-
Effects of different VV ECMO blood flow rates on lung perfusion assessment by hypertonic saline bolus-based electrical impedance tomography Crit. Care (IF 8.8) Pub Date : 2024-08-17 Hongling Zhang, Yongran Wu, Xuehui Gao, Chengchao Peng, Ruirui Li, Azhen Wang, Jiancheng Zhang, Shiying Yuan, Le Yang, Xiaojing Zou, You Shang
Our study aimed to investigate the effects of different extracorporeal membrane oxygenation (ECMO) blood flow rates on lung perfusion assessment using the saline bolus-based electrical impedance tomography (EIT) technique in patients on veno-venous (VV) ECMO. In this single-centered prospective physiological study, patients on VV ECMO who met the ECMO weaning criteria were assessed for lung perfusion
-
Correction: A critical reappraisal of vasopressin and steroids in in-hospital cardiac arrest Crit. Care (IF 8.8) Pub Date : 2024-08-15 Spyros D. Mentzelopoulos, Athanasios Chalkias
Correction: Mentzelopoulos and Chalkias Critical Care (2024) 28:191 https://doi.org/10.1186/s13054-024-04962-8 Following publication of the original article [1], the authors identified an error within row 7 of Table 2. In Table 2, row 7, the lowest percentages of postresuscitation hypotension (i.e. 17% and 15%) actually correspond to the intervention group(s) and the highest (i.e. 28% and 29%) to control
-
Redefining urine output thresholds for acute kidney injury criteria in critically Ill patients: a derivation and validation study Crit. Care (IF 8.8) Pub Date : 2024-08-12 Guido Dias Machado, Leticia Libório Santos, Alexandre Braga Libório
The current definition of acute kidney injury (AKI) includes increased serum creatinine (sCr) concentration and decreased urinary output (UO). Recent studies suggest that the standard UO threshold of 0.5 ml/kg/h may be suboptimal. This study aimed to develop and validate a novel UO-based AKI classification system that improves mortality prediction and patient stratification. Data were obtained from
-
The role of lipid emulsions containing omega-3 fatty acids for medical and surgical critical care patients Crit. Care (IF 8.8) Pub Date : 2024-08-12 Christian Stoppe, Robert G. Martindale, Stanislaw Klek, Philip C. Calder, Paul E. Wischmeyer, Jayshil J. Patel
In critical illness the regulation of inflammation and oxidative stress can improve patient outcomes, and thus omega-3 polyunsaturated fatty acids (PUFAs) have been used as part of parenteral nutrition (PN) owing to their potential anti-inflammatory effects. The international lipids in PN Summit, encompassed discussions and the production of consensus guidelines concerning PN intravenous lipid emulsion
-
High expression of L-GILZ transcript variant 1 (GILZ TV 1) is associated with increased 30-day sepsis mortality, and a high expression ratio possibly contraindicates hydrocortisone administration Crit. Care (IF 8.8) Pub Date : 2024-08-12 Stefan Rusev, Patrick Thon, Birte Dyck, Dominik Ziehe, Tim Rahmel, Britta Marko, Lars Palmowski, Hartmuth Nowak, Björn Ellger, Ulrich Limper, Elke Schwier, Dietrich Henzler, Stefan Felix Ehrentraut, Lars Bergmann, Matthias Unterberg, Michael Adamzik, Björn Koos, Katharina Rump
Sepsis presents a challenge due to its complex immune responses, where balance between inflammation and anti-inflammation is critical for survival. Glucocorticoid-induced leucine zipper (GILZ) is key protein in achieving this balance, suppressing inflammation and mediating glucocorticoid response. This study aims to investigate GILZ transcript variants in sepsis patients and explore their potential
-
Sex matters: Is it time for a SOFA makeover? Crit. Care (IF 8.8) Pub Date : 2024-08-08 Emma Larsson
While sepsis affects individuals regardless of sex, emerging research has highlighted notable differences in how women and men experience, respond to, and recover from sepsis treated in intensive care units (ICU). These differences are influenced by a complex interplay of biological, hormonal, and sociocultural factors. As we explore sepsis management in ICU settings, it becomes evident that understanding
-
Longer ICU stay and invasive mechanical ventilation accelerate telomere shortening in COVID-19 patients 1 year after recovery Crit. Care (IF 8.8) Pub Date : 2024-08-07 Ana Virseda-Berdices, Raquel Behar-Lagares, Oscar Martínez-González, Rafael Blancas, Soraya Bueno-Bustos, Oscar Brochado-Kith, Eva Manteiga, María J. Mallol Poyato, Blanca López Matamala, Carmen Martín Parra, Salvador Resino, María Á Jiménez-Sousa, Amanda Fernández-Rodríguez
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes virus-induced-senescence. There is an association between shorter telomere length (TL) in coronavirus disease 2019 (COVID-19) patients and hospitalization, severity, or even death. However, it remains unknown whether virus-induced-senescence is reversible. We aim to evaluate the dynamics of TL in COVID-19 patients 1 year after recovery
-
The kidney: the critical organ system for guiding nutrition therapy in the ICU-patient? Crit. Care (IF 8.8) Pub Date : 2024-08-07 Wilfred Druml, Thomas Staudinger, Michael Joannidis
Most randomized controlled studies on nutrition in intensive care patients did not yield conclusive results or were neutral or negative concerning the primary endpoints but also in most secondary endpoints. However, there is a consistent observation that in several of these studies there was a negative effect of the nutrition intervention on the kidneys in one of the study arms. During the early phase
-
Neurologic complications in patients receiving aortic versus subclavian versus femoral arterial cannulation for post-cardiotomy extracorporeal life support: results of the PELS observational multicenter study Crit. Care (IF 8.8) Pub Date : 2024-08-07 Giovanni Chiarini, Silvia Mariani, Anne-Kristin Schaefer, Bas C. T. van Bussel, Michele Di Mauro, Dominik Wiedemann, Diyar Saeed, Matteo Pozzi, Luca Botta, Udo Boeken, Robertas Samalavicius, Karl Bounader, Xiaotong Hou, Jeroen J. H. Bunge, Hergen Buscher, Leonardo Salazar, Bart Meyns, Daniel Herr, Sacha Matteucci, Sandro Sponga, Kollengode Ramanathan, Claudio Russo, Francesco Formica, Pranya Sakiyalak
Cerebral perfusion may change depending on arterial cannulation site and may affect the incidence of neurologic adverse events in post-cardiotomy extracorporeal life support (ECLS). The current study compares patients' neurologic outcomes with three commonly used arterial cannulation strategies (aortic vs. subclavian/axillary vs. femoral artery) to evaluate if each ECLS configuration is associated
-
Probing the efficacy of high-flow nasal cannula in the treatment of acute exacerbations of COPD with acute-moderate hypercapnic respiratory failure Crit. Care (IF 8.8) Pub Date : 2024-08-05 Ioannis Pantazopoulos, Georgios Mavrovouni
To the editor: Dear Sir, We have read with great interest the single-centre study by Tan, et al. [1], which concluded that high-flow nasal cannula (HFNC) was not non-inferior to non-invasive ventilation (NIV) and resulted in a higher incidence of treatment failure compared to NIV when used as the initial respiratory support for patients with acute exacerbation of chronic obstructive pulmonary disease
-
Phenotyping COVID-19 respiratory failure in spontaneously breathing patients with AI on lung CT-scan Crit. Care (IF 8.8) Pub Date : 2024-08-05 Emanuele Rezoagli, Yi Xin, Davide Signori, Wenli Sun, Sarah Gerard, Kevin L. Delucchi, Aurora Magliocca, Giovanni Vitale, Matteo Giacomini, Linda Mussoni, Jonathan Montomoli, Matteo Subert, Alessandra Ponti, Savino Spadaro, Giancarla Poli, Francesco Casola, Jacob Herrmann, Giuseppe Foti, Carolyn S. Calfee, John Laffey, Giacomo Bellani, Maurizio Cereda
Automated analysis of lung computed tomography (CT) scans may help characterize subphenotypes of acute respiratory illness. We integrated lung CT features measured via deep learning with clinical and laboratory data in spontaneously breathing subjects to enhance the identification of COVID-19 subphenotypes. This is a multicenter observational cohort study in spontaneously breathing patients with COVID-19
-
Physiological effects and safety of bed verticalization in patients with acute respiratory distress syndrome Crit. Care (IF 8.8) Pub Date : 2024-08-05 Louis Bouchant, Thomas Godet, Gauthier Arpajou, Lucie Aupetitgendre, Sophie Cayot, Renaud Guerin, Matthieu Jabaudon, Camille Verlhac, Raiko Blondonnet, Lucile Borao, Bruno Pereira, Jean-Michel Constantin, Jean-Etienne Bazin, Emmanuel Futier, Jules Audard
Trunk inclination in patients with Acute Respiratory Distress Syndrome (ARDS) in the supine position has gained scientific interest due to its effects on respiratory physiology, including mechanics, oxygenation, ventilation distribution, and efficiency. Changing from flat supine to semi-recumbent increases driving pressure due to decreased respiratory system compliance. Positional adjustments also
-
STAB-5: an aide-mémoire for the efficient prehospital management of penetrating trauma by emergency medical services Crit. Care (IF 8.8) Pub Date : 2024-08-05 M. Robinson, F. Rath, C. Sutton, M. Kinsella, E. ter Avest, L. Carenzo
Penetrating trauma represents a significant percentage of the overall trauma case load in many trauma systems.For patients with penetrating injuries, a longer time to hospital is associated with an increase in risk-adjusted odds of death [1, 2]. Therefore, expedited treatment and transport of by Emergency Medical Services (EMS) crews, who are usually the first healthcare practitioners to attend these
-
Alteration in early resting‑state functional MRI activity in comatose survivors of cardiac arrest: a prospective cohort study Crit. Care (IF 8.8) Pub Date : 2024-08-02 Rui Shao, Tao Wang, Chenchen Hang, Le An, Xingsheng Wang, Luying Zhang, Jingfei Yu, Zhenyu Shan, Qi Yang, Ziren Tang
This study aimed to explore the characteristics of abnormal regional resting-state functional magnetic resonance imaging (rs-fMRI) activity in comatose patients in the early period after cardiac arrest (CA), and to investigate their relationships with neurological outcomes. We also explored the correlations between jugular venous oxygen saturation (SjvO2) and rs-fMRI activity in resuscitated comatose
-
Mechanical versus manual cardiopulmonary resuscitation (CPR): an umbrella review of contemporary systematic reviews and more Crit. Care (IF 8.8) Pub Date : 2024-07-30 Ayman El-Menyar, Mashhood Naduvilekandy, Sandro Rizoli, Salvatore Di Somma, Basar Cander, Sagar Galwankar, Fatimah Lateef, Mohamed Alwi Abdul Rahman, Prabath Nanayakkara, Hassan Al-Thani
High-quality cardiopulmonary resuscitation (CPR) can restore spontaneous circulation (ROSC) and neurological function and save lives. We conducted an umbrella review, including previously published systematic reviews (SRs), that compared mechanical and manual CPR; after that, we performed a new SR of the original studies that were not included after the last published SR to provide a panoramic view
-
Artificial intelligence in acute medicine: a call to action Crit. Care (IF 8.8) Pub Date : 2024-07-29 Maurizio Cecconi, Massimiliano Greco, Benjamin Shickel, Jean-Louis Vincent, Azra Bihorac
On November 30, 2022, OpenAI released ChatGPT, the first chatbot and virtual assistant powered by large language models (LLMs). In just five days, ChatGPT attracted over 1 million users and reached 200 million monthly active users worldwide within fifteen months. This sudden surge of interest in artificial intelligence (AI) has expanded its potential from a niche concept to a mainstream obsession.
-
LUS me up: elevating ARDS diagnosis Crit. Care (IF 8.8) Pub Date : 2024-07-29 Rogério da Hora Passos, Rafaella Maria da Cunha Lyrio, Igor Dovorake Lourenço, Evandro José de Almeida Figueiredo, Uri Adrian Prync Flato, Carmen Valente Barbas, Arnaldo Alves da Silva
Boumans et al. conducted a systematic review and meta-analysis to evaluate the diagnostic accuracy of lung ultrasound (LUS) in acute respiratory distress syndrome (ARDS). The study found that LUS has high specificity (0.942, 95% CI 0.856–0.978) but variable sensitivity (0.631, 95% CI 0.450–0.782) for identifying ARDS-related diffuse lung pathologies. LUS demonstrates comparable or superior performance
-
Critical thresholds of long-pressure reactivity index and impact of intracranial pressure monitoring methods in traumatic brain injury Crit. Care (IF 8.8) Pub Date : 2024-07-29 Erik Hong, Logan Froese, Emeli Pontén, Alexander Fletcher-Sandersjöö, Charles Tatter, Emma Hammarlund, Cecilia A. I. Åkerlund, Jonathan Tjerkaski, Peter Alpkvist, Jiri Bartek, Rahul Raj, Caroline Lindblad, David W. Nelson, Frederick A. Zeiler, Eric P. Thelin
Moderate-to-severe traumatic brain injury (TBI) has a global mortality rate of about 30%, resulting in acquired life-long disabilities in many survivors. To potentially improve outcomes in this TBI population, the management of secondary injuries, particularly the failure of cerebrovascular reactivity (assessed via the pressure reactivity index; PRx, a correlation between intracranial pressure (ICP)
-
Changes in quality of life 1 year after intensive care: a multicenter prospective cohort of ICU survivors Crit. Care (IF 8.8) Pub Date : 2024-07-25 Lucy L. Porter, Koen S. Simons, Stijn Corsten, Brigitte Westerhof, Thijs C. D. Rettig, Esther Ewalds, Inge Janssen, Crétien Jacobs, Susanne van Santen, Arjen J. C. Slooter, Margaretha C. E. van der Woude, Johannes G. van der Hoeven, Marieke Zegers, Mark van den Boogaard
With survival rates of critical illness increasing, quality of life measures are becoming an important outcome of ICU treatment. Therefore, to study the impact of critical illness on quality of life, we explored quality of life before and 1 year after ICU admission in different subgroups of ICU survivors. Data from an ongoing prospective multicenter cohort study, the MONITOR-IC, were used. Patients
-
Plasma for prevention and treatment of glycocalyx degradation in trauma and sepsis Crit. Care (IF 8.8) Pub Date : 2024-07-20 M. S. Kravitz, N. Kattouf, I. J. Stewart, A. A. Ginde, E. P. Schmidt, N. I. Shapiro
The endothelial glycocalyx, a gel-like layer that lines the luminal surface of blood vessels, is composed of proteoglycans, glycoproteins, and glycosaminoglycans. The endothelial glycocalyx plays an essential role in vascular homeostasis, and its degradation in trauma and sepsis can lead to microvascular dysfunction and organ injury. While there are no proven therapies for preventing or treating endothelial
-
Association between whole blood ratio and risk of mortality in massively transfused trauma patients: retrospective cohort study Crit. Care (IF 8.8) Pub Date : 2024-07-19 Makoto Aoki, Toshikazu Abe, Akira Komori, Morihiro Katsura, Kazuhide Matsushima
Although whole blood (WB) transfusion was reported to improve survival in trauma patients with hemorrhagic shock, little is known whether a higher proportion of WB is associated with an improved survival. This study aimed to evaluate the association between whole blood ratio (WBR) and the risk of mortality in trauma patients requiring massive blood transfusion. We performed a retrospective cohort study
-
Hyperoxemia may be more beneficial for patients with sepsis Crit. Care (IF 8.8) Pub Date : 2024-07-19 Liyuan Peng, Xiaoming Qin, Lvlin Chen
To the Editor, We have read with great interest the clinical study by Dong-gon et al. published in Critical Care [1]. The study showed a robust correlation between higher PaO2 (≥ 80 mmHg) during the first three ICU days and a lower 28-day mortality. The optimal PaO2 range represents an intriguing and significant subject for exploration. Our department is the general Intensive Care Unit (ICU) of a tertiary
-
Influence of health insurance on withdrawal of life sustaining treatment for patients with isolated traumatic brain injury: a retrospective multi-center observational cohort study Crit. Care (IF 8.8) Pub Date : 2024-07-18 Armaan K. Malhotra, Husain Shakil, Ahmad Essa, Francois Mathieu, Shaurya Taran, Jetan Badhiwala, Yingshi He, Eva Y. Yuan, Abhaya V. Kulkarni, Jefferson R. Wilson, Avery B. Nathens, Christopher D. Witiw
Healthcare inequities for patients with traumatic brain injury (TBI) represent a major priority area for trauma quality improvement. We hypothesized a relationship between health insurance status and timing of withdrawal of life sustaining treatment (WLST) for adults with severe TBI. This multicenter retrospective observational cohort study utilized data collected between 2017 and 2020. We identified
-
High flow nasal cannula oxygen therapy versus non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease with acute-moderate hypercapnic respiratory failure: a randomized controlled non-inferiority trial Crit. Care (IF 8.8) Pub Date : 2024-07-18 Dingyu Tan, Bingxia Wang, Peng Cao, Yunyun Wang, Jiayan Sun, Ping Geng, Joseph Harold Walline, Yachao Wang, Chenlong Wang
Although cumulative studies have demonstrated a beneficial effect of high-flow nasal cannula oxygen (HFNC) in acute hypercapnic respiratory failure, randomized trials to compare HFNC with non-invasive ventilation (NIV) as initial treatment in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) patients with acute-moderate hypercapnic respiratory failure are limited. The aim of this
-
Guiding resuscitation in shock: base excess or lactate? Crit. Care (IF 8.8) Pub Date : 2024-07-18 Micah Liam Arthur Heldeweg, Thomas Langer, František Duška
Base excess (BE) is a widely used parameter derived from blood gas analysis. A recent international study showed that 40% of surveyed anesthesia and critical care clinicians use BE to guide (intraoperative) fluid management, and that 25% of respondents prefer BE over lactate [1]. This is surprising as lactate production is directly increased by hypovolemia-associated tissue hypoxia, whilst BE is a
-
Early physical rehabilitation dosage in the intensive care unit associates with hospital outcomes after critical COVID-19 Crit. Care (IF 8.8) Pub Date : 2024-07-18 Kirby P. Mayer, Evan Haezebrouck, Lori M. Ginoza, Clarisa Martinez, Minnie Jan, Lori A. Michener, Lindsey E. Fresenko, Ashley A. Montgomery-Yates, Anna G. Kalema, Amy M. Pastva, Michelle Biehl, Matthew F. Mart, Joshua K. Johnson
To examine the relationship between physical rehabilitation parameters including an approach to quantifying dosage with hospital outcomes for patients with critical COVID-19. Retrospective practice analysis from March 5, 2020, to April 15, 2021. Intensive care units (ICU) at four medical institutions. n = 3780 adults with ICU admission and diagnosis of COVID-19. We measured the physical rehabilitation
-
Prioritising deteriorating patients using time-to-event analysis: prediction model development and internal–external validation Crit. Care (IF 8.8) Pub Date : 2024-07-17 Robin Blythe, Rex Parsons, Adrian G. Barnett, David Cook, Steven M. McPhail, Nicole M. White
Binary classification models are frequently used to predict clinical deterioration, however they ignore information on the timing of events. An alternative is to apply time-to-event models, augmenting clinical workflows by ranking patients by predicted risks. This study examines how and why time-to-event modelling of vital signs data can help prioritise deterioration assessments using lift curves,
-
Identification and transcriptomic assessment of latent profile pediatric septic shock phenotypes Crit. Care (IF 8.8) Pub Date : 2024-07-17 Mihir R. Atreya, Min Huang, Andrew R. Moore, Hong Zheng, Yehudit Hasin-Brumshtein, Julie C. Fitzgerald, Scott L. Weiss, Natalie Z. Cvijanovich, Michael T. Bigham, Parag N. Jain, Adam J. Schwarz, Riad Lutfi, Jeffrey Nowak, Neal J. Thomas, Michael Quasney, Mary K. Dahmer, Torrey Baines, Bereketeab Haileselassie, Andrew J. Lautz, Natalja L. Stanski, Stephen W. Standage, Jennifer M. Kaplan, Basilia Zingarelli
Sepsis poses a grave threat, especially among children, but treatments are limited owing to heterogeneity among patients. We sought to test the clinical and biological relevance of pediatric septic shock subclasses identified using reproducible approaches. We performed latent profile analyses using clinical, laboratory, and biomarker data from a prospective multi-center pediatric septic shock observational
-
Operator independent continuous ultrasound monitoring of diaphragm excursion predicts successful weaning from mechanical ventilation: a prospective observational study Crit. Care (IF 8.8) Pub Date : 2024-07-16 Alexandre Demoule, Quentin Fossé, Alain Mercat, Daniel Bergum, Sara Virolle, Côme Bureau, Marit Mellemseter, Rafaël Guichou, Thomas Similowski, Martin Dres, Satar Mortaza
In mechanically ventilated patients, diaphragm ultrasound can identify diaphragm weakness and predict weaning failure. We evaluated whether a novel operator-independent ultrasound-based medical device allowing continuous monitoring of the diaphragm (CUSdi) could reliably (1) measure diaphragm excursion (EXdi) and peak contraction velocity (PCVdi), (2) predict weaning outcome, and (3) approximate transdiaphragmatic
-
Utility and rationale for continuous EEG monitoring: a primer for the general intensivist Crit. Care (IF 8.8) Pub Date : 2024-07-16 Ribal Bitar, Usaamah M. Khan, Eric S. Rosenthal
This review offers a comprehensive guide for general intensivists on the utility of continuous EEG (cEEG) monitoring for critically ill patients. Beyond the primary role of EEG in detecting seizures, this review explores its utility in neuroprognostication, monitoring neurological deterioration, assessing treatment responses, and aiding rehabilitation in patients with encephalopathy, coma, or other
-
Clinical characteristics and outcomes of immunocompromised critically ill patients with cytomegalovirus end-organ disease: a multicenter retrospective cohort study Crit. Care (IF 8.8) Pub Date : 2024-07-16 Sara Fernández, Ignacio Grafia, Olivier Peyrony, Emmanuel Canet, Clara Vigneron, Clément Monet, Nahéma Issa, Maxens Decavele, Anne-Sophie Moreau, Alexandre Lautrette, Guillaume Lacave, Guillaume Morel, Cyril Cadoz, Laurent Argaud, Liran Statlender, Karam Azem, Jean-Pierre Quenot, Olivier Lesieur, Javier Fernández, Marta Farrero, Mª Ángeles Marcos, Virgine Lemiale, Pedro Castro, Élie Azoulay
Cytomegalovirus (CMV) infection in patients with cellular immune deficiencies is associated with significant morbidity and mortality. However, data on CMV end-organ disease (CMV-EOD) in critically ill, immunocompromised patients are scarce. Our objective here was to describe the clinical characteristics and outcomes of CMV-EOD in this population. We conducted a multicenter, international, retrospective
-
Early bolus epinephrine administration during pediatric cardiopulmonary resuscitation for bradycardia with poor perfusion: an ICU-resuscitation study Crit. Care (IF 8.8) Pub Date : 2024-07-16 Amanda J. O’Halloran, Ron W. Reeder, Robert A. Berg, Tageldin Ahmed, Michael J. Bell, Robert Bishop, Matthew Bochkoris, Candice Burns, Joseph A. Carcillo, Todd C. Carpenter, J. Michael Dean, J. Wesley Diddle, Myke Federman, Richard Fernandez, Ericka L. Fink, Deborah Franzon, Aisha H. Frazier, Stuart H. Friess, Kathryn Graham, Mark Hall, David A. Hehir, Christopher M. Horvat, Leanna L. Huard, Martha
Half of pediatric in-hospital cardiopulmonary resuscitation (CPR) events have an initial rhythm of non-pulseless bradycardia with poor perfusion. Our study objectives were to leverage granular data from the ICU-RESUScitation (ICU-RESUS) trial to: (1) determine the association of early epinephrine administration with survival outcomes in children receiving CPR for bradycardia with poor perfusion; and
-
Absolute values of regional ventilation-perfusion mismatch in patients with ARDS monitored by electrical impedance tomography and the role of dead space and shunt compensation Crit. Care (IF 8.8) Pub Date : 2024-07-15 Marco Leali, Ines Marongiu, Elena Spinelli, Valentina Chiavieri, Joaquin Perez, Mauro Panigada, Giacomo Grasselli, Tommaso Mauri
Assessment of regional ventilation/perfusion (V′/Q) mismatch using electrical impedance tomography (EIT) represents a promising advancement for personalized management of the acute respiratory distress syndrome (ARDS). However, accuracy is still hindered by the need for invasive monitoring to calibrate ventilation and perfusion. Here, we propose a non-invasive correction that uses only EIT data and
-
Integrated clustering of multiple immune marker trajectories reveals different immunotypes in severely injured patients Crit. Care (IF 8.8) Pub Date : 2024-07-15 Maxime Bodinier, Estelle Peronnet, Jean-François Llitjos, Louis Kreitmann, Karen Brengel-Pesce, Thomas Rimmelé, Aurore Fleurie, Julien Textoris, Fabienne Venet, Delphine Maucort-Boulch, Guillaume Monneret
The immune response of critically ill patients, such as those with sepsis, severe trauma, or major surgery, is heterogeneous and dynamic, but its characterization and impact on outcomes are poorly understood. Until now, the primary challenge in advancing our understanding of the disease has been to concurrently address both multiparametric and temporal aspects. We used a clustering method to identify
-
Efficacy and safety of different polymyxin-containing regimens for the treatment of pneumonia caused by multidrug-resistant gram-negative bacteria: a systematic review and network meta-analysis Crit. Care (IF 8.8) Pub Date : 2024-07-14 Yi Zhou, Guizhong Wang, Ying Zhao, Weijia Chen, Xuyan Chen, Yuqi Qiu, Yuanyu Liu, Shuqi Wu, Jianbin Guan, Ping Chang, Yong Liu, Zhanguo Liu
The optimal administration of polymyxins for treating multidrug-resistant gram-negative bacterial (MDR-GNB) pneumonia remains unclear. This study aimed to systematically assess the efficacy and safety of three polymyxin-containing regimens by conducting a comprehensive network meta-analysis. We comprehensively searched nine databases. Overall mortality was the primary outcome, whereas the secondary
-
Enhancing sepsis biomarker development: key considerations from public and private perspectives Crit. Care (IF 8.8) Pub Date : 2024-07-13 Jean-Francois Llitjos, Enitan D. Carrol, Marcin F. Osuchowski, Marc Bonneville, Brendon P. Scicluna, Didier Payen, Adrienne G. Randolph, Stephan Witte, Jesus Rodriguez-Manzano, Bruno François
Implementation of biomarkers in sepsis and septic shock in emergency situations, remains highly challenging. This viewpoint arose from a public–private 3-day workshop aiming to facilitate the transition of sepsis biomarkers into clinical practice. The authors consist of international academic researchers and clinician-scientists and industry experts who gathered (i) to identify current obstacles impeding
-
Resilience after severe critical illness: a prospective, multicentre, observational study (RESIREA) Crit. Care (IF 8.8) Pub Date : 2024-07-12 Alice Mathieu, Jean Reignier, Amélie Le Gouge, Gaetan Plantefeve, Jean-Paul Mira, Laurent Argaud, Pierre Asfar, Julio Badie, Nicolae-Vlad Botoc, Hoang-Nam Bui, Delphine Chatellier, Louis Chauvelot, Christophe Cracco, Michael Darmon, Agathe Delbove, Jérôme Devaquet, Louis-Marie Dumont, Olivier Gontier, Samuel Groyer, Yannick Hourmant, Samir Jaber, Fabien Lambiotte, Benjamin Madeux, Julien Maizel, Olivier
Critical-illness survivors may experience post-traumatic stress disorder (PTSD) and quality-of-life impairments. Resilience may protect against psychological trauma but has not been adequately studied after critical illness. We assessed resilience and its associations with PTSD and quality of life, and also identified factors associated with greater resilience. This prospective, multicentre, study
-
Prognostic value of serial (1,3)-β-d-glucan measurements in ICU patients with invasive candidiasis Crit. Care (IF 8.8) Pub Date : 2024-07-12 Simone Carelli, Brunella Posteraro, Riccardo Torelli, Elena De Carolis, Maria Sole Vallecoccia, Rikardo Xhemalaj, Salvatore Lucio Cutuli, Eloisa Sofia Tanzarella, Antonio Maria Dell’Anna, Gianmarco Lombardi, Fabiola Cammarota, Alessandro Caroli, Domenico Luca Grieco, Maurizio Sanguinetti, Massimo Antonelli, Gennaro De Pascale
To determine whether a decrease in serum (1,3)-β-d-glucan (BDG) was associated with reduced mortality and to investigate the performance of BDG downslope in predicting clinical outcome in invasive candidiasis. Observational cohort study in ICU patients over a ten-year period (2012–2022) in Italy. Proven invasive candidiasis with at least 2 BDG determinations were considered. In the study population
-
Implications of sedation during the use of noninvasive ventilation in children with acute respiratory failure (SEDANIV Study) Crit. Care (IF 8.8) Pub Date : 2024-07-11 Lorena Bermúdez-Barrezueta, Juan Mayordomo-Colunga, María Miñambres-Rodríguez, Susana Reyes, Juan Valencia-Ramos, Yolanda Margarita Lopez-Fernandez, Mikel Mendizábal-Diez, Ana Vivanco-Allende, Alba Palacios-Cuesta, Lidia Oviedo-Melgares, José Luis Unzueta-Roch, Jorge López-González, María Teresa Jiménez-Villalta, Maite Cuervas-Mons Tejedor, Lourdes Artacho González, Ainhoa Jiménez Olmos, Martí Pons-Òdena
The objective of this study was to analyze the effects of sedation administration on clinical parameters, comfort status, intubation requirements, and the pediatric intensive care unit (PICU) length of stay (LOS) in children with acute respiratory failure (ARF) receiving noninvasive ventilation (NIV). Thirteen PICUs in Spain participated in a prospective, multicenter, observational trial from January
-
Bayesian networks may allow better performance and usability than logistic regression Crit. Care (IF 8.8) Pub Date : 2024-07-11 Jared M. Wohlgemut, Erhan Pisirir, Rebecca S. Stoner, Evangelia Kyrimi, Barbaros Yet, William Marsh, Zane B. Perkins, Nigel R. M. Tai
We read with great interest the article by Brac et al. entitled “Development and validation of the TIC score for early detection of traumatic coagulopathy upon hospital admission: a cohort study” [1]. We congratulate the authors on their work focusing on trauma-induced coagulopathy (TIC), a key outcome early after trauma that increases the risk of mortality and may be treated and potentially reversed
-
Left and right atrial strain analysis to predicting new-onset atrial fibrillation in patients with septic shock: a single-center retrospective echocardiography study Crit. Care (IF 8.8) Pub Date : 2024-07-11 Christophe Beyls, Alexis Hermida, Camille Daumin, Max-Paul Delmotte, Arnaud Nsiku, Pierre Huette, Camille Bunelle, Hervé Dupont, Osama Abou-Arab, Yazine Mahjoub
To the Editor, New-onset atrial fibrillation (NOAF) is the most common arrhythmogenic complication in septic shock patients, significantly increasing the risk of thromboembolic events and mortality [1]. Septic shock may rapidly induce septic cardiomyopathy, leading to atrial remodeling and fibrosis, which predisposes patients to NOAF. Although bedside transthoracic echocardiography (TTE) is commonly
-
The paradox of workplace violence in the intensive care unit: a focus group study Crit. Care (IF 8.8) Pub Date : 2024-07-11 Fredric Sjöberg, Martin Salzmann-Erikson, Eva Åkerman, Eva Joelsson-Alm, Anna Schandl
Conflicts with patients and relatives occur frequently in intensive care units (ICUs), driven by factors that are intensified by critical illness and its treatments. A majority of ICU healthcare professionals have experienced verbal and/or physical violence. There is a need to understand how healthcare professionals in ICUs experience and manage this workplace violence. A qualitative descriptive analysis
-
Fluid management for sepsis-induced hypotension in patients with advanced chronic kidney disease: a secondary analysis of the CLOVERS trial Crit. Care (IF 8.8) Pub Date : 2024-07-11 Anselm Jorda, Ivor S. Douglas, Thomas Staudinger, Gottfried Heinz, Felix Bergmann, Rainer Oberbauer, Gürkan Sengölge, Markus Zeitlinger, Bernd Jilma, Nathan I. Shapiro, Georg Gelbenegger
Early fluid management in patients with advanced chronic kidney disease (CKD) and sepsis-induced hypotension is challenging with limited evidence to support treatment recommendations. We aimed to compare an early restrictive versus liberal fluid management for sepsis-induced hypotension in patients with advanced CKD. This post-hoc analysis included patients with advanced CKD (eGFR of less than 30 mL/min/1
-
A proof of concept for microcirculation monitoring using machine learning based hyperspectral imaging in critically ill patients: a monocentric observational study Crit. Care (IF 8.8) Pub Date : 2024-07-10 Judith Kohnke, Kevin Pattberg, Felix Nensa, Henning Kuhlmann, Thorsten Brenner, Karsten Schmidt, René Hosch, Florian Espeter
Impaired microcirculation is a cornerstone of sepsis development and leads to reduced tissue oxygenation, influenced by fluid and catecholamine administration during treatment. Hyperspectral imaging (HSI) is a non-invasive bedside technology for visualizing physicochemical tissue characteristics. Machine learning (ML) for skin HSI might offer an automated approach for bedside microcirculation assessment
-
Unveiling the hidden burden: the impact of undiagnosed comorbidities on health-related quality of life in ICU survivors Crit. Care (IF 8.8) Pub Date : 2024-07-10 Jill Moser, Roos Mensink, Marisa Onrust, Fredrike Blokzijl, Jacqueline Koeze
With great interest we read the recent article by Orwelius et al. [1] on the impact of comorbidities on health-related quality of life (HRQoL) in ICU survivors. We commend the authors for their work on addressing this challenging topic and for providing an insightful review. While we agree with the key issues highlighted by the authors, we believe that several points warrant further discussion. One
-
Physiological and clinical effects of trunk inclination adjustment in patients with respiratory failure: a scoping review and narrative synthesis Crit. Care (IF 8.8) Pub Date : 2024-07-09 Martín H. Benites, Marcelo Zapata-Canivilo, Fabian Poblete, Francisco Labbe, Romina Battiato, Andrés Ferre, Jorge Dreyse, Guillermo Bugedo, Alejandro Bruhn, Eduardo L. V. Costa, Jaime Retamal
Adjusting trunk inclination from a semi-recumbent position to a supine-flat position or vice versa in patients with respiratory failure significantly affects numerous aspects of respiratory physiology including respiratory mechanics, oxygenation, end-expiratory lung volume, and ventilatory efficiency. Despite these observed effects, the current clinical evidence regarding this positioning manoeuvre
-
Immune profiling of critically ill patients with acute kidney injury during the first week after various types of injuries: the REALAKI study Crit. Care (IF 8.8) Pub Date : 2024-07-08 Frank Bidar, Louis Peillon, Maxime Bodinier, Fabienne Venet, Guillaume Monneret, Anne-Claire Lukaszewicz, Jean-François Llitjos, Julien Textoris, Thomas Rimmelé
Acute kidney injury (AKI) is common in hospitalized patients and results in significant morbidity and mortality. The objective of the study was to explore the systemic immune response of intensive care unit patients presenting with AKI, especially the association between immune profiles and persistent AKI during the first week after admission following various types of injuries (sepsis, trauma, surgery
-
Thiamine supplementation in septic shock patients: still looking for the target population Crit. Care (IF 8.8) Pub Date : 2024-07-08 Amanda Gomes Pereira, Nara A. Costa, Mariana B. de Moraes, Marina P. Okoshi, Leonardo A. M. Zornoff, Paula S. Azevedo, Marcos F. Minicucci, Sérgio A. R. de Paiva, Bertha F. Polegato
In recent years, there has been a growing interest in thiamine as a potential adjunctive therapy in septic shock, given its key role in the maintenance of cellular metabolism and energy production, being involved in various biological processes [1]. It is supposed that treatment of thiamine deficiency could mitigate alterations associated with organ dysfunction and lead to better outcomes in this critical
-
Clinical application of targeted next-generation sequencing in severe pneumonia: a retrospective review Crit. Care (IF 8.8) Pub Date : 2024-07-08 Peng Zhang, Baoyi Liu, Shuang Zhang, Xuefei Chang, Lihe Zhang, Dejian Gu, Xin Zheng, Jiaqing Chen, Saiyin Xiao, Zhentao Wu, Xuemin Cai, Mingfa Long, Wenjie Lu, Mingzhu Zheng, Rongrong Chen, Rui Gao, Yan Zheng, Jinhua Wu, Qiujuan Feng, Gang He, Yantang Chen, Weihao Zheng, Wanli Zuo, Yanming Huang, Xin Zhang
The precise identification of the underlying causes of infectious diseases, such as severe pneumonia, is essential, and the development of next-generation sequencing (NGS) has enhanced the effectiveness of pathogen detection. However, there is limited information on the systematic assessment of the clinical use of targeted next-generation sequencing (tNGS) in cases of severe pneumonia. A retrospective
-
Diagnostic accuracy of lung ultrasound in diagnosis of ARDS and identification of focal or non-focal ARDS subphenotypes: a systematic review and meta-analysis Crit. Care (IF 8.8) Pub Date : 2024-07-08 Maud M. A. Boumans, William Aerts, Luigi Pisani, Lieuwe D. J. Bos, Marry R. Smit, Pieter R. Tuinman
Acute respiratory distress syndrome (ARDS) is a life-threatening respiratory condition with high mortality rates, accounting for 10% of all intensive care unit admissions. Lung ultrasound (LUS) as diagnostic tool for acute respiratory failure has garnered widespread recognition and was recently incorporated into the updated definitions of ARDS. This raised the hypothesis that LUS is a reliable method
-
Trials and the importance of usual care Crit. Care (IF 8.8) Pub Date : 2024-07-08 Kyle C. White, Kevin B. Laupland, Rinaldo Bellomo
Dear Editor, We read with great interest the REDUSE trial paper by Linden and colleagues [1] and particularly commend the comprehensive protocol that recognised the importance of nutrition to fluid accumulation [2] and detailed instructions on concentrating drug administration. However, we are concerned about the external validity of fluid input with the usual care arm of the REDUSE trial. Such patients
-
Calcium supplementation during trauma resuscitation: a propensity score-matched analysis from the TraumaRegister DGU® Crit. Care (IF 8.8) Pub Date : 2024-07-05 Dries Helsloot, Mark Fitzgerald, Rolf Lefering, Christopher Groombridge, Nathalie Becaus, Sandra Verelst, Carlo Missant
In major trauma patients, hypocalcemia is associated with increased mortality. Despite the absence of strong evidence on causality, early calcium supplementation has been recommended. This study investigates whether calcium supplementation during trauma resuscitation provides a survival benefit. We conducted a retrospective analysis using data from the TraumaRegister DGU® (2015–2019), applying propensity
-
Andexanet alpha versus four-factor prothrombin complex concentrate in DOACs anticoagulation reversal: an updated systematic review and meta-analysis Crit. Care (IF 8.8) Pub Date : 2024-07-05 Daniele Orso, Federico Fonda, Alessandro Brussa, Irene Comisso, Elisabetta Auci, Marco Sartori, Tiziana Bove
There is currently a lack of evidence for the comparative effectiveness of Andexanet alpha and four-factor prothrombin complex concentrate (4F-PCC) in anticoagulation reversal of direct oral anticoagulants (DOACs). The primary aim of our systematic review was to verify which drug is more effective in reducing short-term all-cause mortality. The secondary aim was to determine which of the two reverting
-
Gut-derived immune cells and the gut-lung axis in ARDS Crit. Care (IF 8.8) Pub Date : 2024-07-04 Mairi Ziaka, Aristomenis Exadaktylos
The gut serves as a vital immunological organ orchestrating immune responses and influencing distant mucosal sites, notably the respiratory mucosa. It is increasingly recognized as a central driver of critical illnesses, with intestinal hyperpermeability facilitating bacterial translocation, systemic inflammation, and organ damage. The “gut-lung” axis emerges as a pivotal pathway, where gut-derived
-
Impact of the COVID-19 pandemic on lung-protective ventilation practice in critically ill patients with respiratory failure: a retrospective cohort study from a New England healthcare network Crit. Care (IF 8.8) Pub Date : 2024-07-04 Ricardo Munoz-Acuna, Elena Ahrens, Aiman Suleiman, Luca J. Wachtendorf, Basit A. Azizi, Simone Redaelli, Tim M. Tartler, Guanqing Chen, Elias N. Baedorf-Kassis, Maximilian S. Schaefer, Shahla Siddiqui
To the Editor—Before the Coronavirus Disease 2019 (COVID-19) pandemic, over three million patients in the United States of America (USA) suffered from hypoxemic respiratory failure annually. COVID-19-related hypoxemic respiratory failure required admission to the intensive care unit (ICU) in nearly 30% of cases and mechanical ventilation for more than 10% of patients, leading to strain in the healthcare
-
Progressive hemorrhagic injury and ischemia after severe traumatic brain injury according to hemoglobin transfusion thresholds: a post-hoc analysis of the transfusion requirements after head trauma trial Crit. Care (IF 8.8) Pub Date : 2024-07-03 André L. N. Gobatto, Davi Solla, Sérgio Brasil, Fabio S. Taccone, Carlos G. Carlotti Jr, Luiz Marcelo S. Malbouisson, Wellingson S. Paiva
Trial registration: ClinicalTrials.gov, NCT02203292. Registered on 29 July 2014. Following severe traumatic brain injury (TBI), up to 50% of patients develop significant anemia, which compromises oxygen delivery to the cerebral tissue [1]. Furthermore, about 20–50% of TBI cases complicate with progressive hemorrhagic injuries (PHI) within the first 72 h post-injury [2] and 19–68% develop vasospasm
-
Extracorporeal cardiopulmonary resuscitation versus standard treatment for refractory out-of-hospital cardiac arrest: a Bayesian meta-analysis Crit. Care (IF 8.8) Pub Date : 2024-07-03 Samuel Heuts, Johannes F. H. Ubben, Michal J. Kawczynski, Andrea Gabrio, Martje M. Suverein, Thijs S. R. Delnoij, Petra Kavalkova, Daniel Rob, Arnošt Komárek, Iwan C. C. van der Horst, Jos G. Maessen, Demetris Yannopoulos, Jan Bělohlávek, Roberto Lorusso, Marcel C. G. van de Poll
The outcomes of several randomized trials on extracorporeal cardiopulmonary resuscitation (ECPR) in patients with refractory out-of-hospital cardiac arrest were examined using frequentist methods, resulting in a dichotomous interpretation of results based on p-values rather than in the probability of clinically relevant treatment effects. To determine such a probability of a clinically relevant ECPR-based
-
The impact of norepinephrine dose reporting heterogeneity on mortality prediction in septic shock patients Crit. Care (IF 8.8) Pub Date : 2024-07-03 Sebastian Morales, Pedro D. Wendel-Garcia, Miguel Ibarra-Estrada, Christian Jung, Ricardo Castro, Jaime Retamal, Luis I. Cortínez, Nicolás Severino, Greta Emilia Kiavialaitis, Gustavo Ospina-Tascón, Jan Bakker, Glenn Hernández, Eduardo Kattan
Norepinephrine (NE) is a cornerstone drug in the management of septic shock, with its dose being used clinically as a marker of disease severity and as mortality predictor. However, variations in NE dose reporting either as salt formulations or base molecule may lead to misinterpretation of mortality risks and hinder the process of care. We conducted a retrospective analysis of the MIMIC-IV database
-
Performance of the MRI lesion pattern score in predicting neurological outcome after out of hospital cardiac arrest: a retrospective cohort analysis Crit. Care (IF 8.8) Pub Date : 2024-07-02 Manuela Iten, Antonia Moser, Franca Wagner, Matthias Haenggi
Despite advances in resuscitation practice, patient survival following cardiac arrest remains poor. The utilization of MRI in neurological outcome prognostication post-cardiac arrest is growing and various classifications has been proposed; however a consensus has yet to be established. MRI, though valuable, is resource-intensive, time-consuming, costly, and not universally available. This study aims
-
Unravelling the complexity of ventilator-associated pneumonia: a systematic methodological literature review of diagnostic criteria and definitions used in clinical research Crit. Care (IF 8.8) Pub Date : 2024-07-02 Markus Fally, Faiuna Haseeb, Ahmed Kouta, Jan Hansel, Rebecca C. Robey, Thomas Williams, Tobias Welte, Timothy Felton, Alexander G. Mathioudakis
Ventilator-associated pneumonia (VAP) is a prevalent and grave hospital-acquired infection that affects mechanically ventilated patients. Diverse diagnostic criteria can significantly affect VAP research by complicating the identification and management of the condition, which may also impact clinical management. We conducted this review to assess the diagnostic criteria and the definitions of the