally restricted to those discharged alive from ICU using a left-truncated design, with further adjustment for respiratory failure at ICU admission in these analyses.ResultsTwo hundred and twenty-one PWH were admitted to ICU (72% male, median [interquartile range] age 45 [38–53] years) of whom 108 died within 1-year (cumulative 1-year survival: 50%). Overall, the hazard of 1-year mortality was decreased by 10% per year (crude hazard ratio (HR): 0.90 (95% confidence interval: 0.87-0.93)); the association was reduced to 7% per year (adjusted HR: 0.93 (0.89-0.98)) after adjustment. Conclusions were similar among the subset of 136 patients discharged alive (unadjusted: 0.91 (0.84-0.98); adjusted 0.92 (0.84, 1.02)).ConclusionsBetween 2000 and 2019, 1-year mortality after ICU admission declined at this ICU. Our findings highlight the need for multi-centre studies and the importance of continued engagement in care after hospital discharge among PWH.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-04-02T01:40:31Z
      DOI: 10.1177/08850666241241480
       
  • Analysis of Vancomycin Dosage and Plasma Levels in Critically Ill Adult
           Patients Requiring Extracorporeal Membrane Oxygenation (ECMO)

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      Authors: Andrés Ferre, Andrés Giglio, Brenda Zylbersztajn, Rodolfo Valenzuela, Nicolette Van Sint Jan, Christian Fajardo, Andres Reccius, Jorge Dreyse, Pablo Hasbun
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Introduction: Critically ill patients undergoing extracorporeal membrane oxygenation (ECMO) exhibit unique pharmacokinetics. This study aimed to assess the achievement of vancomycin therapeutic targets in these patients. Methods: This retrospective cohort study included patients on ECMO treated with vancomycin between January 2010 and December 2018. Ninety patients were analyzed based on ECMO connection modality, baseline creatinine levels, estimated glomerular filtration rate (eGFR), renal replacement therapy (RRT) requirements, and vancomycin loading dose administration. Results: Twenty-three percent of the patients achieved the therapeutic range defined by baseline levels. No significant differences in meeting the therapeutic goal were found in multivariate analysis considering ECMO cannulation modality, initial creatinine level, initial eGFR, RRT requirement, or loading dose use. All trough levels between 15 and 20 mcg/mL achieved an estimated area under the curve/minimum inhibitory concentration (AUC/MIC) between 400 and 600, almost all trough levels over 10 mcg/mL predicted an AUC/MIC>400. Discussion: Achieving therapeutic plasma levels in these patients remains challenging, potentially due to factors such as individual pharmacokinetics and pathophysiology. A trough plasma level between 12 and 20 estimated the therapeutic AUC/MIC for all models, proposing a possible lower target, maintaining exposure, and potentially avoiding adverse effects. Despite being one of the largest cohorts of vancomycin use in ECMO patients studied, its retrospective nature and single-center focus limits its broad applicability.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-04-01T06:58:52Z
      DOI: 10.1177/08850666241243306
       
  • Incidence of Symptomatic Venous Thromboembolisms in Stroke Patients

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      Authors: Mostafa AL Turk, Michael Abraham
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Venous thromboembolism (VTE) is a common but preventable complication observed in critically ill patients. Deep vein thrombosis (DVT) is the most common type of VTE, with clinical significance based on location and symptoms. There is an increased incidence of DVT and pulmonary embolism (PE) in ischemic stroke patients using unfractionated heparin (UFH) for VTE prophylaxis compared with those using enoxaparin. However, UFH is still used in some patients due to its perceived safety, despite conflicting literature suggesting that enoxaparin may have a protective effect. The current study aimed to determine the incidence of VTEs in patients with acute ischemic strokes on UFH versus enoxaparin for VTE prophylaxis, subclassifying the VTEs depending on their location and symptoms. It also aimed to examine the safety profile of both drugs. A total of 909 patients admitted to the Neuro-ICU with the diagnosis of acute ischemic stroke were identified, and 634 patients were enrolled in the study—170 in the enoxaparin group and 464 in the UFH group—after applying the exclusion criteria. Nineteen patients in the UFH group (4.1%) and 3 patients in the enoxaparin group (1.8%) had a VTE. The incidence of DVT in the UFH group was 12 (2.6%), all of which were symptomatic, compared with 3 (1.8%) in the enoxaparin group, wherein one case was symptomatic. Nine patients (1.9%) in the UFH group developed a PE during the study period, and all of them were symptomatic. No patients in the enoxaparin group developed PE. No statistically significant difference was found between both groups. However, 18 patients in the UFH group (3.9%) experienced intracranial hemorrhage compared with none in the enoxaparin group, and this difference was statistically significant. Enoxaparin was found to be as effective as and potentially safer than UFH when used for VTE prophylaxis in stroke patients.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-03-26T07:50:24Z
      DOI: 10.1177/08850666241242683
       
  • 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
      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
       
  • Vascular Reactivity Index as an Effective Predictor of Mortality in
           Patients With Septic Shock: A Retrospective Study

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      Authors: Sun Jingyi, Gao Cunliang, Chen Biao, Xie Yingguang, Ma Jinluan, Cao Xiaohua, Li Wenqiang
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      BackgroundSepsis is a serious complication that occurs after trauma, burns, and infections, and it is an important cause of death in intensive care unit (ICU) patients. Despite many new measures being proposed for sepsis treatment, its mortality rate remains high; sepsis has become a serious threat to human health, and there is an urgent need to carry out in-depth clinical research related to sepsis. In recent years, it has been found that septic shock-induced vasoplegia is a result of vascular hyporesponsiveness to vasopressors. Therefore, this study intended to establish an objective formula related to vasoplegia that can be used to assess the prognosis of patients and guide clinical treatment.Materials and MethodsA retrospective cohort study was conducted using data from 106 septic shock patients admitted to the ICU of Jining No. 1 People's Hospital from January 2020 to December 2022. The patients were divided into mortality and survival groups based on 28-day survival, and hemodynamics were monitored by the pulse index continuous cardiac output system. The dose and duration of vasopressors, major hemodynamic parameters, lactic acid (Lac) levels, and Sequential Organ Failure Assessment scores were recorded within 48 h of hospital admission. Multifactorial logistic regression was used to analyze the independent risk factors affecting the prognosis of patients, and the predictive value of the vascular response index (VRI) was analyzed by the receiver operating characteristic (ROC) curve.ResultsThe differences between the survival and mortality groups in terms of age, sex ratio, body weight, ICU length of stay, distribution of infection sites, underlying disease conditions, baseline Lac levels, and some hemodynamic parameters were not statistically significant (P > .05). The results of multifactorial logistic regression showed that the admission Acute Physiology and Chronic Health Evaluation II score, Lac level at 24 h of treatment, maximal vasoactive inotropic score at 24 h (VISmax24), maximal vasoactive inotropic score at 48 h (VISmax48), and VRI were independent risk factors affecting 28-day mortality. Within 48 h of receiving vasopressor therapy, the VRI was lower in the mortality group than in the survival group. The area under the ROC curve for the VRI was 0.86, and the best cutoff value of the VRI for predicting 28-day mortality was 32.50 (YI = 0.80), with a sensitivity of 0.90, a specificity of 0.90, and a better prediction of mortality than the other indicators.ConclusionsThe VRI is a good predictor of mortality in patients with septic shock, and a lower VRI indicates more severe vasoplegia, poorer prognosis, and higher mortality in patients with septic shock.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-03-11T11:21:38Z
      DOI: 10.1177/08850666241233183
       
  • Early Beta-Blocker Utilization in Critically Ill Patients With
           Moderate-Severe Traumatic Brain Injury: A Retrospective Cohort Study

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      Authors: Margot Kelly-Hedrick, Sunny Yang Liu, Jordan Komisarow, Jordan Hatfield, Tetsu Ohnuma, Miriam M. Treggiari, Katharine Colton, Evangeline Arulraja, Monica S. Vavilala, Daniel T. Laskowitz, Joseph P. Mathew, Adrian Hernandez, Michael L. James, Karthik Raghunathan, Vijay Krishnamoorthy
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      BackgroundThere is limited evidence that beta-blockers may provide benefit for patients with moderate-severe traumatic brain injury (TBI) during the acute injury period. Larger studies on utilization patterns and impact on outcomes in clinical practice are lacking.ObjectiveThe present study uses a large, national hospital claims-based dataset to examine early beta-blocker utilization patterns and its association with clinical outcomes among critically ill patients with moderate-severe TBI.MethodsWe conducted a retrospective cohort study of the administrative claims Premier Healthcare Database of adults (≥17 years) with moderate-severe TBI admitted to the intensive care unit (ICU) from 2016 to 2020. The exposure was receipt of a beta-blocker during day 1 or 2 of ICU stay (BB+). The primary outcome was hospital mortality, and secondary outcomes were: hospital length of stay (LOS), ICU LOS, discharge to home, and vasopressor utilization. In a sensitivity analysis, we explored the association of beta-blocker class (cardioselective and noncardioselective) with hospital mortality. We used propensity weighting methods to address possible confounding by treatment indication.ResultsA total of 109 665 participants met inclusion criteria and 39% (n = 42 489) were exposed to beta-blockers during the first 2 days of hospitalization. Of those, 42% received cardioselective only, 43% received noncardioselective only, and 14% received both. After adjustment, there was no association with hospital mortality in the BB+ group compared to the BB− group (adjusted odds ratio [OR] = 0.99, 95% confidence interval [CI] = 0.94, 1.04). The BB+ group had longer hospital stays, lower chance of discharged home, and lower risk of vasopressor utilization, although these difference were clinically small. Beta-blocker class was not associated with hospital mortality.ConclusionIn this retrospective cohort study, we found variation in use of beta-blockers and early exposure was not associated with hospital mortality. Further research is necessary to understand the optimal type, dose, and timing of beta-blockers for this population.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-03-07T06:30:31Z
      DOI: 10.1177/08850666241236724
       
  • Nephrotoxic Risk Associated With Combination Therapy of Vancomycin and
           Piperacillin-Tazobactam in Critically Ill Patients With Chronic Kidney
           Disease

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      Authors: Tamyah Pipkin, Stuart Pope, Alley Killian, Sarah Green, Benjamin Albrecht, Katherine Nugent
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Background: The combination of vancomycin and piperacillin-tazobactam (VPT) has been associated with acute kidney injury (AKI) in hospitalized patients when compared to similar combinations. Additional studies examining this nephrotoxic risk in critically ill patients have not consistently demonstrated the aforementioned association. Furthermore, patients with baseline renal dysfunction have been excluded from almost all of these studies, creating a need to examine the risk in this patient population. Methods: This was a retrospective cohort analysis of critically ill adults with baseline chronic kidney disease (CKD) who received vancomycin plus an anti-pseudomonal beta-lactam at Emory University Hospital. The primary outcome was incidence of AKI. Secondary outcomes included stage of AKI, time to development of AKI, time to return to baseline renal function, new requirement for renal replacement therapy, intensive care unit and hospital length of stay, and in-hospital mortality. Results: A total of 109 patients were included. There was no difference observed in the primary outcome between the VPT (50%) and comparator (58%) group (P = .4), stage 2 or 3 AKI (15.9% vs 6%; P = .98), time to AKI development (1.7 vs 2 days; P = .5), time to return to baseline renal function (4 vs 3 days; P = .2), new requirement for RRT (4.5% vs 1.5%; P = .3), ICU length of stay (7.3 vs 7.4 days; P = .9), hospital length of stay (19.3 vs 20.1 days; P = .87), or in-hospital mortality (15.9% vs 10.8%; P = .4). A significant difference was observed in the duration of antibiotic exposure (3.32 vs 2.62 days; P = .045 days). Conclusion: VPT was not associated with an increased risk of AKI or adverse renal outcomes. Our findings suggest that the use of this antibiotic combination should not be avoided in this patient population. More robust prospective studies are warranted to confirm these findings.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-02-28T08:49:10Z
      DOI: 10.1177/08850666241234577
       
  • Risk Factors Associated with Intensive Care Admission in Children with
           Severe Acute Respiratory Syndrome Coronavirus 2-Related Multisystem
           Inflammatory Syndrome (MIS-C) in Latin America: A Multicenter
           Observational Study of the REKAMLATINA Network

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      Authors: Jaime Fernández-Sarmiento, Lorena Acevedo, Laura Fernanda Niño-Serna, Raquel Boza, Jimena García-Silva, Adriana Yock-Corrales, Marco A Yamazaki-Nakashimada, Enrique Faugier-Fuentes, Olguita del Águila, German Camacho-Moreno, Dora Estripeaut, Iván F Gutiérrez, Kathia Luciani, Graciela Espada, Martha I Álvarez-Olmos, Paola Pérez-Camacho, Saulo Duarte-Passos, Maria C Cervi, Edwin M Cantillano, Beatriz A Llamas-Guillén, Patricia Saltigeral-Simental, Javier Criales, Enrique Chacon-Cruz, Miguel García-Domínguez, Karla L Borjas Aguilar, Daniel Jarovsky, Gabriela Ivankovich-Escoto, Adriana H Tremoulet, Rolando Ulloa-Gutierrez
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Background: Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 varies widely in its presentation and severity, with low mortality in high-income countries. In this study in 16 Latin American countries, we sought to characterize patients with MIS-C in the pediatric intensive care unit (PICU) compared with those hospitalized on the general wards and analyze the factors associated with severity, outcomes, and treatment received. Study Design: An observational ambispective cohort study was conducted including children 1 month to 18 years old in 84 hospitals from the REKAMLATINA network from January 2020 to June 2022. Results: A total of 1239 children with MIS-C were included. The median age was 6.5 years (IQR 2.5-10.1). Eighty-four percent (1043/1239) were previously healthy. Forty-eight percent (590/1239) were admitted to the PICU. These patients had more myocardial dysfunction (20% vs 4%; P 
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-02-28T08:39:30Z
      DOI: 10.1177/08850666241233189
       
  • Updated Review of Radiologic Imaging and Intervention for Acute
           Pancreatitis and Its Complications

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      Authors: Joshua Willis, Eric vanSonnenberg
      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
       
  • Epidemiology and Outcomes of Critical Illness and Novel Predictors of
           Mortality in an Ethiopian Medical Intensive Care Unit

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      Authors: Aschalew Worku, Deborah Haisch, Madhavi Parekh, Amir Sultan, Abebe Shumet, Kibrom G/Selassie, Max O’Donnell, Amsalu Binegdie, Charles B. Sherman, Neil W. Schluger
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Low- and middle-income countries (LMICs) bear most of the global burden of critical illness. Managing this burden requires improved understanding of epidemiology and outcomes in LMIC intensive care units (ICUs), including LMIC-specific mortality prediction scores. This study was a retrospective observational study at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia, examining all consecutive medical ICU admissions from June 2014 to April 2015. The primary outcome was ICU mortality; secondary outcomes were prolonged ICU stay and prolonged mechanical ventilation. ICU mortality prediction models were created using multivariable logistic regression and compared with the Mortality Probability Model-II (MPM-II). Associations with secondary outcomes were examined with multivariable logistic regression. There were 198 admissions during the study period; mortality was 35%. Age, shock on admission, mechanical ventilation, human immunodeficiency virus, and Glasgow Coma Scale ≤8 were associated with ICU mortality. The receiver operating characteristic curve for this 5-factor model had an AUC of 0.8205 versus 0.7468 for MPM-II, favoring the simplified new model. Mechanical ventilation and lack of shock were associated with prolonged ICU stays. Mortality in an LMIC medical ICU was high. This study examines an LMIC medical ICU population, showing a simplified prediction model may predict mortality as well as complex models.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-02-28T08:13:41Z
      DOI: 10.1177/08850666241233481
       
  • Comparison of Clinical Characteristics and Outcomes in Intensive Care
           Units Between Patients with Coronavirus Disease 2019 (COVID-19) and
           Patients with Influenza: A Systematic Review and Meta-Analysis

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      Authors: Zhuan Zhong, Xin Wang, Jia Guo, Xingzhao Li, Yingying Han
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      BackgroundSevere infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or influenza virus can cause patients to be admitted to intensive care units (ICUs). It is necessary to understand the differences in clinical characteristics and outcomes between these two types of critically ill patients.MethodsWe searched Embase, PubMed, and Web of Science for articles and performed a meta-analysis using Stata 14.0 with a random-effects model. This paper was written in strict accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.ResultsThirty-five articles involving 131,692 ICU patients with coronavirus disease 2019 (COVID-19) and 30,286 ICU patients with influenza were included in our meta-analysis. Compared with influenza patients, COVID-19 patients were more likely to be male (odds ratio (OR) = 1.75, 95% CI: 1.54-1.99) and older (standardized mean difference (SMD) = 0.16, 95% CI: 0.03-0.29). In terms of laboratory test results, COVID-19 patients had higher lymphocyte (SMD = 0.38, 95% CI: 0.17-0.59) and platelet counts (SMD = 0.52, 95% CI: 0.29-0.75) but lower creatinine (SMD = −0.29, 95% CI: −0.55-0.03) and procalcitonin levels (SMD = −0.78, 95% CI: −1.11-0.46). Diabetes (SMD = 1.27, 95% CI: 1.08-1.48) and hypertension (SMD = 1.30, 95% CI: 1.05-1.60) were more prevalent in COVID-19 patients, while influenza patients were more likely to have cancer (OR = 0.52, 95% CI: 0.44-0.62), cirrhosis (OR = 0.52, 95% CI: 0.44-0.62), immunodepression (OR = 0.38, 95% CI: 0.25-0.58), and chronic pulmonary diseases (OR = 0.35, 95% CI: 0.24-0.52). We also found that patients with COVID-19 had longer ICU stays (SMD = 0.20, 95% CI: 0.05-0.34), were more likely to develop acute respiratory distress syndrome (OR = 4.90, 95% CI: 2.77-8.64), and had higher mortality (OR = 1.35, 95% CI: 1.17-1.55).ConclusionsThere are some differences in the basic characteristics, comorbidities, laboratory test results and complications between ICU patients with COVID-19 and ICU patients with influenza. Critically ill patients with COVID-19 often require more medical resources and have worse clinical outcomes. PROSPERO Registration Number: CRD42023452238
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-02-26T07:16:18Z
      DOI: 10.1177/08850666241232888
       
  • Association of Shock Indices with Peri-Intubation Hypotension and Other
           Outcomes: A Sub-Study of the KEEP PACE Trial

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      Authors: Nathan J. Smischney, Mohamed O. Seisa, Darrell R. Schroeder
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      BackgroundBased on current evidence, there appears to be an association between peri-intubation hypotension and patient morbidity and mortality. Studies have identified shock indices as possible pre-intubation risk factors for peri-intubation hypotension. Thus, we sought to evaluate the association between shock index (SI), modified shock index (MSI), and diastolic shock index (DSI) and peri-intubation hypotension along with other outcomes.MethodsThe present study is a sub-study of a randomized controlled trial involving critically ill patients undergoing intubation. We defined peri-intubation hypotension as a decrease in mean arterial pressure
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-02-26T05:46:17Z
      DOI: 10.1177/08850666241235591
       
  • Study of Empiric Antibiotic Prescription Patterns and Microbiological
           Isolates in Hemodynamically Stable and Unstable ICU Patients With
           Community-Acquired Sepsis

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      Authors: Mahuya Bhattacharyya, Ananya Saha, Subhash Todi
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Background: The efficacy of combination empiric antibiotic therapy for all intensive care unit (ICU) patients with community-acquired sepsis is a subject of ongoing debate in the era of increasing antibiotic resistance. This study was conducted to evaluate the patterns of antibiotic usage and microbial resistance in sepsis patients admitted to the ICU with both hemodynamically stable (HS) and unstable states and to analyze their clinical outcomes. Methods: In this observational study, patients aged 18 years and above who received antibiotics upon admission and had a culture report were included. These patients were categorized into the following groups: HS and hemodynamically unstable (HU), single or combined antibiotics group (more than one antibiotic used empirically to cover one or more groups of organisms), culture-positive and culture-negative group. The microbiological isolates were grouped according to their identified resistance patterns. The outcome parameters involved assessing the differences in empiric antibiotics use upon admission and microbial resistance with hemodynamic stability and investigating any associations with ICU and hospital outcomes. Results: The study included a total of 2675 patients, of which 70.3% were in the HS group, and 29.7% in the HU group. The use of combination antibiotics was significantly higher (p < 0 .0001) across all groups. Carbapenems were used more frequently in the single antibiotic group (p < 0 .001). The culture was positive in 27.8% (n  =  747) of patients. A significantly higher number of patients in the HU group (p < 0 .001) were found to have carbapenem-resistant and multidrug-resistant organisms. The ICU and hospital mortality rates were significantly higher in the HU group (p < 0 .001), the culture-positive group with resistance (p < 0 .001), and the HS patients who received combination antibiotics. Conclusion: The usage of combination antibiotics, coupled with the presence of resistant organisms, emerged as an important variable in predicting ICU and hospital mortality rates in cases of community-acquired sepsis.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-02-26T05:45:18Z
      DOI: 10.1177/08850666241234625
       
  • Comparing Simulation Training of Bronchoscopy-Guided Percutaneous
           Dilatational Tracheostomy Using Conventional Versus 3D Printed Simulators
           (TRAC-Sim Study)

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      Authors: Moritz Wegner, Fabian Dusse, Finnard Beeser, Nicolas Leister, Marian Lefarth, Simon-Richard Finke, Bernd W. Böttiger, Bernhard Dorweiler, Sandra Emily Stoll
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Background: Individual implementation rate of bronchoscopy-guided percutaneous dilatational tracheostomy (PDT) varies among intensivists. Simulation training (ST) can increase the safety of medical procedures by reducing stress levels of the performing team. The aim of this study was to evaluate the benefit of ST in PDT regarding procedural time, quality of performance, and percepted feelings of safety of the proceduralist and to compare conventional simulators (CSIM) with simulators generated from 3D printers (3DSIM). Methods: We conducted a prospective, single-center, randomized, blinded cross-over study comparing the benefit of CSIM versus 3DSIM for ST of PDT. Participants underwent a standardized theoretical training and were randomized to ST with CSIM (group A) or 3DSIM (group B). After ST, participants’ performance was assessed by two blinded examiners on a porcine trachea regarding time required for successful completion of PDT and correct performance (assessed by a performance score). Percepted feelings of safety were assessed before and after ST. This was followed by a second training and second assessment of the same aspects with crossed groups. Results: 44 participants were included: 24 initially trained with CSIM (group A) and 20 with 3DSIM (group B). Correctness of the PDT performance increased significantly in group B (p 
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-02-26T05:44:49Z
      DOI: 10.1177/08850666241232918
       
  • Prognostic Implications of the Timing of ST-Elevation Myocardial
           Infarction Development in Relation to COVID-19 Infection

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      Authors: Aleksandra D. Milošević, Marija M. Polovina, Dario D. Jelic, Damjan D. Simic, Mihajlo M. Viduljevic, Dragan M. Matic, Milenko M. Tomic, Tatjana N. Adzic, Milika R. Asanin
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Background: Patients with ST-segment elevation myocardial infarction (STEMI) and COVID-19 infection have a worse clinical course and prognosis. The prognostic significance of the timing of STEMI in relation to COVID-19 infection was not investigated. Objectives: To assess whether the time of STEMI development in relation to COVID-19 infection (concurrent or following the infection) influenced the short-term prognosis. Methods: This was an observational study of consecutive COVID-19 patients with STEMI admitted to the COVID-hospital Batajnica (February 2021–March 2022). The patients were divided into the “STEMI first” group: patients with STEMI and a positive polymerase chain reaction test for COVID-19, and the “COVID-19 first” group: patients who developed STEMI during COVID-19 treatment. All patients underwent coronary angiography. The primary endpoint was in-hospital all-cause mortality. Results: The study included 87 patients with STEMI and COVID-19 (Mage, 66.7 years, 66% male). The “STEMI first” group comprised 54 (62.1%) patients, and the “COVID-19 first” group included 33 (37.9%) patients. Both groups shared a comparatively high burden of comorbidities, similar angiographic and procedural characteristics, and high percentages of performed percutaneous coronary interventions with stent implantation (90.7% vs. 87.9%). In-hospital mortality was significantly higher in the “COVID-19 first” group compared to the “STEMI first” group (51.5% vs. 27.8%). Following adjustment, the “COVID-19 first” group had a hazard ratio of 3.22 (95% confidence interval, 1.18–8.75, p = .022) for in-hospital all-cause death, compared with the “STEMI first” group (reference). Conclusion: Clinical presentation with COVID-19 infection, followed by STEMI (“COVID-19 first”), was associated with greater short-term mortality compared to patients presenting with STEMI and testing positive for COVID-19 (“STEMI first”).
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-02-20T06:21:02Z
      DOI: 10.1177/08850666241232938
       
  • 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
      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
       
  • Continuous Versus Intermittent Control Cuff Pressure for Preventing
           Ventilator-Associated Pneumonia: An Updated Meta-Analysis

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      Authors: Yanshuo Wu, Yanan Li, Meirong Sun, Jingjing Bu, Congcong Zhao, Zhenjie Hu, Yanling Yin
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      ObjectiveThis study aimed to evaluate the effect of continuous control cuff pressure (CCCP) versus intermittent control cuff pressure (ICCP) for the prevention of ventilator-associated pneumonia (VAP) in critically ill patients.MethodsRelevant literature was searched in several databases, including PubMed, Embase, Web of Science, ProQuest, the Cochrane Library, Wanfang Database and China National Knowledge Infrastructure between inception and September 2022. Randomized controlled trials were considered eligible if they compared CCCP with ICCP for the prevention of VAP in critically ill patients. This meta-analysis was performed using the RevMan 5.3 and Trial Sequential Analysis 0.9 software packages. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to assess the level of evidence.ResultsWe identified 14 randomized control trials with a total of 2080 patients. Meta-analysis revealed that CCCP was associated with a significantly lower incidence of VAP compared with ICCP (relative risk [RR] = 0.52; 95% confidence interval [CI]: 0.37-0.74; P 
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-02-20T06:19:51Z
      DOI: 10.1177/08850666241232369
       
  • The Impact of Fluid Balance on Acute Kidney Injury in Nontraumatic
           Subarachnoid Hemorrhage

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      Authors: Dante Merrill, Jack M. Craven, Scott Silvey, Daniel Gouger, Chen Wang, Rishi Patel, Vishal Yajnik
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Background: Nontraumatic subarachnoid hemorrhage (SAH) can lead to poor neurologic outcomes, particularly when delayed cerebral ischemia (DCI) occurs. Maintenance of euvolemia following SAH is thought to reduce the risk of DCI. However, attempts at maintaining euvolemia often err on the side of hypervolemia. In this study, we assessed the relationship between fluid balance and acute kidney injury (AKI) in SAH patients, assessing hypervolemia versus euvolemia and their impact on AKI. Methods: In a quaternary care center, neuroscience intensive care unit we conducted a retrospective longitudinal analysis in adult patients who suffered a nontraumatic SAH. Results: Out of 139 patients, 15 (10.8%) patients developed an AKI while hospitalized, with 7 stage I, 3 stage II, and 5 stage III injuries. Acute kidney injury patients had higher peak sodium (150.1 mEq/L vs 142.7 mEq/L, 95% confidence interval [CI]: [2.7-12.1 mEq/L]), higher discharge chloride (109.1 mEq/L vs 104.9 mEq/L, 95% CI: [0.7-7.6 mEq/L]), and lower hemoglobin at discharge (9.3 g/dL vs 11.3 g/dL, 95% CI: [1.0-2.9 g/dL]). At 7 days, AKI patients had a fluid balance that was 1.82 L higher (P = .04), and 3.38 L higher at 14 days (P = .02), in comparison to day 3. Acute kidney injury was associated with significant mortality increases. This increase in mortality was found at 30 days from admission with a 9.52-fold increase, and at 60 days with a 6.25-fold increase. As a secondary outcome, vasospasm (19 patients, 13.7%) showed no association with AKI. Conclusions: Acute kidney injury following SAH is correlated with clinically significant hypervolemia, elevated sodium, elevated chloride, decreased urine output, and decreased hemoglobin at discharge—risk factors for all SAH patients. This study further elucidates the harm of hypervolemia and gives greater practical evidence to physicians attempting to balance the dangers of vasospasm and AKI.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-02-20T06:19:22Z
      DOI: 10.1177/08850666241226900
       
  • Efficacy and Safety of Nirmatrelvir/Ritonavir in Severe Hospitalized
           Patients with COVID-19 and in Patients at High Risk for Progression to
           Critical Illness: A Real-World Study

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      Authors: Xiaohua Chen, Ying Zhu, Leer Shen, Dan Zhou, Nannan Feng, Qiang Tong
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Background: Nirmatrelvir/Ritonavir is an orally administered anti-SARS-Cov-2 drug used in mild-to-moderate COVID-19 patients. Our retrospective cohort study aims to evaluate the efficacy and safety of Nirmatrelvir/Ritonavir in severe hospitalized patients with Omicron infection, as well as in patients at high risk for progression to critical illness in real-world settings. Methods: A total of 350 patients received Nirmatrelvir/Ritonavir while 350 matched controls did not. Patients with confirmed COVID-19 were administered Nirmatrelvir 300 mg and Ritonavir 100 mg orally twice a day for 5 days, with the medication initiated on the first day after admission. The primary endpoint of the study was a composite outcome of hospitalization or death from any cause within 28 days. Secondary endpoints included the occurrence of adverse events and the evaluation of serum levels of IL-6 and viral load. Results: We documented the mortality risk from any cause within 28 days, viral load, serum IL-6 levels, and adverse events. Nirmatrelvir/Ritonavir reduced the 28-day risk of all-cause mortality by 86% (P = .011, hazard ratio (HR) = 0.14, 95% confidence interval (CI) = 0.03, 0.64). At baseline, the serum level of IL-6 was significantly higher in the antiviral treatment group compared to the control group (P 
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-02-15T07:10:59Z
      DOI: 10.1177/08850666241228841
       
  • Association of Body Mass Index with Multiple Organ Failure in Hospitalized
           Patients with COVID-19: A Multicenter Retrospective Cohort Study

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      Authors: Timothy Phillips, Abdallah Mughrabi, Levindo J. Garcia, Christopher El Mouhayyar, Laith Hattar, Hocine Tighiouart, Andrew H. Moraco, Claudia Nader, Bertrand L. Jaber
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Purpose: This study examines whether excessive adipose tissue, as measured by the body mass index (BMI), is associated with higher systemic markers of inflammation and higher risk of severe acute organ failure among patients with coronavirus disease 2019 (COVID-19). Methods: This was a multicenter retrospective cohort study of 1370 hospitalized adults (18 years or older) with COVID-19 during the first wave of the pandemic. Patient-level variables were extracted from the electronic medical record. The primary predictor variable was the BMI at time of hospital admission, in accordance with the World Health Organization classification. Multivariable logistic regression analyses examined the association of BMI with the composite of acute respiratory distress syndrome (ARDS), as defined by the use of high-flow nasal canula, non-invasive ventilation, or mechanical ventilation, severe acute kidney injury (AKI), as defined by acute dialysis requirement, or in-hospital death. Results: After adjustment for important cofounders, the BMI stratum of> 40 kg/m2 (compared to the BMI 
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-02-12T05:25:06Z
      DOI: 10.1177/08850666241232362
       
  • Management of Immunosuppressive Therapy in Kidney Transplant Recipients
           with Sepsis: A Multicenter Retrospective Study

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      Authors: Hyung Duk Kim, Byung Ha Chung, Chul Woo Yang, Seok Chan Kim, Kyung Hoon Kim, Shin Young Kim, Kyu Yean Kim, Jongmin Lee
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      BackgroundUp to 6% of kidney transplant recipients (KTRs) experience life-threatening complications requiring intensive care unit (ICU) admission, and one of the most common medical complications requiring ICU admission is infection. This study aimed to evaluate the effect of immunosuppressive therapy (IST) modification on prognosis of KTRs with sepsis.MethodsWe conducted a multicenter retrospective study in 4 university-affiliated hospitals to evaluate the effect of adjusting the IST in KTRs with sepsis. Only patients who either maintained IST after ICU admission or those who underwent immediate (within 24 h of ICU admission) reduction or withdrawal of IST following ICU admission were included in this study. “Any reduction” was defined as a dosage reduction of any IST or discontinuation of at least 1 IST. “Complete withdrawal of IST” was defined as concomitant discontinuation of all ISTs, except steroids.ResultsDuring the study period, 1596 of the KTRs were admitted to the ICU, and 112 episodes of sepsis or septic shock were identified. The overall in-hospital mortality rate was 35.7%. In-hospital mortality was associated with higher sequential organ failure assessment score, simplified acute physiology score 3, non-identical human leukocyte antigen relation, presence of septic shock, and complete withdrawal of IST. After adjusting for potential confounding factors, complete withdrawal of IST remained significantly associated with in-hospital mortality (adjusted coefficient, 1.029; 95% confidence interval, 0.024-2.035) and graft failure (adjusted coefficient, 2.001; 95% confidence interval, 0.961-3.058).ConclusionsComplete IST withdrawal was common and associated with worse outcomes in critically ill KTRs with sepsis.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-02-07T06:38:41Z
      DOI: 10.1177/08850666241231495
       
  • Clinical Characteristics, Outcomes, and Risk Factors for Mortality in
           Pregnant/Puerperal Women with COVID-19 Admitted to ICU in Turkey: A
           Multicenter, Retrospective Study from a Middle-Income Country

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      Authors: Nur Baykara
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      BackgroundCoronaviruses have been the cause of 3 major outbreaks during the last 2 decades. Information on coronavirus diseases in pregnant women is limited, and even less is known about seriously ill pregnant women. Data are also lacking regarding the real burden of coronavirus disease 2019 (COVID-19) infection in pregnant women from low/middle-income countries. The aim of this study was to determine the characteristics and clinical course of COVID-19 in pregnant/puerperal women admitted to ICUs in Turkey.MethodsThis was a national, multicenter, retrospective study. The study population comprised all SARS-CoV-2-infected pregnant/puerperal women admitted to participating ICUs between 1 March 2020 and 1 January 2022. Data regarding demographics, comorbidities, illness severity, therapies, extrapulmonary organ injuries, non-COVID-19 infections, and maternal and fetal/neonatal outcomes were recorded. LASSO logistic regression and multiple logistic regression analyses were used to identify predictive variables in terms of ICU mortality.ResultsA total of 597 patients (341 pregnant women, 255 puerperal women) from 59 ICUs in 44 hospitals were included and of these patients, 87.1% were unvaccinated. The primary reason for ICU admission was acute hypoxemic respiratory failure in 522 (87.4%), acute hypoxemic respiratory failure plus shock in 14 (2.3%), ischemic cerebrovascular accident (CVA) in 5 (0.8%), preeclampsia/eclampsia/HELLP syndrome in 6 (1.0%), and post-caesarean follow-up in 36 (6.0%). Nonsurvivors were sicker than survivors upon ICU admission, with higher APACHE II (p 
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-02-07T03:36:53Z
      DOI: 10.1177/08850666231222838
       
  • Reintubation Rate and Mortality After Emergent Airway Management Outside
           the Operating Room

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      Authors: Uzung Yoon, Jeffrey Mojica, Matthew Wiltshire, Marc Torjman
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      BackgroundLittle is known about reintubations outside of the operating room. The objective of this study was to evaluate the reintubation rate and mortality after emergent airway management outside operating room (OR), including intensive care unit (ICU) and nonICU settings.MethodsA retrospective cohort study. The primary outcome measures were reintubation rate and mortality. Secondary outcome measures were location and indication for intubation, time until reintubation, total intubated days, ICU-stay, hospital-stay, 30-day in-hospital mortality, and overall in-hospital mortality.ResultsA total of 336 outside-OR intubations were performed in 275 patients. Of those 275 patients, 51 (18.5%) were reintubated during the same hospital admission. (41%) of the reintubations occurred in a non-ICU setting. Reintubations occurred after up to 30-days after extubation. Most frequently between 7 and 30 days (32.8%, n = 20). Most of the reintubated patients were reintubated just once (56.9%; n = 29), but some were reintubated 2 times (29.4%; n = 15) or over 3 times (13.7%; n = 7). Reintubated patients had significant longer total ICU-stay (24 ± 3 days vs 12 ± 1 day, p 
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-02-02T05:27:07Z
      DOI: 10.1177/08850666241230022
       
  • Hypotension During Vasopressor Infusion Occurs in Predictable Clusters: A
           Multicenter Analysis

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      Authors: Daisuke Horiguchi, Sungtae Shin, Jeremy A. Pepino, Jeffrey T. Peterson, Iain E. Kehoe, Joshua N. Goldstein, Jarone Lee, Brian K. Kwon, Jin-Oh Hahn, Andrew T. Reisner
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Background: Published evidence indicates that mean arterial pressure (MAP) below a goal range (hypotension) is associated with worse outcomes, though MAP management failures are common. We sought to characterize hypotension occurrences in ICUs and consider the implications for MAP management. Methods: Retrospective analysis of 3 hospitals’ cohorts of adult ICU patients during continuous vasopressor infusion. Two cohorts were general, mixed ICU patients and one was exclusively acute spinal cord injury patients. “Hypotension-clusters” were defined where there were ≥10 min of cumulative hypotension over a 60-min period and “constant hypotension” was ≥10 continuous minutes. Trend analysis was performed (predicting future MAP using 14 min of preceding MAP data) to understand which hypotension-clusters could likely have been predicted by clinician awareness of MAP trends. Results: In cohorts of 155, 66, and 16 ICU stays, respectively, the majority of hypotension occurred within the hypotension-clusters. Failures to keep MAP above the hypotension threshold were notable in the bottom quartiles of each cohort, with hypotension durations of 436, 167, and 468 min, respectively, occurring within hypotension-clusters per day. Mean arterial pressure trend analysis identified most hypotension-clusters before any constant hypotension occurred (81.2%-93.6% sensitivity, range). The positive predictive value of hypotension predictions ranged from 51.4% to 72.9%. Conclusions: Across 3 cohorts, most hypotension occurred in temporal clusters of hypotension that were usually predictable from extrapolation of MAP trends.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-01-29T06:48:35Z
      DOI: 10.1177/08850666241226893
       
  • Characteristics and Clinical Prognosis of Septic Patients With Persistent
           Lymphopenia

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      Authors: Juanjuan Jing, Yushan Wei, Xue Dong, Dandan Li, Chenyang Zhang, Zhiyao Fang, Jia Wang, Xianyao Wan
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Background: Septic patients with persistent lymphopenia may be in an immunosuppressed state. Therefore, we evaluated and compared the clinical characteristics and outcomes of septic patients with persistent lymphopenia (≥2d) and those with nonpersistent lymphopenia. Methods: A retrospective cohort study was designed. A total of 1306 patients with sepsis who were attended to the First Affiliated Hospital of Dalian Medical University from March 2016 to August 2022 were included. The primary clinical outcome was 90d mortality. The secondary clinical outcomes were the length of stay, hospital mortality, 28d mortality, the incidence of secondary infection, and differences in clinical characteristics. Results: Among 1306 patients with sepsis, 913 (69.9%) patients developed persistent lymphopenia. Compared with patients with nonpersistent lymphopenia, patients with persistent lymphocytopenia were admitted to intensive care unit (75.7% vs 52.7%, P 
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-01-16T02:32:21Z
      DOI: 10.1177/08850666241226877
       
  • Accuracy of Noninvasive Blood Pressure Monitoring in Critically Ill Adults

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      Authors: Erin N. Haber, Rajiv Sonti, Suzanne M. Simkovich, C. William Pike, Christian L. Boxley, Allan Fong, William S. Weintraub, Nathan K. Cobb
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      BackgroundBlood pressure (BP) is routinely invasively monitored by an arterial catheter in the intensive care unit (ICU). However, the available data comparing the accuracy of noninvasive methods to arterial catheters for measuring BP in the ICU are limited by small numbers and diverse methodologies.PurposeTo determine agreement between invasive arterial blood pressure monitoring (IABP) and noninvasive blood pressure (NIBP) in critically ill patients.MethodsThis was a single center, observational study of critical ill adults in a tertiary care facility evaluating agreement (≤10% difference) between simultaneously measured IABP and NIBP. We measured clinical features at time of BP measurement inclusive of patient demographics, laboratory data, severity of illness, specific interventions (mechanical ventilation and dialysis), and vasopressor dose to identify particular clinical scenarios in which measurement agreement is more or less likely.ResultsOf the 1852 critically ill adults with simultaneous IABP and NIBP readings, there was a median difference of 6 mm Hg in mean arterial pressure (MAP), interquartile range (1-12), P 
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-01-12T05:21:15Z
      DOI: 10.1177/08850666231225173
       
  • 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
      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
       
  • Long-Term Mortality and Health-Related Quality of Life After Continuous
           Versus Intermittent Renal Replacement Therapy in ICU Survivors: A
           Secondary Analysis of the Quality of Life After ICU Study

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      Authors: Mariana Martins Siqueira Santos, Daniel Sganzerla, Isabel Jesus Pereira, Regis Goulart Rosa, Cristina Granja, Cassiano Teixeira, Luís Azevedo
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Purpose: We assessed long-term outcomes in intensive care unit (ICU) survivors with acute kidney injury (AKI) submitted to intermittent or continuous renal replacement therapy (RRT) for comparisons between groups. Methods: The multicenter prospective cohort study included 195 adult ICU survivors with an ICU stay>72 h in 10 ICUs that had at least one episode of AKI treated with intermittent RRT (IRRT) or continuous RRT (CRRT) during ICU stay. The main outcomes were mortality and health-related quality of life (HRQoL). Hospital readmissions and physical dependence were also assessed. Results: Regarding RRT, 83 (42.6%) patients received IRRT and 112 (57.4%) received CRRT. Despite the similarity regarding sociodemographic characteristics, pre-ICU state of health and type of admission between groups, the risk of death (23.5% vs 42.7%; P 
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-01-10T07:31:50Z
      DOI: 10.1177/08850666231224392
       
  • Impact of Sedation Practices on Mortality in COVID-19-Associated Adult
           Respiratory Distress Syndrome Patients: A Multicenter Retrospective
           Descriptive Study

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      Authors: Mahmoud Alwakeel, Yan Wang, Heather Torbic, Gretchen L. Sacha, Xiaofeng Wang, Francois Abi Fadel, Abhijit Duggal
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Background: Reduction in sedation exposure is an important metric in intensive care unit (ICU) patients. However, challenges arose during the coronavirus disease-2019 (COVID-19) pandemic in adhering to this practice, driven by concerns on transmission and disease severity issues. Accordingly, diverse sedation approaches emerged, although the effect on mortality has not been studied thoroughly. Methods: Retrospective cohort study in the medical ICU of seven hospitals within a major Health System in Northeast Ohio. We included all adult patients admitted with COVID-19 requiring invasive mechanical ventilation (IMV) from March 2020 to December 2021. Results: Study included 2394 COVID-19 patients requiring IMV. Across waves, sample included 55-63% male subjects, with an average age of 61-68 years (P 
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-01-09T10:17:19Z
      DOI: 10.1177/08850666231224395
       
  • Time and Risk Factors of Trauma-Related Mortality: A 5-Year Retrospective
           Analysis From a National Level I Trauma Center

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      Authors: Mohammad Asim, Ayman El-Menyar, Husham Abdelrahman, Rafael Consunji, Tariq Siddiqui, Ahad Kanbar, Ibrahim Taha, Sandro Rizoli, Hassan Al-Thani
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Background: We aimed to analyze in-hospital timing and risk factors for mortality in a level 1 trauma center. Methods: This is a retrospective analysis of all trauma-related mortality between 2013 and 2018. Patients were divided and analyzed based on the time of mortality (early (≤48 h) vs late (>48 h)), and within different age groups. Multivariate regression analysis was performed to predict in-hospital mortality. Results: 8624 trauma admissions and 677 trauma-related deaths occurred (47.7% at the scene and 52.3% in-hospital). Among in-hospital mortality, the majority were males, with a mean age of 35.8 ± 17.2 years. Most deaths occurred within 3–7 days (35%), followed by 33% after 1 week, 20% on the first day, and 12% on the second day of admission. Patients with early mortality were more likely to have a lower Glasgow coma scale, a higher shock index, a higher chest and abdominal abbreviated injury score, and frequently required exploratory laparotomy and massive blood transfusion (P 
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-01-09T09:05:17Z
      DOI: 10.1177/08850666231225607
       
  • 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
      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
       
  • Simultaneous Venous-Arterial Doppler Ultrasound During Early Fluid
           Resuscitation to Characterize a Novel Doppler Starling Curve: A
           Prospective Observational Pilot Study

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      Authors: Jon-Émile S. Kenny, Ross Prager, Philippe Rola, Korbin Haycock, Stanley O. Gibbs, Delaney H. Johnston, Christine Horner, Joseph K. Eibl, Vivian C. Lau, Benjamin O. Kemp
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Background: The likelihood of a patient being preload responsive—a state where the cardiac output or stroke volume (SV) increases significantly in response to preload—depends on both cardiac filling and function. This relationship is described by the canonical Frank-Starling curve. Research Question: We hypothesize that a novel method for phenotyping hypoperfused patients (ie, the “Doppler Starling curve”) using synchronously measured jugular venous Doppler as a marker of central venous pressure (CVP) and corrected flow time of the carotid artery (ccFT) as a surrogate for SV will refine the pretest probability of preload responsiveness/unresponsiveness. Study Design and Methods: We retrospectively analyzed a prospectively collected convenience sample of hypoperfused adult emergency department (ED) patients. Doppler measurements were obtained before and during a preload challenge using a wireless, wearable Doppler ultrasound system. Based on internal jugular and carotid artery Doppler surrogates of CVP and SV, respectively, we placed hemodynamic assessments into quadrants (Qx) prior to preload augmentation: low CVP with normal SV (Q1), high CVP and normal SV (Q2), low CVP and low SV (Q3) and high CVP and low SV (Q4). The proportion of preload responsive and unresponsive assessments in each quadrant was calculated based on the maximal change in ccFT (ccFTΔ) during either a passive leg raise or rapid fluid challenge. Results: We analyzed 41 patients (68 hemodynamic assessments) between February and April 2021. The prevalence of each phenotype was: 15 (22%) in Q1, 8 (12%) in Q2, 39 (57%) in Q3, and 6 (9%) in Q4. Preload unresponsiveness rates were: Q1, 20%; Q2, 50%; Q3, 33%, and Q4, 67%. Interpretation: Even fluid naïve ED patients with sonographic estimates of low CVP have high rates of fluid unresponsiveness, making dynamic testing valuable to prevent ineffective IVF administration.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-01-08T08:57:47Z
      DOI: 10.1177/08850666231224396
       
  • Novel Oxygenation and Saturation Indices for Mortality Prediction in
           COVID-19 ARDS Patients: The Impact of Driving Pressure and Mechanical
           Power

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      Authors: Sinan Aşar, Fatih Rahim, Payam Rahimi, Özlem Acicbe, Furkan Tontu, Zafer Çukurova
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Background: The oxygenation index (OI) and oxygen saturation index (OSI) are proven mortality predictors in pediatric and adult patients, traditionally using mean airway pressure (Pmean). We introduce novel indices, replacing Pmean with DP (ΔPinsp), MPdyn, and MPtot, assessing their potential for predicting COVID-19 acute respiratory distress syndrome (ARDS) mortality, comparing them to traditional indices. Methods: We studied 361 adult COVID-19 ARDS patients for 7 days, collecting ΔPinsp, MPdyn, and MPtot, OI-ΔPinsp, OI-MPdyn, OI-MPtot, OSI-ΔPinsp, OSI-MPdyn, and OSI-MPtot. We compared these in surviving and non-surviving patients over the first 7 intensive care unit (ICU) days using Mann–Whitney U test. Logistic regression receiver operating characteristic (ROC) analysis assessed AUC and CI values for ICU mortality on day three. We determined cut-off values using Youden's method and conducted multivariate Cox regression on parameter limits. Results: All indices showed significant differences between surviving and non-surviving patients on the third day of ICU care. The AUC values of OI-ΔPinsp were significantly higher than those of P/F and OI-Pmean (P values .0002 and
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-01-05T09:32:21Z
      DOI: 10.1177/08850666231223498
       
  • Postarrest Care Bundle Improves Quality of Care and Clinical Outcomes in
           the Normothermia Era

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      Authors: Andrew J. Caddell, Dave Nagpal, Ahmed F. Hegazy
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      PurposeTemperature targets in patients with cardiac arrest and return of spontaneous circulation (ROSC) have changed. Changes to higher temperature targets have been associated with higher breakthrough fevers and mortality. A post-ROSC normothermia bundle was developed to improve compliance with temperature targets.MethodsIn August 2021, “ad hoc” normothermia at the discretion of the attending intensivist was initiated. In December 2021, a post-ROSC normothermia protocol was implemented, incorporating a rigorous, stepwise approach to fever prevention (temperature ≥ 37.8). We conducted a before-after cohort study of all adult patients post-ROSC who survived to intensive care unit admission between August 1, 2021, and April 1, 2022. They were divided into “ad hoc” and “protocol” groups. Clinical outcomes compared included fevers, active cooling, and paralytic use.ResultsFifty-eight post-ROSC patients were admitted; 24 in the “ad hoc” and 34 in the “protocol” groups. Patient demographics were similar between groups. The “ad hoc” group had more shockable rhythms (67% vs 24%, P = .001) and cardiac catheterizations (42% vs 15%, P = .03). The “protocol” group were significantly less likely to have a fever at 40 h (6% vs 40%, P 
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-01-05T01:56:41Z
      DOI: 10.1177/08850666231223482
       
  • Early Autocalibrated Arterial Waveform Analysis for the Management of Burn
           Shock—A Cohort Study

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      Authors: Marianne Kruse, Konrad Ernst Liesenborghs, David Josuttis, Philip Plettig, Denis Guembel, Ida Katinka Lenz, Claas Guethoff, Volker Gebhardt, Marc Dominik Schmittner
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Adequate fluid therapy is crucial for resuscitation after major burns. To adapt this to individual patient demands, standard is adjustment of volume to laboratory parameters and values of enhanced hemodynamic monitoring. To implement calibrated parameters, patients must have reached the intensive care unit (ICU). The aim of this study was, to evaluate the use of an auto-calibrated enhanced hemodynamic monitoring device to improve fluid management before admission to ICU. We used PulsioflexProAqt® (Getinge) during initial treatment and burn shock resuscitation. Analysis was performed regarding time of measurement, volume management, organ dysfunction, and mortality. We conducted a monocentre, prospective cohort study of 20 severely burned patients,>20% total body surface area (TBSA), receiving monitoring immediately after admission. We compared to 57 patients, matched in terms of TBSA, age, sex, and existence of inhalation injury out of a retrospective control group, who received standard care. Hemodynamic measurement with autocalibrated monitoring started significantly earlier: 3.75(2.67-6.0) hours (h) after trauma in the study group versus 13.6(8.1-17.5) h in the control group (P 
      Citation: Journal of Intensive Care Medicine
      PubDate: 2024-01-04T07:36:31Z
      DOI: 10.1177/08850666231224388
       
  • 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
      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
       
  • Risk Stratification of QTc Prolongation in Critically Ill Patients
           Receiving Antipsychotics for the Management of Delirium Symptoms

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      Authors: Monika Sadlonova, Scott R. Beach, Margo C. Funk, Jordan H. Rosen, Andres F. Ramirez Gamero, Rebecca A. Karlson, Jeff C. Huffman, Christopher M. Celano
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      BackgroundPatients experiencing significant agitation or perceptual disturbances related to delirium in an intensive care setting may benefit from short-term treatment with an antipsychotic medication. Some antipsychotic medications may prolong the QTc interval, which increases the risk of potentially fatal ventricular arrhythmias. In this targeted review, we describe the evidence regarding the relationships between antipsychotic medications and QTc prolongation and practical methods for monitoring the QTc interval and mitigating arrhythmia risk.MethodsSearches of PubMed and Cochrane Library were performed to identify studies, published before February 2023, investigating the relationships between antipsychotic medications and QTc prolongation or arrhythmias.ResultsMost antipsychotic medications commonly used for the management of delirium symptoms (eg, intravenous haloperidol, olanzapine, quetiapine) cause a moderate degree of QTc prolongation. Among other antipsychotics, those most likely to cause QTc prolongation are iloperidone and ziprasidone, while aripiprazole and lurasidone appear to have minimal risk for QTc prolongation. Genetic vulnerabilities, female sex, older age, pre-existing cardiovascular disease, electrolyte abnormalities, and non-psychiatric medications also increase the risk of QTc prolongation. For individuals at risk of QTc prolongation, it is essential to measure the QTc interval accurately and consistently and consider medication adjustments if needed.ConclusionsAntipsychotic medications are one of many risk factors for QTc prolongation. When managing agitation related to delirium, it is imperative to assess an individual patient's risk for QTc prolongation and to choose a medication and monitoring strategy commensurate to the risks. In intensive care settings, we recommend regular ECG monitoring, using a linear regression formula to correct for heart rate. If substantial QTc prolongation (eg, QTc > 500 msec) is present, a change in pharmacologic treatment can be considered, though a particular medication may still be warranted if the risks of discontinuation (eg, extreme agitation, removal of invasive monitoring devices) outweigh the risks of arrhythmias.AimsThis review aims to summarize the current literature on relationships between antipsychotic medications and QTc prolongation and to make practical clinical recommendations towards the approach of antipsychotic medication use for the management of delirium-related agitation and perceptual disturbances in intensive care settings.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2023-12-22T07:32:41Z
      DOI: 10.1177/08850666231222470
       
  • Real-Time Camera Image-Guided Nasoenteric Tube Placement in Prone COVID-19
           ICU Patients: A Single-Center Study

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      Authors: Yuequn Chen, Guiqiong Wu, Chaojun Qu, Zimao Ye, Yihao Kang, Xin Tian
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Background & Aims: This study aims to assess the application value of the real-time camera image-guided nasoenteric tube placement in critically ill COVID-19 patients undergoing endotracheal intubation and prone position ventilation therapy. Methods: We enrolled 116 COVID-19 patients receiving endotracheal intubation and prone position ventilation therapy in the intensive care unit (ICU). Patients were randomly divided into the real-time camera image-guided nasoenteric tube placement (n = 58) and bedside blind insertion (n = 58) groups. The success rate, placement time, complications, cost, heart rate, respiratory rate, Glasgow Coma Scale (GCS), and Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores were compared between the 2 groups. Results: For ICU patients with COVID-19 undergoing prone position ventilation therapy, the success rate and cost were significantly higher in the real-time camera image-guided group compared to the bedside blind group (P 
      Citation: Journal of Intensive Care Medicine
      PubDate: 2023-12-18T06:52:25Z
      DOI: 10.1177/08850666231220909
       
  • Barriers to Implementing the ICU Liberation Bundle in a Single-center
           Pediatric and Cardiac ICUs

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      Authors: Anna McCudden, Hector R. Valdivia, Jane L. Di Gennaro, Lina Berika, Jerry Zimmerman, Leslie A. Dervan
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Objectives: The intensive care unit (ICU) Liberation “ABCDEF” Bundle improves outcomes in critically ill adults. We aimed to identify common barriers to Pediatric ICU Liberation Bundle element implementation, to describe differences in barrier perception by ICU staff role, and to describe changes in reported barriers over time. Study Design: A 91-item survey was developed based on existing literature, iteratively revised, and tested by the PICU Liberation Committee at Seattle Children's Hospital, a tertiary free-standing academic children's hospital. Voluntary surveys were administered electronically to all ICU staff twice over 4-week periods in 2017 and 2020. Survey Respondents: 119 (2017) and 163 (2020) pediatric and cardiac ICU staff, including nurses (n = 142, 50%), respiratory therapists (RTs) (n = 46, 16%), attending and fellow physicians, hospitalists, and advanced practice providers (APPs) (n = 62, 22%), physical, occupational, and speech-language pathology therapists (n = 25, 9%), and pharmacists (n = 7, 2%). Measurements and Main Results: Respondents widely agreed that increased workload (78%-100% across roles), communication (53%-84%), and lack of RT-directed ventilator weaning (68%-88%) are barriers to implementation. Other barriers differed by role. In 2020, nurses reported liability (59%) and personal injury (68%) concerns, patient severity of illness (24%), and family discomfort with ICU liberation practices (41%) more frequently than physicians and APPs (16%, 6%, 8%, and 19%, respectively; P 
      Citation: Journal of Intensive Care Medicine
      PubDate: 2023-12-18T06:00:14Z
      DOI: 10.1177/08850666231220558
       
  • Factors Associated With New Analgesic Requirements Following Critical
           Illness

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      Authors: Mark Andonovic, Martin Shaw, Tara Quasim, Pamela MacTavish, Joanne McPeake
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      BackgroundChronic opioid use represents a significant burden to global healthcare with adverse long-term outcomes. Elevated patient reported pain levels and analgesic prescriptions have been reported following discharge from critical care. We describe analgesic requirements following discharge from hospital and identify if a critical care admission is a significant factor for stronger analgesic prescriptions.MethodsThis retrospective observational cohort study identified patients in the UK Biobank with a registered admission to any UK hospital between January 1, 2010 and December 31, 2015 and information on prescriptions drawn both prior to and following hospital discharge. Two matched cohorts were created from the dataset: critical care patients and hospital patients admitted without a critical care encounter. Outcomes were analgesic requirements following hospital discharge and factors associated with increased analgesic prescriptions. Multivariable logistic regression was used to identify factors associated with prescriptions from higher steps on the World Health Organization (WHO) analgesic ladder.ResultsIn total, 660 formed the total study population. Strong opioid prescriptions following discharge were significantly higher in the critical care cohort (P value
      Citation: Journal of Intensive Care Medicine
      PubDate: 2023-12-13T04:41:23Z
      DOI: 10.1177/08850666231219916
       
  • The Microbiome and Metabolome of the Gut of Children with Sepsis and
           Septic Shock

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      Authors: Jhuma Sankar, Vaishali Thakral, Kanchan Bharadwaj, Sheetal Agarwal, Sushil Kumar Kabra, Rakesh Lodha, Sumit Rathore
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      BackgroundThere is limited understanding of alteration of gut microbiota and metabolome in children with sepsis/septic shock.MethodsIn this prospective observational study carried out in a pediatric intensive care unit of a tertiary care center from 2020 to 2022, patients aged
      Citation: Journal of Intensive Care Medicine
      PubDate: 2023-12-11T06:25:17Z
      DOI: 10.1177/08850666231216361
       
  • Impact of Preexisting Depression and Anxiety on Hospital Readmission and
           Long-Term Survival After Cardiac Arrest

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      Authors: Patrick J. Coppler, McKenzie Brown, Darcy M. Moschenross, Priya R. Gopalan, Alexander M. Presciutti, Ankur A. Doshi, Kelly N. Sawyer, Adam Frisch, Clifton W. Callaway, Jonathan Elmer
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      BackgroundWhile sudden cardiac arrest (CA) survivors are at risk for developing psychiatric disorders, little is known about the impact of preexisting mental health conditions on long-term survival or postacute healthcare utilization. We examined the prevalence of preexisting psychiatric conditions in CA patients who survived hospital discharge, characterized incidence and reason for inpatient psychiatry consultation during these patients’ acute hospitalizations, and determined the association of pre-CA depression and anxiety with hospital readmission rates and long-term survival. We hypothesized that prior depression or anxiety would be associated with higher hospital readmission rates and lower long-term survival.MethodsWe conducted a retrospective cohort study including patients resuscitated from in- and out-of-hospital CA who survived both admission and discharge from a single hospital between January 1, 2010, and December 31, 2017. We identified patients from our prospective registry, then performed a structured chart review to abstract past psychiatric history, prescription medications for psychiatric conditions, and identify inpatient psychiatric consultations. We used administrative data to identify readmissions within 1 year and vital status through December 31, 2020. We used multivariable Cox regressions controlling for patient demographics, medical comorbidities, discharge Cerebral Performance Category and disposition, depression, and anxiety history to predict long-term survival and hospital readmission.ResultsWe included 684 subjects. Past depression or anxiety was noted in 24% (n = 162) and 19% (n = 129) of subjects. A minority of subjects (n = 139, 20%) received a psychiatry consultation during the index hospitalization. Overall, 262 (39%) subjects had at least 1 readmission within 1 year. Past depression was associated with an increased hazard of hospital readmission (hazard ratio 1.50, 95% CI 1.11–2.04), while past anxiety was not associated with readmission. Neither depression nor anxiety were independently associated with long-term survival.ConclusionsDepression is an independent risk factor for hospital readmission in CA survivors.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2023-12-11T05:51:19Z
      DOI: 10.1177/08850666231218963
       
  • Right Heart Failure in the Intensive Care Unit: Etiology, Pathogenesis,
           Diagnosis, and Treatment

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      Authors: Elizabeth Tarras, Akhil Khosla, Paul M. Heerdt, Inderjit Singh
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Right heart (RH) failure carries a high rate of morbidity and mortality. Patients who present with RH failure often exhibit complex aberrant cardio-pulmonary physiology with varying presentations. The treatment of RH failure almost always requires care and management from an intensivist. Treatment options for RH failure patients continue to evolve rapidly with multiple options available, including different pharmacotherapies and mechanical circulatory support devices that target various components of the RH circulatory system. An understanding of the normal RH circulatory physiology, treatment, and support options for the RH failure patients is necessary for all intensivists to improve outcomes. The purpose of this review is to provide clinical guidance on the diagnosis and management of RH failure within the intensive care unit setting, and to highlight the different pathophysiological manifestations of RH failure, its hemodynamics, and treatment options available at the disposal of the intensivist.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2023-11-30T05:37:15Z
      DOI: 10.1177/08850666231216889
       
  • Neurological Complications of the Lower Extremities After Femoral
           Cannulated Extracorporeal Membrane Oxygenation: A Systematic Review

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      Authors: Frauke Johannes, Rahel Frohofer-Vollenweider, Yvonne Teuschl
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      BackgroundFemoral cannulated extracorporeal membrane oxygenation (ECMO) has been associated with neurologic complications in the lower extremity ipsilateral to the cannulation. There is uncertainty about the prevalence of these complications and their mechanisms of development.ObjectiveAim of this systematic review was to investigate the prevalence of neurological complications after ECMO and to describe possible underlying mechanisms.MethodA systematic literature search was performed in Medline-Ovid, Embase, Cochrane Library, CINAHL, and PEDro until April 2021 for clinical trials in English or German language which quantified neurologic complications in the lower extremity ipsilateral to the ECMO cannulation of adults. The complications had to be delimitable to intensive care unit–acquired weakness. Methodological quality was assessed by 2 independent investigators using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies of the National Heart, Lung, and Blood Institute.ResultsEight observational studies were included in the synthesis. Study quality was good to fair in 88% of the papers. Overall, 47 of 202 patients (23.3%; ranging from 3% to 48% across studies) with femoral ECMO cannulation showed neurologic complications of the lower extremity ipsilateral to the cannulation. Peripheral ischemia and compression of nerves by the ECMO cannula are discussed as mechanisms of injury.ConclusionThe occurrence of neurological complications after ECMO was common and can lead to long-term impairment. The mechanisms are largely unknown but currently there is no sufficient evidence for the involvement of ECMO. Standardized assessments are needed to systematically screen for neurological complications early after ECMO, to enable countermeasures and prevent further complications.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2023-11-29T07:00:04Z
      DOI: 10.1177/08850666231217679
       
  • The State of the Union: Trauma System Development in the United States

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      Authors: Frederick B. Rogers, Nicholas J. Larson, David J. Dries, Barbara A. Olson-Bullis, Benoît Blondeau
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Injury is both a national and international epidemic that affects people of all age, race, religion, and socioeconomic class. Injury was the fourth leading cause of death in the United States (U.S.) in 2021 and results in an incalculable emotional and financial burden on our society. Despite this, when prevention fails, trauma centers allow communities to prepare to care for the traumatically injured patient. Using lessons learned from the military, trauma care has grown more sophisticated in the last 50 years. In 1966, the first civilian trauma center was established, bringing management of injury into the new age. Now, the American College of Surgeons recognizes 4 levels of trauma centers (I-IV), with select states recognizing Level V trauma centers. The introduction of trauma centers in the U.S. has been proven to reduce morbidity and mortality for the injured patient. However, despite the proven benefits of trauma centers, the U.S. lacks a single, unified, trauma system and instead operates within a “system of systems” creating vast disparities in the level of care that can be received, especially in rural and economically disadvantaged areas. In this review we present the history of trauma system development in the U.S, define the different levels of trauma centers, present evidence that trauma systems and trauma centers improve outcomes, outline the current state of trauma system development in the U.S, and briefly mention some of the current challenges and opportunities in trauma system development in the U.S. today.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2023-11-20T06:05:21Z
      DOI: 10.1177/08850666231216360
       
  • Comparison of SAT and SBT Conduct During the ABC Trial and PILOT Trial

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      Authors: Tuqa Alkhateeb, Matthew W. Semler, Timothy D. Girard, E. Wesley Ely, Joanna L. Stollings
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      BackgroundImplementation of the “B” element—both spontaneous awakening trials (SATs) and spontaneous breathing trials (SBTs)—of the ABCDEF bundle improves the outcomes for mechanically ventilated patients. In 2021, the Pragmatic Investigation of optimal Oxygen Targets (PILOT) trial investigating optimal oxygenation targets in patients on mechanical ventilation was completed.ObjectivesTo compare SAT and SBT conduct between a randomized controlled trial and current clinical care.MethodsThe 2008 Awakening and Breathing Controlled (ABC) Trial (2003-2006) randomized mechanically ventilated patients to paired SATs and SBTs versus sedation per usual care plus SBTs. The PILOT trial (2018-2021) enrolled patients years later where SAT + SBT conduct was observed. We compared SAT and SBT conduct in ABC's interventional group (SAT + SBT; n = 167, 1140 patient days) to that in PILOT (n = 2083, 8355 patient days).ResultsSpontaneous awakening trial safety screens were done in all 1140 ABC patient-days on sedation and/or analgesia and in 3889 of 4228 (92%) in PILOT. Spontaneous awakening trial safety screens were passed in 939 of 1140 (82%) instances in ABC versus only 1897 of 3889 (49%) in PILOT. Interestingly, SAT was performed in ≥95% of passed SAT safety screens in both trials and was passed in 837 of 895 (94%) in ABC versus 1145 of 1867 (61%) in PILOT. SBT safety screens were performed in all 983 ABC instances and 8031 of 8370 (96%) in PILOT. SBT safety screens were passed in 647 of 983 (66%) in ABC versus 4475 of 8031 (56%) in PILOT. Spontaneous breathing trial was performed in ≥93% of passed SBT safety screens in both trials and was passed in 319 of 603 (53%) in ABC versus 3337 of 4454 (75%) in PILOT.ConclusionThis study compared SAT/SBT conduction in an ideal setting to real-world practice, 13 years later. Performance of SAT/SBT safety screens, SATs, and SBTs between a definitive clinical trial (ABC) as compared to current clinical care (PILOT) remained high.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2023-11-20T06:04:41Z
      DOI: 10.1177/08850666231213337
       
  • Neurally Adjusted Ventilatory Assist Versus Pressure Support Ventilation:
           A Comprehensive Review

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      Authors: Saikiran Mandyam, Muhammad Qureshi, Yamini Katamreddy, Devam Parghi, Priyanka Patel, Vidhi Patel, Fnu Anshul
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Mechanical ventilation serves as crucial life support for critically ill patients. Although it is life-saving prolonged ventilation carries risks and complications like barotrauma, Ventilator-associated pneumonia, sepsis, and many others. Optimizing patient-ventilator interactions and facilitating early weaning is necessary for improved intensive care unit (ICU) outcomes. Traditionally Pressure support ventilation (PSV) mode is widely used for weaning patients who are intubated and mechanically ventilated. Neurally adjusted ventilatory assist (NAVA) mode of the ventilator is an emerging ventilator mode that delivers pressure depending on the patient's respiratory drive, which in turn prevents over-inflation and improves the patient's ventilator interactions. Our article revises and compares the effectiveness of NAVA compared to PSV ventilation under different contexts. Overall we conclude that NAVA level of ventilation can be safely administered in a patient with acute respiratory failure, provided diaphragmatic paralysis is not considered. NAVA improves asynchrony index, wean-off time, and sleep quality and is associated with increased ventilator-free days. These results are based on small-scale studies with low power, and further studies are warranted in large-scale cohorts with more diverse populations to confirm these results.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2023-11-15T08:43:58Z
      DOI: 10.1177/08850666231212807
       
  • Update on Management and Outcomes of Congenital Diaphragmatic Hernia

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      Authors: K. Taylor Wild, Holly L. Hedrick, Anne M. Ades, Maria V. Fraga, Catherine M. Avitabile, Juliana S. Gebb, Edward R. Oliver, Kristen Coletti, Erin M. Kesler, K. Taylor Van Hoose, Howard B. Panitch, Sandy Johng, Renee P. Ebbert, Lisa M. Herkert, Casey Hoffman, Deanna Ruble, Sabrina Flohr, Tom Reynolds, Melissa Duran, Audrey Foster, Rebecca S. Isserman, Emily A. Partridge, Natalie E. Rintoul
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Infants with congenital diaphragmatic hernia (CDH) benefit from comprehensive multidisciplinary teams that have experience in caring for the unique and complex issues associated with CDH. Despite prenatal referral to specialized high-volume centers, advanced ventilation strategies and pulmonary hypertension management, and extracorporeal membrane oxygenation, mortality and morbidity remain high. These infants have unique and complex issues that begin in fetal and infant life, but persist through adulthood. Here we will review the literature and share our clinical care pathway for neonatal care and follow up. While many advances have occurred in the past few decades, our work is just beginning to continue to improve the mortality, but also importantly the morbidity of CDH.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2023-11-07T07:46:24Z
      DOI: 10.1177/08850666231212874
       
  • A Primer on Chimeric Antigen Receptor T-cell Therapy-related Toxicities
           for the Intensivist

    • Free pre-print version: Loading...

      Authors: Shin Yeu Ong, John H. Baird
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Chimeric antigen receptor (CAR) T-cell therapy is an innovative treatment approach that has shown remarkable efficacy against several hematologic malignancies. However, its use can be associated with unique and sometimes severe toxicities that require admission to intensive care unit in 30% of patients, and intensivists should be aware of immune-mediated toxicities of CAR T-cell therapy and management of adverse events. We will review available literature on current diagnostic criteria and therapeutic strategies for mitigating these most common toxicities associated with CAR T-cell therapy including cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) in the post-infusion period. The authors will also review other toxicities associated with CAR T-cell therapy including cytopenias, acquired immunocompromised states, and infections, and discuss the available literature on best supportive care and prophylaxis recommendations. Critical care medicine specialists play a crucial role in the management of patients undergoing CAR T-cell therapies. With the expanding use of these products in increasing numbers of treating centers, intensivists’ roles as part of the multidisciplinary team caring for these patients will have an outsized impact on the continued success of these promising therapies.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2023-10-30T06:44:54Z
      DOI: 10.1177/08850666231205264
       
  • Diffuse Alveolar Hemorrhage in Hematopoietic Cell Transplantation

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      Authors: Ylinne Lynch, Lisa K. Vande Vusse
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Diffuse alveolar hemorrhage (DAH) is a morbid syndrome that occurs after autologous and allogeneic hematopoietic cell transplantation in children and adults. DAH manifests most often in the first few weeks following transplantation. It presents with pneumonia-like symptoms and acute respiratory failure, often requiring high levels of oxygen supplementation or mechanical ventilatory support. Hemoptysis is variably present. Chest radiographs typically feature widespread alveolar filling, sometimes with peripheral sparing and pleural effusions. The diagnosis is suspected when serial bronchoalveolar lavages return increasingly bloody fluid. DAH is differentiated from infectious causes of alveolar hemorrhage when extensive microbiological testing reveals no pulmonary pathogens. The cause is poorly understood, though preclinical and clinical studies implicate pretransplant conditioning regimens, particularly those using high doses of total-body-irradiation, acute graft-versus-host disease (GVHD), medications used to prevent GVHD, and other factors. Treatment consists of supportive care, systemic corticosteroids, platelet transfusions, and sometimes includes antifibrinolytic drugs and topical procoagulant factors. Therapeutic blockade of tumor necrosis factor-α showed promise in observational studies, but its benefit for DAH remains uncertain after small clinical trials. Even with these treatments, mortality from progression and relapse is high. Future investigational therapies could target the vascular endothelial cell biology theorized to contribute to alveolar bleeding and pathways that contribute to susceptibility, inflammation, cellular resilience, and tissue repair. This review will help clinicians navigate through the limited evidence to diagnose and treat DAH, counsel patients and families, and plan for future research.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2023-10-24T03:55:21Z
      DOI: 10.1177/08850666231207331
       
  • Diagnostic and Therapeutic Strategies to Severe Hyponatremia in the
           Intensive Care Unit

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      Authors: Helbert Rondon-Berrios
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Hyponatremia is the most common electrolyte abnormality encountered in critically ill patients and is linked to heightened morbidity, mortality, and healthcare resource utilization. However, its causal role in these poor outcomes and the impact of treatment remain unclear. Plasma sodium is the main determinant of plasma tonicity; consequently, hyponatremia commonly indicates hypotonicity but can also occur in conjunction with isotonicity and hypertonicity. Plasma sodium is a function of total body exchangeable sodium and potassium and total body water. Hypotonic hyponatremia arises when total body water is proportionally greater than the sum of total body exchangeable cations, that is, electrolyte-free water excess; the latter is the result of increased intake or decreased (kidney) excretion. Hypotonic hyponatremia leads to water movement into brain cells resulting in cerebral edema. Brain cells adapt by eliminating solutes, a process that is largely completed by 48 h. Clinical manifestations of hyponatremia depend on its biochemical severity and duration. Symptoms of hyponatremia are more pronounced with acute hyponatremia where brain adaptation is incomplete while they are less prominent in chronic hyponatremia. The authors recommend a physiological approach to determine if hyponatremia is hypotonic, if it is mediated by arginine vasopressin, and if arginine vasopressin secretion is physiologically appropriate. The treatment of hyponatremia depends on the presence and severity of symptoms. Brain herniation is a concern when severe symptoms are present, and current guidelines recommend immediate treatment with hypertonic saline. In the absence of significant symptoms, the concern is neurologic sequelae resulting from rapid correction of hyponatremia which is usually the result of a large water diuresis. Some studies have found desmopressin useful to effectively curtail the water diuresis responsible for rapid correction.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2023-10-12T06:55:40Z
      DOI: 10.1177/08850666231207334
       
  • Easing Suffering for ICU Patients and Their Families: Evidence and
           Opportunities for Primary and Specialty Palliative Care in the ICU

    • Free pre-print version: Loading...

      Authors: Christine Doherty, Shelli Feder, Sarah Gillespie-Heyman, Kathleen M. Akgün
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Intensive care unit (ICU) admissions are often accompanied by many physical and existential pressure points that can be extraordinarily wearing on patients and their families and surrogate decision makers (SDMs). Multidisciplinary palliative support, including physicians, advanced practice nurses, nutritionists, chaplains and other team members, may alleviate many of these sources of potential suffering. However, the palliative needs of ICU patients undoubtedly exceed the bandwidth of current consultative specialty palliative medicine teams. Informed by standard-of-care palliative medicine domains, we review common ICU symptoms (pain, dyspnea and thirst) and their prevalence, sources and their treatment. We then identify palliative needs and impacts in the domains of communication, SDM support and transitions of care for patients and their families through their journey in the ICU, from discharge and recovery at home to chronic critical illness, post-ICU disability or death. Finally, we examine the evidence for strategies to incorporate specialty palliative medicine and palliative principles into ICU care for the improvement of patient- and family-centered care. While randomized controlled studies have failed to demonstrate measurable improvement in pre-determined outcomes for patient- and family-relevant outcomes, embracing the principles of palliative medicine and assuring their delivery in the ICU is likely to translate to overall improvement in humanistic, person-centered care that supports patients and their SDMs during and following critical illness.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2023-10-12T06:54:36Z
      DOI: 10.1177/08850666231204305
       
  • Managing the Chronically Ventilated Critically Ill Population

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      Authors: Astha Chichra, Mayanka Tickoo, Shyoko Honiden
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Advances in intensive care over the past few decades have significantly improved the chances of survival for patients with acute critical illness. However, this progress has also led to a growing population of patients who are dependent on intensive care therapies, including prolonged mechanical ventilation (PMV), after the initial acute period of critical illness. These patients are referred to as the “chronically critically ill” (CCI). CCI is a syndrome characterized by prolonged mechanical ventilation, myoneuropathies, neuroendocrine disorders, nutritional deficiencies, cognitive and psychiatric issues, and increased susceptibility to infections. It is associated with high morbidity and mortality as well as a significant increase in healthcare costs. In this article, we will review disease burden, outcomes, psychiatric effects, nutritional and ventilator weaning strategies as well as the role of palliative care for CCI with a specific focus on those requiring PMV.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2023-10-03T11:33:28Z
      DOI: 10.1177/08850666231203601
       
  • Temperature Control in the Era of Personalized Medicine: Knowledge Gaps,
           Research Priorities, and Future Directions

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      Authors: Rachel Beekman, Akhil Khosla, Ryan Buckley, Shyoko Honiden, Emily J. Gilmore
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Hypoxic–ischemic brain injury (HIBI) is the leading cause of death and disability after cardiac arrest. To date, temperature control is the only intervention shown to improve neurologic outcomes in patients with HIBI. Despite robust preclinical evidence supporting hypothermia as neuroprotective therapy after cardiac arrest, there remains clinical equipoise regarding optimal core temperature, therapeutic window, and duration of therapy. Current guidelines recommend continuous temperature monitoring and active fever prevention for at least 72 h and additionally note insufficient evidence regarding temperature control targeting 32 °C-36 °C. However, population-based thresholds may be inadequate to support the metabolic demands of ischemic, reperfused, and dysregulated tissue. Promoting a more personalized approach with individualized targets has the potential to further improve outcomes. This review will analyze current knowledge and evidence, address research priorities, explore the components of high-quality temperature control, and define critical future steps that are needed to advance patient-centered care for cardiac arrest survivors.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2023-10-03T11:32:29Z
      DOI: 10.1177/08850666231203596
       
  • Natural History, Pathophysiology, and Recent Management Modalities of
           Intraventricular Hemorrhage

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      Authors: Muhammed Amir Essibayi, Omar Ibrahim Abdallah, Ali Mortezaei, Saif Eddine Zaidi, Dhrumil Vaishnav, Jacob Cherian, Parikh Gungin, David Altschul, Mohamed Labib
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Intraventricular hemorrhage (IVH) is a clinical challenge observed among 40–45% of intracerebral hemorrhage (ICH) cases. IVH can be classified according to the source of the hemorrhage into primary and secondary IVH. Primary intraventricular hemorrhage (PIVH), unlike secondary IVH, involves only the ventricles with no hemorrhagic parenchymal source. Several risk factors of PIVH were reported which include hypertension, smoking, age, and excessive alcohol consumption. IVH is associated with high mortality and morbidity and several prognostic factors were identified such as IVH volume, number of ventricles with blood, involvement of fourth ventricle, baseline Glasgow Coma Scale score, and hydrocephalus. Prompt management of patients with IVH is required to stabilize the clinical status of patients upon admission. Nevertheless, further advanced management is crucial to reduce the morbidity and mortality associated with intraventricular bleeding. Recent treatments showed promising outcomes in the management of IVH patients such as intraventricular anti-inflammatory drugs, lumbar drainage, and endoscopic evacuation of IVH, however, their safety and efficacy are still in question. This literature review presents the epidemiology, physiopathology, risk factors, and outcomes of IVH in adults with an emphasis on recent treatment options.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2023-09-28T09:41:45Z
      DOI: 10.1177/08850666231204582
       
  • Analytical Review of Unplanned Extubation in Intensive Care Units and
           Recommendation on Multidisciplinary Preventive Approaches

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      Authors: Antonious Anis, Ravi Patel, Maged A Tanios
      Abstract: Journal of Intensive Care Medicine, Ahead of Print.
      Unplanned extubations (UE) frequently occur in critical care units. These events are precipitated by many risk factors and are associated with adverse outcomes for patients. We reviewed the current literature to examine factors related to UE and presented the analysis of 41 articles critical to the topic. Our review has identified specific risk factors that we discuss in this review, such as sedation strategies, physical restraints, endotracheal tube position, and specific nursing care aspects associated with an increased incidence of UE. We recommend interventions to reduce the risk of UE. However, we recommend that bundled rather than a single intervention is likely to yield higher success, given the heterogeneity of factors contributing to increasing the risk of UE.
      Citation: Journal of Intensive Care Medicine
      PubDate: 2023-09-06T07:31:14Z
      DOI: 10.1177/08850666231199055
       
 
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  Subjects -> MEDICAL SCIENCES (Total: 8186 journals)
    - ALLERGOLOGY AND IMMUNOLOGY (205 journals)
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EMERGENCY AND INTENSIVE CRITICAL CARE (121 journals)                     

Showing 1 - 123 of 123 Journals sorted alphabetically
AACN Advanced Critical Care     Full-text available via subscription   (Followers: 36)
Academic Emergency Medicine     Hybrid Journal   (Followers: 100)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 2)
Acute and Critical Care     Open Access   (Followers: 10)
Acute Cardiac Care     Hybrid Journal   (Followers: 12)
Acute Medicine     Full-text available via subscription   (Followers: 7)
Advances in Emergency Medicine     Open Access   (Followers: 21)
Advances in Neonatal Care     Hybrid Journal   (Followers: 44)
African Journal of Anaesthesia and Intensive Care     Full-text available via subscription   (Followers: 8)
African Journal of Emergency Medicine     Open Access   (Followers: 6)
AINS - Anasthesiologie - Intensivmedizin - Notfallmedizin - Schmerztherapie     Hybrid Journal   (Followers: 5)
American Journal of Emergency Medicine     Hybrid Journal   (Followers: 57)
Annals of Emergency Medicine     Hybrid Journal   (Followers: 150)
Annals of Intensive Care     Open Access   (Followers: 39)
Annals of the American Thoracic Society     Full-text available via subscription   (Followers: 16)
Archives of Academic Emergency Medicine     Open Access   (Followers: 6)
Archives of Trauma Research     Open Access   (Followers: 5)
ASAIO Journal     Hybrid Journal   (Followers: 2)
Australasian Journal of Paramedicine     Open Access   (Followers: 9)
Australian Critical Care     Full-text available via subscription   (Followers: 21)
Bangladesh Critical Care Journal     Open Access   (Followers: 1)
BMC Emergency Medicine     Open Access   (Followers: 29)
BMJ Quality & Safety     Hybrid Journal   (Followers: 66)
Burns Open     Open Access   (Followers: 1)
Canadian Journal of Respiratory, Critical Care, and Sleep Medicine     Hybrid Journal   (Followers: 2)
Case Reports in Acute Medicine     Open Access   (Followers: 4)
Case Reports in Critical Care     Open Access   (Followers: 14)
Case Reports in Emergency Medicine     Open Access   (Followers: 23)
Chronic Wound Care Management and Research     Open Access   (Followers: 8)
Clinical and Applied Thrombosis/Hemostasis     Open Access   (Followers: 28)
Clinical Medicine Insights : Trauma and Intensive Medicine     Open Access   (Followers: 3)
Clinical Risk     Hybrid Journal   (Followers: 6)
Crisis: The Journal of Crisis Intervention and Suicide Prevention     Hybrid Journal   (Followers: 17)
Critical Care     Open Access   (Followers: 78)
Critical Care and Resuscitation     Full-text available via subscription   (Followers: 29)
Critical Care Clinics     Full-text available via subscription   (Followers: 35)
Critical Care Explorations     Open Access   (Followers: 3)
Critical Care Medicine     Hybrid Journal   (Followers: 324)
Critical Care Research and Practice     Open Access   (Followers: 13)
Current Emergency and Hospital Medicine Reports     Hybrid Journal   (Followers: 6)
Current Opinion in Critical Care     Hybrid Journal   (Followers: 74)
Disaster and Emergency Medicine Journal     Open Access   (Followers: 12)
Egyptian Journal of Critical Care Medicine     Open Access   (Followers: 2)
EMC - Urgenze     Full-text available via subscription  
Emergency Care Journal     Open Access   (Followers: 8)
Emergency Medicine (Medicina neotložnyh sostoânij)     Open Access  
Emergency Medicine Australasia     Hybrid Journal   (Followers: 18)
Emergency Medicine Clinics of North America     Full-text available via subscription   (Followers: 19)
Emergency Medicine International     Open Access   (Followers: 8)
Emergency Medicine Journal     Hybrid Journal   (Followers: 56)
Emergency Medicine News     Full-text available via subscription   (Followers: 7)
Emergency Nurse     Full-text available via subscription   (Followers: 16)
Enfermería Intensiva (English ed.)     Full-text available via subscription   (Followers: 2)
European Burn Journal     Open Access   (Followers: 8)
European Journal of Emergency Medicine     Hybrid Journal   (Followers: 25)
Frontiers in Emergency Medicine     Open Access   (Followers: 8)
Global Journal of Transfusion Medicine     Open Access   (Followers: 1)
Hong Kong Journal of Emergency Medicine     Full-text available via subscription   (Followers: 5)
Indian Journal of Burns     Open Access   (Followers: 3)
Injury     Hybrid Journal   (Followers: 21)
Intensive Care Medicine     Hybrid Journal   (Followers: 87)
Intensive Care Medicine Experimental     Open Access   (Followers: 2)
Intensivmedizin up2date     Hybrid Journal   (Followers: 4)
International Journal of Critical Illness and Injury Science     Open Access   (Followers: 1)
International Journal of Emergency Medicine     Open Access   (Followers: 9)
International Journal of Emergency Mental Health and Human Resilience     Open Access   (Followers: 2)
International Paramedic Practice     Full-text available via subscription   (Followers: 17)
Iranian Journal of Emergency Medicine     Open Access  
Irish Journal of Paramedicine     Open Access   (Followers: 3)
Journal Européen des Urgences et de Réanimation     Hybrid Journal   (Followers: 1)
Journal of Acute Care Physical Therapy     Hybrid Journal   (Followers: 4)
Journal of Cardiac Critical Care TSS     Open Access   (Followers: 1)
Journal Of Cardiovascular Emergencies     Open Access  
Journal of Concussion     Open Access  
Journal of Critical Care     Hybrid Journal   (Followers: 51)
Journal of Critical Care Medicine     Open Access   (Followers: 18)
Journal of Education and Teaching in Emergency Medicine     Open Access   (Followers: 1)
Journal of Emergencies, Trauma and Shock     Open Access   (Followers: 13)
Journal of Emergency Medical Services     Full-text available via subscription   (Followers: 12)
Journal of Emergency Medicine     Hybrid Journal   (Followers: 53)
Journal of Emergency Medicine, Trauma and Acute Care     Open Access   (Followers: 26)
Journal of Emergency Practice and Trauma     Open Access   (Followers: 6)
Journal of Intensive Care     Open Access   (Followers: 9)
Journal of Intensive Care Medicine     Hybrid Journal   (Followers: 23)
Journal of Intensive Medicine     Open Access   (Followers: 1)
Journal of Neuroanaesthesiology and Critical Care     Open Access   (Followers: 4)
Journal of Stroke Medicine     Hybrid Journal   (Followers: 3)
Journal of the American College of Emergency Physicians Open     Open Access   (Followers: 2)
Journal of the Intensive Care Society     Hybrid Journal   (Followers: 5)
Journal of the Royal Army Medical Corps     Hybrid Journal   (Followers: 7)
Journal of Thrombosis and Haemostasis     Hybrid Journal   (Followers: 52)
Journal of Translational Critical Care Medicine     Open Access   (Followers: 3)
Journal of Trauma and Acute Care Surgery, The     Hybrid Journal   (Followers: 36)
La Presse Médicale Open     Open Access  
Médecine de Catastrophe - Urgences Collectives     Hybrid Journal  
Medicina Intensiva     Open Access   (Followers: 3)
Medicina Intensiva (English Edition)     Hybrid Journal   (Followers: 1)
Mediterranean Journal of Emergency Medicine & Acute Care : MedJEM     Open Access  
Notfall + Rettungsmedizin     Hybrid Journal   (Followers: 4)
OA Critical Care     Open Access   (Followers: 3)
OA Emergency Medicine     Open Access   (Followers: 2)
Open Access Emergency Medicine     Open Access   (Followers: 6)
Open Journal of Emergency Medicine     Open Access   (Followers: 2)
Palliative Care : Research and Treatment     Open Access   (Followers: 25)
Palliative Medicine     Hybrid Journal   (Followers: 58)
Prehospital Emergency Care     Hybrid Journal   (Followers: 20)
Regulatory Toxicology and Pharmacology     Hybrid Journal   (Followers: 26)
Research and Opinion in Anesthesia and Intensive Care     Open Access   (Followers: 3)
Resuscitation     Hybrid Journal   (Followers: 59)
Resuscitation Plus     Open Access   (Followers: 2)
Saudi Critical Care Journal     Open Access   (Followers: 2)
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine     Open Access   (Followers: 12)
Seminars in Thrombosis and Hemostasis     Hybrid Journal   (Followers: 28)
Shock : Injury, Inflammation, and Sepsis : Laboratory and Clinical Approaches     Hybrid Journal   (Followers: 12)
Sklifosovsky Journal Emergency Medical Care     Open Access  
The Journal of Trauma Injury Infection and Critical Care     Full-text available via subscription   (Followers: 23)
Therapeutics and Clinical Risk Management     Open Access   (Followers: 1)
Transplant Research and Risk Management     Open Access   (Followers: 1)
Trauma Case Reports     Open Access   (Followers: 1)
Trauma Monthly     Open Access   (Followers: 4)
Visual Journal of Emergency Medicine     Full-text available via subscription   (Followers: 1)
Western Journal of Emergency Medicine     Open Access   (Followers: 11)
 AEM Education and Training : A Global Journal of Emergency Care     Open Access   (Followers: 1)

           

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