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A comparison of extracorporeal and conventional cardiopulmonary resuscitation for cardiac arrest Crit. Care (IF 15.1) Pub Date : 2024-03-18 Yang Zhao, Qian Wang, Bin Zang
To the Editor, We are highly interested in the recent article published in Critical Care by Low CJW et al., titled "Extracorporeal cardiopulmonary resuscitation versus conventional CPR in cardiac arrest: an updated meta-analysis and trial sequential analysis" [1]. In updating their previous systematic review and meta-analysis [2], the authors found that extracorporeal cardiopulmonary resuscitation
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The incidences of acute mesenteric ischaemia vary greatly depending on the population and diagnostic activity Crit. Care (IF 15.1) Pub Date : 2024-03-18 Annika Reintam Blaser, Kadri Tamme, Joel Starkopf, Alastair Forbes, Marko Murruste, Peep Talving, Stefan Acosta, Martin Björck
We much appreciate the interest of Drs Gazelli and Nacher regarding the AMESI study [1, 2], and for their effort to debate the difficulties in establishing a “true incidence” of acute mesenteric ischaemia (AMI) [3]. To address the question of true incidence, we first need to acknowledge the multifaceted nature of AMI. The main drivers of arterial occlusive AMI are cardiac arrhythmias (that increase
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Trauma systems in high socioeconomic index countries in 2050 Crit. Care (IF 15.1) Pub Date : 2024-03-16 Tobias Gauss, Mariska de Jongh, Marc Maegele, Elaine Cole, Pierre Bouzat
Considerable political, structural, environmental and epidemiological change will affect high socioeconomic index (SDI) countries over the next 25 years. These changes will impact healthcare provision and consequently trauma systems. This review attempts to anticipate the potential impact on trauma systems and how they could adapt to meet the changing priorities. The first section describes possible
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The elusive relationship between cardiac filling and fluid responsiveness Crit. Care (IF 15.1) Pub Date : 2024-03-15 Jon-Emile S. Kenny, Ross Prager, Korbin Haycock
Munoz et al. [1] have recently published an important pilot study in Critical Care. In 90 mechanically ventilated patients with circulatory failure who were admitted to the intensive care unit (ICU) for less than 24 h, four measures of ‘venous congestion’ (VC) were related to fluid responsiveness (FR) or unresponsiveness (FUR). To score VC, each patient received 1 point for any of the following: (1)
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Effects of prone positioning on lung mechanical power components in patients with acute respiratory distress syndrome: a physiologic study Crit. Care (IF 15.1) Pub Date : 2024-03-15 Christoph Boesing, Joerg Krebs, Alice Marguerite Conrad, Matthias Otto, Grietje Beck, Manfred Thiel, Patricia R. M. Rocco, Thomas Luecke, Laura Schaefer
Prone positioning (PP) homogenizes ventilation distribution and may limit ventilator-induced lung injury (VILI) in patients with moderate to severe acute respiratory distress syndrome (ARDS). The static and dynamic components of ventilation that may cause VILI have been aggregated in mechanical power, considered a unifying driver of VILI. PP may affect mechanical power components differently due to
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Trends in pre-hospital volume resuscitation of blunt trauma patients: a 15-year analysis of the British (TARN) and German (TraumaRegister DGU®) National Registries Crit. Care (IF 15.1) Pub Date : 2024-03-15 M. F. Bath, J. Schloer, J. Strobel, W. Rea, R. Lefering, M. Maegele, H. De’Ath, Z. B. Perkins
Fluid resuscitation has long been a cornerstone of pre-hospital trauma care, yet its optimal approach remains undetermined. Although a liberal approach to fluid resuscitation has been linked with increased complications, the potential survival benefits of a restrictive approach in blunt trauma patients have not been definitively established. Consequently, equipoise persists regarding the optimal fluid
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Scrutinizing mechanical circulatory support in cardiogenic shock: Have we jumped the gun? Crit. Care (IF 15.1) Pub Date : 2024-03-15 Enzo Lüsebrink, Hugo Lanz, Holger Thiele
Despite increasing therapeutic options and disposable resources, cardiogenic shock (CS) remains a formidable condition with high mortality. Today, veno-arterial extracorporeal membrane oxygenation and microaxial flow devices (Impella, Abiomed, Danvers, USA) are established forms of mechanical circulatory support (MCS) in CS, with increasing application over the years. Despite this trend, incorporation
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Albumin for sepsis-related peripheral tissue hypoperfusion Crit. Care (IF 15.1) Pub Date : 2024-03-14 Mingqiang Wang, Lin Zhong
We read with interest the manuscript by Gabarre et al. regarding albumin infusion [1]. Here, I believe there is a minor issue that needs clarification. The sample size in each group of this study is quite small. On this basis, there is a difference in the need for vasopressor between the two groups, although it did not reach statistical significance (0.4 vs. 0.7, P = 0.06). Considering that all patients
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Prognostic value of near-infrared spectroscopy regional oxygen saturation and cerebrovascular reactivity index in acute traumatic neural injury: a CAnadian High-Resolution Traumatic Brain Injury (CAHR-TBI) Cohort Study Crit. Care (IF 15.1) Pub Date : 2024-03-14 Alwyn Gomez, Logan Froese, Donald Griesdale, Eric P. Thelin, Rahul Raj, Levi van Iperenburg, Jeanette Tas, Marcel Aries, Kevin Y. Stein, Clare Gallagher, Francis Bernard, Andreas H. Kramer, Frederick A. Zeiler
Near-infrared spectroscopy regional cerebral oxygen saturation (rSO2) has gained interest as a raw parameter and as a basis for measuring cerebrovascular reactivity (CVR) due to its noninvasive nature and high spatial resolution. However, the prognostic utility of these parameters has not yet been determined. This study aimed to identify threshold values of rSO2 and rSO2-based CVR at which outcomes
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Impact of COVID-19 on posttraumatic stress disorder in ICU survivors: a prospective observational comparative cohort study Crit. Care (IF 15.1) Pub Date : 2024-03-14 Pierre Kalfon, Wissam El-Hage, Marie-Agnès Geantot, Constance Favier, Laetitia Bodet-Contentin, Khaldoun Kuteifan, Pierre-Yves Olivier, Didier Thévenin, Julien Pottecher, Jullien Crozon-Clauzel, Bénédicte Mauchien, Arnaud Galbois, Roland de Varax, Sabine Valera, Philippe Estagnasie, Audrey Berric, Martine Nyunga, Nathalie Revel, Georges Simon, Benjamin Kowalski, Achille Sossou, Thomas Signouret, Marc
Posttraumatic stress disorder (PTSD) after a stay in the intensive care unit (ICU) can affect one in five ICU survivors. At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, admission to the ICU for COVID-19 was stressful due to the severity of this disease. This study assessed whether admission to the ICU for COVID-19 was associated with a higher prevalence of PTSD compared with other
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Real-time machine learning model to predict short-term mortality in critically ill patients: development and international validation Crit. Care (IF 15.1) Pub Date : 2024-03-14 Leerang Lim, Ukdong Gim, Kyungjae Cho, Dongjoon Yoo, Ho Geol Ryu, Hyung-Chul Lee
A real-time model for predicting short-term mortality in critically ill patients is needed to identify patients at imminent risk. However, the performance of the model needs to be validated in various clinical settings and ethnicities before its clinical application. In this study, we aim to develop an ensemble machine learning model using routinely measured clinical variables at a single academic
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Flow starvation during square-flow assisted ventilation detected by supervised deep learning techniques Crit. Care (IF 15.1) Pub Date : 2024-03-14 Candelaria de Haro, Verónica Santos-Pulpón, Irene Telías, Alba Xifra-Porxas, Carles Subirà, Montserrat Batlle, Rafael Fernández, Gastón Murias, Guillermo M. Albaiceta, Sol Fernández-Gonzalo, Marta Godoy-González, Gemma Gomà, Sara Nogales, Oriol Roca, Tai Pham, Josefina López-Aguilar, Rudys Magrans, Laurent Brochard, Lluís Blanch, Leonardo Sarlabous
Flow starvation is a type of patient-ventilator asynchrony that occurs when gas delivery does not fully meet the patients’ ventilatory demand due to an insufficient airflow and/or a high inspiratory effort, and it is usually identified by visual inspection of airway pressure waveform. Clinical diagnosis is cumbersome and prone to underdiagnosis, being an opportunity for artificial intelligence. Our
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Mean arterial pressure during cardiopulmonary bypass: A modifiable risk factor for acute kidney injury in cardiac surgery patients? Crit. Care (IF 15.1) Pub Date : 2024-03-12 Nikolaus Schreiber, Simon Orlob, Stephanie Fida, Christoph Klivinyi, Alexander H. Kirsch, Michael Kolland, Michael Schörghuber
Dear Editor, Acute kidney injury (AKI) frequently occurs as a complication in patients undergoing cardiac surgery, with reported incidence rates ranging from 20 to 40% [1]. The development of cardiac surgery-associated AKI (CSA-AKI) is linked to adverse outcomes such as increased short- and long-term mortality, as well as prolonged hospital stays [1]. Despite its significance, the underlying mechanisms
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Transitions of blood immune endotypes and improved outcome by anakinra in COVID-19 pneumonia: an analysis of the SAVE-MORE randomized controlled trial Crit. Care (IF 15.1) Pub Date : 2024-03-12 Evdoxia Kyriazopoulou, Yehudit Hasin-Brumshtein, Uros Midic, Garyfallia Poulakou, Haralampos Milionis, Simeon Metallidis, Myrto Astriti, Archontoula Fragkou, Aggeliki Rapti, Eleonora Taddei, Ioannis Kalomenidis, Georgios Chrysos, Andrea Angheben, Ilias Kainis, Zoi Alexiou, Francesco Castelli, Francesco Saverio Serino, Petros Bakakos, Emanuele Nicastri, Vasiliki Tzavara, Sofia Ioannou, Lorenzo Dagna
Endotype classification may guide immunomodulatory management of patients with bacterial and viral sepsis. We aimed to identify immune endotypes and transitions associated with response to anakinra (human interleukin 1 receptor antagonist) in participants in the SAVE-MORE trial. Adult patients hospitalized with radiological findings of PCR-confirmed severe pneumonia caused by SARS-CoV-2 and plasma-soluble
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Long-term outcome in new onset refractory status epilepticus: a retrospective study Crit. Care (IF 15.1) Pub Date : 2024-03-12 Federica Stretti, Stefan Yu Bögli, Francesca Casagrande, Amanda Eisele, Marian Galovic, Emanuela Keller, Giovanna Brandi
New onset refractory status epilepticus (NORSE) is a neurologic emergency without an immediately identifiable cause. The complicated and long ICU stay of the patients can lead to perceiving a prolongation of therapies as futile. However, a recovery is possible even in severe cases. This retrospective study investigates ICU treatments, short- and long-term outcome and ethical decisions of a case series
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Pathophysiology of acute lung injury in patients with acute brain injury: the triple-hit hypothesis Crit. Care (IF 15.1) Pub Date : 2024-03-07 Mairi Ziaka, Aristomenis Exadaktylos
It has been convincingly demonstrated in recent years that isolated acute brain injury (ABI) may cause severe dysfunction of peripheral extracranial organs and systems. Of all potential target organs and systems, the lung appears to be the most vulnerable to damage after ABI. The pathophysiology of the bidirectional brain–lung interactions is multifactorial and involves inflammatory cascades, immune
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Accuracy of respiratory muscle assessments to predict weaning outcomes: a systematic review and comparative meta-analysis Crit. Care (IF 15.1) Pub Date : 2024-03-07 Diego Poddighe, Marine Van Hollebeke, Yasir Qaiser Choudhary, Débora Ribeiro Campos, Michele R. Schaeffer, Jan Y. Verbakel, Greet Hermans, Rik Gosselink, Daniel Langer
Several bedside assessments are used to evaluate respiratory muscle function and to predict weaning from mechanical ventilation in patients on the intensive care unit. It remains unclear which assessments perform best in predicting weaning success. The primary aim of this systematic review and meta-analysis was to summarize and compare the accuracy of the following assessments to predict weaning success:
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Toxicities, intensive care management, and outcome of chimeric antigen receptor T cells in adults: an update Crit. Care (IF 15.1) Pub Date : 2024-03-05 Mathieu Bellal, Jolan Malherbe, Gandhi Damaj, Damien Du Cheyron
Chimeric antigen receptor T cells are a promising new immunotherapy for haematological malignancies. Six CAR-T cells products are currently available for adult patients with refractory or relapsed high-grade B cell malignancies, but they are associated with severe life-threatening toxicities and side effects that may require admission to ICU. The aim of this short pragmatic review is to synthesize
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The acute mesenteric ischaemia (AMESI) study: a matter of incidence Crit. Care (IF 15.1) Pub Date : 2024-03-04 Lorenzo Garzelli, Mathieu Nacher
We read with great interest the recent study by Dr. Reintam Blaser et al. “Incidence, diagnosis, management and outcome of acute mesenteric ischaemia: a prospective, multicenter observational study (AMESI Study)” [1] in which they prospectively identified the occurrence rate of acute mesenteric ischaemia (AMI) among adult patients hospitalized in acute care hospitals in different parts of the world
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Impact of hyperoxia on the gut during critical illnesses Crit. Care (IF 15.1) Pub Date : 2024-03-01 Ninan Dai, Juan Gu, Yanhong Luo, Yuanfa Tao, Yuehting Chou, Ying He, Han Qin, Tao Chen, Xiaoyun Fu, Miao Chen, Zhouxiong Xing
Molecular oxygen is typically delivered to patients via oxygen inhalation or extracorporeal membrane oxygenation (ECMO), potentially resulting in systemic hyperoxia from liberal oxygen inhalation or localized hyperoxia in the lower body from peripheral venoarterial (VA) ECMO. Consequently, this exposes the gastrointestinal tract to excessive oxygen levels. Hyperoxia can trigger organ damage due to
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Imatinib treatment improves hyperglycaemic dysregulation in severe COVID-19: a secondary analysis of blood biomarkers in a randomised controlled trial Crit. Care (IF 15.1) Pub Date : 2024-02-29 Erik Duijvelaar, Xiaoke Pan, Harm Jan Bogaard, Etto C. Eringa, Jurjan Aman
SARS-CoV-2 can induce insulin resistance, which is, among others, mediated by adipose tissue dysfunction and reduced angiotensin-converting enzyme 2 (ACE2) enzymatic activity. In SARS-CoV-2-infected mice, the tyrosine kinase inhibitor imatinib attenuates inflammation and improves insulin sensitivity. Here, we report the effects of imatinib on incident hyperglycaemia, circulating levels of glucoregulatory
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Prevention of post-operative delirium using an overnight infusion of dexmedetomidine in patients undergoing cardiac surgery: a pragmatic, randomized, double-blind, placebo-controlled trial Crit. Care (IF 15.1) Pub Date : 2024-02-29 Olivier Huet, Thomas Gargadennec, Jean-Ferréol Oilleau, Bertrand Rozec, Nicolas Nesseler, Adrien Bouglé, Thomas Kerforne, Sigismond Lasocki, Vedat Eljezi, Géraldine Dessertaine, Julien Amour, Xavier Chapalain
After cardiac surgery, post-operative delirium (PoD) is acknowledged to have a significant negative impact on patient outcome. To date, there is no valuable and specific treatment for PoD. Critically ill patients often suffer from poor sleep condition. There is an association between delirium and sleep quality after cardiac surgery. This study aimed to establish whether promoting sleep using an overnight
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Using a targeted metabolomics approach to explore differences in ARDS associated with COVID-19 compared to ARDS caused by H1N1 influenza and bacterial pneumonia Crit. Care (IF 15.1) Pub Date : 2024-02-27 Chel Hee Lee, Mohammad M. Banoei, Mariam Ansari, Matthew P. Cheng, Francois Lamontagne, Donald Griesdale, David E. Lasry, Koray Demir, Vinay Dhingra, Karen C. Tran, Terry Lee, Kevin Burns, David Sweet, John Marshall, Arthur Slutsky, Srinivas Murthy, Joel Singer, David M. Patrick, Todd C. Lee, John H. Boyd, Keith R. Walley, Robert Fowler, Greg Haljan, Donald C. Vinh, Alison Mcgeer, David Maslove, Puneet
Acute respiratory distress syndrome (ARDS) is a life-threatening critical care syndrome commonly associated with infections such as COVID-19, influenza, and bacterial pneumonia. Ongoing research aims to improve our understanding of ARDS, including its molecular mechanisms, individualized treatment options, and potential interventions to reduce inflammation and promote lung repair. To map and compare
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The use of mechanical CPR for IHCA during the COVID-19 pandemic as compared to the pre-pandemic period Crit. Care (IF 15.1) Pub Date : 2024-02-27 Conor Crowley, Justin Salciccioli, Yuxiu Lei, Christopher Hansen, Tomoyoshi Tamura, Edy Y. Kim, Ari Moskowitz
Timely and effective chest compressions are one of the few therapies with clear benefit in cardiac arrest [1]. Mechanical cardiopulmonary resuscitation (mCPR) devices have been developed to provide continuous high-quality CPR and help avoid interruption, compressor fatigue, and variations in compression depth, all of which have been associated poor outcomes [2]. mCPR has largely been investigated in
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Violence against healthcare professionals in intensive care units: a systematic review and meta-analysis of frequency, risk factors, interventions, and preventive measures Crit. Care (IF 15.1) Pub Date : 2024-02-26 Sebastian Berger, Pascale Grzonka, Anja I. Frei, Sabina Hunziker, Sira M. Baumann, Simon A. Amacher, Caroline E. Gebhard, Raoul Sutter
To assess the frequency, risk factors, consequences, and prevention of violence against healthcare workers in intensive care units. PubMed, Scopus, Google Scholar, EMBASE, Cochrane, and Web of Science were searched for studies on violence against healthcare workers in adult intensive care units. Risk factors, patient characteristics, and implications for healthcare workers were collected. Study quality
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How often do we need to update PEEP setting during prone positioning in ARDS? Crit. Care (IF 15.1) Pub Date : 2024-02-26 Ling Sang, Zhimin Lin, Zhanqi Zhao
Patients with acute respiratory distress syndrome (ARDS) require mechanical ventilation. Personalized lung protective ventilation strategy with low tidal volume, adequate positive end-expiratory pressure (PEEP) and limited plateau pressure helps to reduce ventilator-induced lung injury and improves ARDS survival [1]. Prone positioning improves dorsal ventilation and ventilation-perfusion matching in
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Reflections on epidemiological investigations of sepsis in the Asian Region Crit. Care (IF 15.1) Pub Date : 2024-02-26 Mingqiang Wang, Lin Zhong
We read with interest the study by Li et al. [1, 2]. The authors conducted a comprehensive investigation of septic patients in Asian ICUs. Here, we have some concerns and suggestions that we would like to address. In Asia, especially in low- to middle-income countries or regions, the proportion of patients' families requesting withdrawal of treatment is not negligible. Although this phenomenon is rarely
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Improving management of ARDS: uniting acute management and long-term recovery Crit. Care (IF 15.1) Pub Date : 2024-02-23 Nicola Latronico, M. Eikermann, E. W. Ely, D. M. Needham
Acute Respiratory Distress Syndrome (ARDS) is an important global health issue with high in-hospital mortality. Importantly, the impact of ARDS extends beyond the acute phase, with increased mortality and disability for months to years after hospitalization. These findings underscore the importance of extended follow-up to assess and address the Post-Intensive Care Syndrome (PICS), characterized by
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Extracorporeal cardiopulmonary resuscitation versus conventional CPR in cardiac arrest: an updated meta-analysis and trial sequential analysis Crit. Care (IF 15.1) Pub Date : 2024-02-21 Christopher Jer Wei Low, Ryan Ruiyang Ling, Kollengode Ramanathan, Ying Chen, Bram Rochwerg, Tetsuhisa Kitamura, Taku Iwami, Marcus Eng Hock Ong, Yohei Okada
Extracorporeal cardiopulmonary resuscitation (ECPR) may reduce mortality and improve neurological outcomes in patients with cardiac arrest. We updated our existing meta-analysis and trial sequential analysis to further evaluate ECPR compared to conventional CPR (CCPR). We searched three international databases from 1 January 2000 through 1 November 2023, for randomised controlled trials or propensity
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Novel subtypes of severe COVID-19 respiratory failure based on biological heterogeneity: a secondary analysis of a randomized controlled trial Crit. Care (IF 15.1) Pub Date : 2024-02-21 Narges Alipanah-Lechner, James Hurst-Hopf, Kevin Delucchi, Lamorna Swigart, Andrew Willmore, Benjamin LaCombe, Robin Dewar, H. Clifford Lane, Perrine Lallemand, Kathleen D. Liu, Laura Esserman, Michael A. Matthay, Carolyn S. Calfee
Despite evidence associating inflammatory biomarkers with worse outcomes in hospitalized adults with COVID-19, trials of immunomodulatory therapies have met with mixed results, likely due in part to biological heterogeneity of participants. Latent class analysis (LCA) of clinical and protein biomarker data has identified two subtypes of non-COVID acute respiratory distress syndrome (ARDS) with different
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Evidence supports the use of hydrocortisone for patients with community-acquired pneumonia Crit. Care (IF 15.1) Pub Date : 2024-02-20 De-En Lu, Cheng-Yi Chang, Sheng-Wei Cheng, Enoch Kang, Chih-Hsin Lee, Kee-Hsin Chen
Dear editor, Chiang et al. have given a closer look at the evidence regarding the effects of corticosteroids on severe community-acquired pneumonia (CAP) [1], and the article is a correspondence of a synthesis by Wu et al. [2]. In contrast with the initial synthesis, Dr. Chiang et al. added three relevant trials and distinctively analyzed five studies utilizing hydrocortisone from another set of five
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Healthcare-associated infections in patients with severe COVID-19 supported with extracorporeal membrane oxygenation: a nationwide cohort study Crit. Care (IF 15.1) Pub Date : 2024-02-20 Nicolas Nesseler, Alexandre Mansour, Matthieu Schmidt, Marylou Para, Alizée Porto, Pierre-Emmanuel Falcoz, Nicolas Mongardon, Claire Fougerou, James T. Ross, Antoine Beurton, Lucie Gaide-Chevronnay, Pierre-Grégoire Guinot, Guillaume Lebreton, Erwan Flecher, André Vincentelli, Nicolas Massart
Both critically ill patients with coronavirus disease 2019 (COVID-19) and patients receiving extracorporeal membrane oxygenation (ECMO) support exhibit a high incidence of healthcare-associated infections (HAI). However, data on incidence, microbiology, resistance patterns, and the impact of HAI on outcomes in patients receiving ECMO for severe COVID-19 remain limited. We aimed to report HAI incidence
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Cardiogenic shock: all hail the RCT, long live the registry Crit. Care (IF 15.1) Pub Date : 2024-02-19 A. Warren, D. Morrow, Alastair G. Proudfoot
The persistently and unacceptably high mortality of cardiogenic shock (CS) [1] demands the pursuit of evidence to confirm the efficacy and safety of existing and novel interventions at a population level. Randomised controlled trials (RCTs) remain the cornerstone of evidence generation. Nonetheless, sobering neutral clinical trial results [2, 3] and either protracted [4] or failed [5] recruitment have
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Coexistence of a fluid responsive state and venous congestion signals in critically ill patients: a multicenter observational proof-of-concept study Crit. Care (IF 15.1) Pub Date : 2024-02-19 Felipe Muñoz, Pablo Born, Mario Bruna, Rodrigo Ulloa, Cecilia González, Valerie Philp, Roberto Mondaca, Juan Pablo Blanco, Emilio Daniel Valenzuela, Jaime Retamal, Francisco Miralles, Pedro D. Wendel-Garcia, Gustavo A. Ospina-Tascón, Ricardo Castro, Philippe Rola, Jan Bakker, Glenn Hernández, Eduardo Kattan
Current recommendations support guiding fluid resuscitation through the assessment of fluid responsiveness. Recently, the concept of fluid tolerance and the prevention of venous congestion (VC) have emerged as relevant aspects to be considered to avoid potentially deleterious side effects of fluid resuscitation. However, there is paucity of data on the relationship of fluid responsiveness and VC. This
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The administration of four-factor prothrombin complex concentrate exacerbates thrombin generation in trauma patients at risk of massive transfusion: an ancillary study of the PROCOAG trial Crit. Care (IF 15.1) Pub Date : 2024-02-19 Jules Greze, Raphael Marlu, Mariette Baud, Landry Seyve, Tobias Gauss, Pierre Bouzat
The use of four-factor prothrombin complex (4F-PCC) concentrate has been explored in the management of posttraumatic coagulopathy with the purpose of boosting thrombin generation [1]. The recent PROCOAG trial demonstrated no clinical benefit in patients at risk of massive transfusion after empiric administration of 4F-PCC, but an increased incidence of thromboembolic events in the 4F-PCC group compared
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Phenotype-specific therapeutic efficacy of ilofotase alfa in patients with sepsis-associated acute kidney injury Crit. Care (IF 15.1) Pub Date : 2024-02-19 Niklas Bruse, Katerina Pardali, Maarten Kraan, Matthijs Kox, Peter Pickkers
There is no effective treatment for sepsis-associated acute kidney injury (SA-AKI). Ilofotase alfa (human recombinant alkaline phosphatase) has been shown to exert reno-protective properties, although it remains unclear which patients might be most likely to benefit. We aimed to identify a clinical phenotype associated with ilofotase alfa's therapeutic efficacy. Data from 570 out of 650 patients enrolled
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Understanding the nebulisation of antibiotics: the key role of lung microdialysis studies Crit. Care (IF 15.1) Pub Date : 2024-02-19 Jayesh Dhanani, Jason A. Roberts, Antoine Monsel, Antoni Torres, Marin Kollef, Jean-Jacques Rouby
Nebulisation of antibiotics is a promising treatment for ventilator-associated pneumonia (VAP) caused by multidrug-resistant organisms. Ensuring effective antibiotic concentrations at the site of infection in the interstitial space fluid is crucial for clinical outcomes. Current assessment methods, such as epithelial lining fluid and tissue homogenates, have limitations in providing longitudinal pharmacokinetic
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Ketamine versus etomidate as an induction agent for tracheal intubation in critically ill adults: a Bayesian meta-analysis Crit. Care (IF 15.1) Pub Date : 2024-02-17 Takatoshi Koroki, Yuki Kotani, Takahiko Yaguchi, Taisuke Shibata, Motoki Fujii, Stefano Fresilli, Mayuko Tonai, Toshiyuki Karumai, Todd C. Lee, Giovanni Landoni, Yoshiro Hayashi
Tracheal intubation is a high-risk intervention commonly performed in critically ill patients. Due to its favorable cardiovascular profile, ketamine is considered less likely to compromise clinical outcomes. This meta-analysis aimed to assess whether ketamine, compared with other agents, reduces mortality in critically ill patients undergoing intubation. We searched MEDLINE, Embase, and the Cochrane
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Trauma systems in Asian countries: challenges and recommendations Crit. Care (IF 15.1) Pub Date : 2024-02-16 Dinesh Bagaria, Amila S. Ratnayake, Aireen Madrid, Tamara J. Worlton
Trauma burden is one of the leading causes of young human life and economic loss in low- and middle-income countries. Improved emergency and trauma care systems may save up to 2 million lives in these countries. This is a comprehensive expert opinion participated by 4 experts analyzing 6 Asian countries compiling the most pressing trauma care issues in Asia as well as goal directed solutions for uplifting
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Administration of methylene blue in septic shock: pros and cons Crit. Care (IF 15.1) Pub Date : 2024-02-16 Julian Arias-Ortiz, Jean-Louis Vincent
Septic shock typically requires the administration of vasopressors. Adrenergic agents remain the first choice, namely norepinephrine. However, their use to counteract life-threatening hypotension comes with potential adverse effects, so that non-adrenergic vasopressors may also be considered. The use of agents that act through different mechanisms may also provide an advantage. Nitric oxide (NO) is
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Transforming research to improve therapies for trauma in the twenty-first century Crit. Care (IF 15.1) Pub Date : 2024-02-13 Nicole P. Juffermans, Tarik Gözden, Karim Brohi, Ross Davenport, Jason P. Acker, Michael C. Reade, Marc Maegele, Matthew D. Neal, Philip C. Spinella
Improvements have been made in optimizing initial care of trauma patients, both in prehospital systems as well as in the emergency department, and these have also favorably affected longer term outcomes. However, as specific treatments for bleeding are largely lacking, many patients continue to die from hemorrhage. Also, major knowledge gaps remain on the impact of tissue injury on the host immune
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Procalcitonin for the diagnosis of postoperative bacterial infection after adult cardiac surgery: a systematic review and meta-analysis Crit. Care (IF 15.1) Pub Date : 2024-02-07 Davide Nicolotti, Silvia Grossi, Valeria Palermo, Federico Pontone, Giuseppe Maglietta, Francesca Diodati, Matteo Puntoni, Sandra Rossi, Caterina Caminiti
Patients undergoing cardiac surgery are subject to infectious complications that adversely affect outcomes. Rapid identification is essential for adequate treatment. Procalcitonin (PCT) is a noninvasive blood test that could serve this purpose, however its validity in the cardiac surgery population is still debated. We therefore performed a systematic review and meta-analysis to estimate the accuracy
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Albumin versus saline infusion for sepsis-related peripheral tissue hypoperfusion: a proof-of-concept prospective study Crit. Care (IF 15.1) Pub Date : 2024-02-07 Paul Gabarre, Cyrielle Desnos, Alexandra Morin, Louai Missri, Tomas Urbina, Vincent Bonny, Matthieu Turpin, Jean-Luc Baudel, Laurence Berard, Melissa Montil, Bertrand Guidet, Guillaume Voiriot, Jérémie Joffre, Eric Maury, Hafid Ait-Oufella
Albumin has potential endothelial protective effects through antioxidant and anti-inflammatory properties. However, the effect of albumin on peripheral tissue perfusion in human sepsis remains poorly known. Bi-centric prospective study included patients with sepsis with or without shock and prolonged CRT > 3 s despite initial resuscitation. Clinicians in charge of the patients were free to infuse either
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qSOFA combined with suPAR for early risk detection and guidance of antibiotic treatment in the emergency department: a randomized controlled trial Crit. Care (IF 15.1) Pub Date : 2024-02-06 Maria Evangelia Adami, Antigone Kotsaki, Nikolaos Antonakos, Efthymia Giannitsioti, Stamatios Chalvatzis, Maria Saridaki, Christina Avgoustou, Karolina Akinosoglou, Konstantina Dakou, Georgia Damoraki, Konstantina Katrini, Panagiotis Koufargyris, Vasileios Lekakis, Antonia Panagaki, Asimina Safarika, Jesper Eugen-Olsen, Evangelos J. Giamarellos-Bourboulis
Sepsis guidelines suggest immediate start of resuscitation for patients with quick Sequential Organ Failure Assessment (qSOFA) 2 or 3. However, the interpretation of qSOFA 1 remains controversial. We investigated whether measurements of soluble urokinase plasminogen activator receptor (suPAR) may improve risk detection when qSOFA is 1. The study had two parts. At the first part, the combination of
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Thiamine administration in septic shock: a post hoc analysis of two randomized trials Crit. Care (IF 15.1) Pub Date : 2024-02-06 Jacob Vine, John H. Lee, Max S. Kravitz, Anne V. Grossestreuer, Lakshman Balaji, Shannon B. Leland, Noa Berlin, Ari Moskowitz, Michael W. Donnino
This is a post hoc analysis of combined cohorts from two previous Phase II clinical trials to assess the effect of thiamine administration on kidney protection and mortality in patients with septic shock. Patient-level data from the Thiamine in Septic Shock Trial (NCT01070810) and the Thiamine for Renal Protection in Septic Shock Trial (NCT03550794) were combined in this analysis. The primary outcome
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Antibiotic definitive treatment in ventilator associated pneumonia caused by AmpC-producing Enterobacterales in critically ill patients: a prospective multicenter observational study Crit. Care (IF 15.1) Pub Date : 2024-02-05 Matthieu Petit, Frank Bidar, Quentin Fosse, Lucie Lefevre, Marine Paul, Tomas Urbina, Paul Masi, Florent Bavozet, Jérémie Lemarié, Etienne de Montmollin, Chloé Andriamifidy-Berti, Julien Dessajan, Benjamin Zuber, Lara Zafrani, Edwige Peju, Paris Meng, Liliane Charrier, Loic Le Guennec, Marie Simon, Charles-Edouard Luyt, Luc Haudebourg, Guillaume Geri
Ventilator associated pneumonia (VAP) due to wild-type AmpC-producing Enterobacterales (wtAE) is frequent in intensive care unit (ICU) patients. Despite a low level of evidence, definitive antimicrobial therapy (AMT) with third generation cephalosporins (3GCs) or piperacillin is discouraged. Observational prospective study including consecutive wtAE VAP patients in 20 French ICUs. The primary objective
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Blood volume and hemodynamics during treatment of major hemorrhage with Ringer solution, 5% albumin, and 20% albumin: a single-center randomized controlled trial Crit. Care (IF 15.1) Pub Date : 2024-02-05 François Jardot, Robert G. Hahn, Dominique Engel, Christian M. Beilstein, Patrick Y. Wuethrich
Volume replacement with crystalloid fluid is the conventional treatment of hemorrhage. We challenged whether a standardized amount of 5% or 20% albumin could be a viable option to maintain the blood volume during surgery associated with major hemorrhage. Therefore, the aim of this study was to quantify and compare the plasma volume expansion properties of 5% albumin, 20% albumin, and Ringer-lactate
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Combining proteins with n-3 PUFAs (EPA + DHA) and their inflammation pro-resolution mediators for preservation of skeletal muscle mass Crit. Care (IF 15.1) Pub Date : 2024-02-01 Renée Blaauw, Philip C. Calder, Robert G. Martindale, Mette M. Berger
The optimal feeding strategy for critically ill patients is still debated, but feeding must be adapted to individual patient needs. Critically ill patients are at risk of muscle catabolism, leading to loss of muscle mass and its consequent clinical impacts. Timing of introduction of feeding and protein targets have been explored in recent trials. These suggest that “moderate” protein provision (maximum
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Response to: the association between time definition of reintubation and patient outcomes in critically ill patients—several topics should be noticed Crit. Care (IF 15.1) Pub Date : 2024-02-01 Aiko Tanaka, Tetsuhisa Kitamura, Akinori Uchiyama, Yusuke Enokidani, Yukiko Koyama, Takeshi Yoshida, Yuji Fujino
The authors appreciate Jiang and Zhang for their consideration of the topics regarding the association between reintubation and patient outcomes [1]. As discussed in our previous study [2] in Critical Care, reintubation involves multifactorial decisions. To evaluate the association between reintubation and patient outcomes, factors related to reintubation, in addition to mortality, should be determined
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The protective effect of apolipoprotein H in paediatric sepsis Crit. Care (IF 15.1) Pub Date : 2024-01-30 Zhicai Yu, Changxue Xiao, Rong Liu, Dandan Pi, Bian Jin, Zhen Zou, Feng Xu
Sepsis is a severe condition characterized by acute organ dysfunction resulting from an imbalanced host immune response to infections. Apolipoprotein H (APOH) is a critical plasma protein that plays a crucial role in regulating various biological processes. However, the precise role of APOH in the immunopathology of paediatric sepsis remains unclear. In this study, we evaluated the concentration of
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Trajectories of post-traumatic stress in sepsis survivors two years after ICU discharge: a secondary analysis of a randomized controlled trial Crit. Care (IF 15.1) Pub Date : 2024-01-29 Konrad F. R. Schmidt, Jochen S. Gensichen, Maya Schroevers, Martina Kaufmann, Friederike Mueller, Gustav Schelling, Sabine Gehrke-Beck, Monique Boede, Christoph Heintze, Michel Wensing, Daniel Schwarzkopf
Post-traumatic stress has been identified as a frequent long-term complication in survivors of critical illnesses after sepsis. Little is known about long-term trajectories of post-traumatic stress and potentially modifiable risk factors following the ICU stay. Study objective was to explore and compare different clinical trajectories of post-traumatic stress symptoms in sepsis survivors up to two
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Time in ICU and post-intensive care syndrome: how long is long enough? Crit. Care (IF 15.1) Pub Date : 2024-01-23 Dylan Flaws, John F. Fraser, Kevin Laupland, Jayshree Lavana, Sue Patterson, Alexis Tabah, Oystein Tronstad, Mahesh Ramanan
Our understanding of post-ICU recovery is influenced by which patients are selected to study and treat. Many studies currently list an ICU length of stay of at least 24, 48, or 72 h as an inclusion criterion. This may be driven by established evidence that prolonged time in an ICU bed and prolonged ventilation can complicate post-ICU rehabilitation. However, recovery after short ICU stays still needs
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Cerebral autoregulation in traumatic brain injury: ultra-low-frequency pressure reactivity index and intracranial pressure across age groups Crit. Care (IF 15.1) Pub Date : 2024-01-23 Paolo Gritti, Marco Bonfanti, Rosalia Zangari, Ezio Bonanomi, Alessia Farina, Giulio Pezzetti, Isabella Pelliccioli, Luca Longhi, Maria Di Matteo, Andrea Viscone, Gabriele Lando, Gaia Cavalleri, Simonetta Gerevini, Francesco Biroli, Ferdinando Luca Lorini
The ultra-low-frequency pressure reactivity index (UL-PRx) has been established as a surrogate method for bedside estimation of cerebral autoregulation (CA). Although this index has been shown to be a predictor of outcome in adult and pediatric patients with traumatic brain injury (TBI), a comprehensive evaluation of low sampling rate data collection (0.0033 Hz averaged over 5 min) on cerebrovascular
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Incidence, diagnosis, management and outcome of acute mesenteric ischaemia: a prospective, multicentre observational study (AMESI Study) Crit. Care (IF 15.1) Pub Date : 2024-01-23 Annika Reintam Blaser, Merli Mändul, Martin Björck, Stefan Acosta, Miklosh Bala, Zsolt Bodnar, Dumitru Casian, Zaza Demetrashvili, Mario D’Oria, Virginia Durán Muñoz-Cruzado, Alastair Forbes, Hanne Fuglseth, Moran Hellerman Itzhaki, Benjamin Hess, Karri Kase, Mikhail Kirov, Kristoffer Lein, Matthias Lindner, Cecilia Inés Loudet, Damian J. Mole, Marko Murruste, Alexandre Nuzzo, Sten Saar, Maximilian
The aim of this multicentre prospective observational study was to identify the incidence, patient characteristics, diagnostic pathway, management and outcome of acute mesenteric ischaemia (AMI). All adult patients with clinical suspicion of AMI admitted or transferred to 32 participating hospitals from 06.06.2022 to 05.04.2023 were included. Participants who were subsequently shown not to have AMI
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Association between CA-125 and post-extubation respiratory failure: a cohort study Crit. Care (IF 15.1) Pub Date : 2024-01-23 Fataki Lombuli, Tiago Hermes Maeso Montes, Márcio Manozzo Boniatti
To the Editor, Liberating patients from mechanical ventilation (MV) is a crucial step in the care of critically ill patients. Delayed or unsuccessful weaning from MV is associated with unfavorable clinical outcomes [1]. Identifying patients at a higher risk of weaning failure can facilitate optimal timing for extubation and guide appropriate interventions. There are multiple mechanisms contributing
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Prognostic evaluation of quick sequential organ failure assessment score in ICU patients with sepsis across different income settings Crit. Care (IF 15.1) Pub Date : 2024-01-23 Andrew Li, Lowell Ling, Hanyu Qin, Yaseen M. Arabi, Sheila Nainan Myatra, Moritoki Egi, Je Hyeong Kim, Mohd Basri Mat Nor, Do Ngoc Son, Wen-Feng Fang, Bambang Wahyuprajitno, Madiha Hashmi, Mohammad Omar Faruq, Boonsong Patjanasoontorn, Maher Jaffer Al Bahrani, Babu Raja Shrestha, Ujma Shrestha, Khalid Mahmood Khan Nafees, Kyi Kyi Sann, Jose Emmanuel M. Palo, Naranpurev Mendsaikhan, Aidos Konkayev,
There is conflicting evidence on association between quick sequential organ failure assessment (qSOFA) and sepsis mortality in ICU patients. The primary aim of this study was to determine the association between qSOFA and 28-day mortality in ICU patients admitted for sepsis. Association of qSOFA with early (3-day), medium (28-day), late (90-day) mortality was assessed in low and lower middle income
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Societal costs of sepsis in the Netherlands Crit. Care (IF 15.1) Pub Date : 2024-01-22 Erik C. N. Luijks, Elisabeth C. van der Slikke, Arthur R. H. van Zanten, Jan C. ter Maaten, Maarten J. Postma, Henk B. M. Hilderink, Robert H. Henning, Hjalmar R. Bouma
Sepsis is a life-threatening syndrome characterized by acute loss of organ function due to infection. Sepsis survivors are at risk for long-term comorbidities, have a reduced Quality of Life (QoL), and are prone to increased long-term mortality. The societal impact of sepsis includes its disease burden and indirect economic costs. However, these societal costs of sepsis are not fully understood. This
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Effect of prehospital high-dose glucocorticoid on hemodynamics in patients resuscitated from out-of-hospital cardiac arrest: a sub-study of the STEROHCA trial Crit. Care (IF 15.1) Pub Date : 2024-01-22 Laust E. R. Obling, Rasmus P. Beske, Martin A. S. Meyer, Johannes Grand, Sebastian Wiberg, Thomas Mohr, Anders Damm-Hejmdal, Julie L. Forman, Ruth Frikke-Schmidt, Fredrik Folke, Jacob E. Møller, Jesper Kjaergaard, Christian Hassager
Following resuscitated out-of-hospital cardiac arrest (OHCA), inflammatory markers are significantly elevated and associated with hemodynamic instability and organ dysfunction. Vasopressor support is recommended to maintain a mean arterial pressure (MAP) above 65 mmHg. Glucocorticoids have anti-inflammatory effects and may lower the need for vasopressors. This study aimed to assess the hemodynamic
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A comparison of video laryngoscopy and direct laryngoscopy in critically ill patients Crit. Care (IF 15.1) Pub Date : 2024-01-21 Yang Zhao, Qian Wang, Bin Zang
We read the article “Video versus direct laryngoscopy in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials” by Araújo et al. [1] with great interest. Although the article is well-written, certain parts merit further discussion. Following the authors' search strategy, our reevaluation revealed that the study omitted several randomized controlled
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Enhanced exclusive enteral nutrition delivery during the first 7 days is associated with decreased 28-day mortality in critically ill patients with normal lactate level: a post hoc analysis of a multicenter randomized trial Crit. Care (IF 15.1) Pub Date : 2024-01-20 Yizhe Chen, Zirui Liu, Qiuhui Wang, Fei Gao, Hongyang Xu, Lu Ke, Zheng-Yii Lee, Christian Stoppe, Daren K. Heyland, Fengming Liang, Jiajia Lin
Exclusive enteral nutrition (EN) is often observed during the first week of ICU admission because of the extra costs and safety considerations for early parenteral nutrition. This study aimed to assess the association between nutrition intake and 28-day mortality in critically ill patients receiving exclusive EN. This is a post hoc analysis of a cluster-randomized clinical trial that assesses the effect