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Atrial fibrillation and mortality in critically ill patients undergoing emergent fixed-wing air ambulance transport: a retrospective cohort study medRxiv. Intensive Care Crit. Med. Pub Date : 2024-04-14 Marcus Fredriksson Sundbom, Hannah Langelotz, Helena Nyström, Roman A’roch, Michael Haney
Objective To examine if atrial fibrillation at the time of emergency transport to tertiary care hospital by air ambulance is associated with increased mortality risk.
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Development and Validation of the VIOSync Sepsis Prediction Index: A Novel Machine Learning Model for Sepsis Prediction in ICU Patients medRxiv. Intensive Care Crit. Med. Pub Date : 2024-04-14 Sotirios G. Liliopoulos, Alexander Dejaco, Vasileios S. Dimakopoulos, Ioannis A. Gkouzionis
Background Sepsis is the third leading cause of death worldwide and the main cause of in-hospital mortality. Despite decades of research, sepsis remains a major challenge faced by patients, clinicians, and medical systems worldwide. Early identification and prediction of patients at risk of sepsis and adverse outcomes associated with sepsis are critical. In this work, we aimed to develop an artificial
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Tracheal aspirate metagenomics reveals association of antibiotic resistance with non-pulmonary sepsis mortality medRxiv. Intensive Care Crit. Med. Pub Date : 2024-04-10 Héctor Rodríguez-Pérez, Laura Ciuffreda, Tamara Hernández-Beeftink, Beatriz Guillen-Guio, David Domínguez, Almudena Corrales, Elena Espinosa, Julia Alcoba-Florez, Jose M. Lorenzo-Salazar, Rafaela González-Montelongo, Jesús Villar, Carlos Flores
Background Previous metabarcoding studies based on 16S rRNA sequencing in patients with extrapulmonary sepsis have found early pulmonary dysbiosis associated with a poor prognosis. To further discern this association, here we aimed to better characterize the pulmonary bacterial communities in these patients by leveraging metagenomics and to evaluate if the presence of antibiotic resistance genes (ARGs)
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Preregistered analytic plan: the gut microbiome and acute kidney injury in sepsis medRxiv. Intensive Care Crit. Med. Pub Date : 2024-04-05 Katherine M. Winner, Rishi Chanderraj, Ying He, Mark Nuppnau, Robert J. Woods, Michael Heung, Jennifer A. Schaub, Michael W. Sjoding, Robert P. Dickson
Overview We here share a pre-registered analytic plan for a matched case-control study nested in a retrospective cohort of hospitalized patients with suspected sepsis. We will compare gut microbiota (measured near the time of admission) among patients with sepsis who do and do not develop sepsis-induced acute kidney injury.
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Association between sex and race and ethnicity and intravenous sedation use in patients receiving invasive ventilation medRxiv. Intensive Care Crit. Med. Pub Date : 2024-04-05 Sarah L. Walker, Federico Angriman, Lisa Burry, Leo Anthony Celi, Kirsten M. Fiest, Judy Gichoya, Alistair Johnson, Kuan Liu, Sangeeta Mehta, Georgiana Roman-Sarita, Laleh Seyyed-Kalantari, Thanh-Giang T. Vu, Elizabeth L. Whitlock, George Tomlinson, Christopher J. Yarnell
Rationale Intravenous sedation is an important tool for managing invasively ventilated patients, yet excess sedation is harmful, and dosing could be influenced by implicit bias.
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Comparison of carbon dioxide control during pressure controlled versus pressure regulated volume controlled ventilation in children (CoCO2): protocol for a pilot digital randomized controlled trial medRxiv. Intensive Care Crit. Med. Pub Date : 2024-03-30 Rebeca Mozun, Daphné Chopard, Florian Zapf, Philipp Baumann, Barbara Brotschi, Anika Adam, Vera Jaeggi, Beat Bangerter, Kristen Gibbons, Juerg Burren, Luregn J Schlapbach
Introduction Digital trials are a promising strategy to increase the evidence base for common interventions and may convey considerable efficiency benefits in trial conduct. Although paediatric intensive care units (PICUs) are rich in routine electronic data, highly pragmatic digital trials in this field remain scarce. There are unmet evidence needs for optimal mechanical ventilation modes in paediatric
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Clinical factors associated with racial differences in the prevalence of occult hypoxemia: a retrospective case-control study medRxiv. Intensive Care Crit. Med. Pub Date : 2024-03-29 Sofia K. Mettler, Nipith Charoenngam, Aunchalee Jaroenlapnopparat, Courtney Tern, Nutchapon Xanthavanij, Sofia Economidou, Matthew J. Strand, Brian D. Hobbs, Matthew Moll, Michael H. Cho
Background Recent studies showed that Black patients more often have falsely normal oxygen saturation on pulse oximetry compared to White patients. However, whether the racial differences in occult hypoxemia are mediated by other clinical differences is unknown.
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Early high-sensitivity troponin elevation in predicting short-term mortality in sepsis: A protocol for a systematic review with meta-analysis medRxiv. Intensive Care Crit. Med. Pub Date : 2024-03-29 Santiago Ferrière-Steinert, Joaquín Valenzuela Jiménez, Sebastián Heskia Araya, Thomas Kouyoumdjian Carvajal, José Ramos-Rojas, Abraham I. J. Gajardo
Background Sepsis is a common admission diagnosis in the intensive care unit (ICU). The Sepsis-3 consensus associates sepsis diagnosis with acute organ dysfunction. In these patients troponin elevation is a well-established phenomenon, but its clinical significance is not settled, as no systematic review has addressed the prognostic significance of the increasingly prevalent high-sensitivity troponin
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Centhaquine Increases Stroke Volume and Cardiac Output in Patients with Hypovolemic Shock medRxiv. Intensive Care Crit. Med. Pub Date : 2024-03-29 Aman Khanna, Krish Vaidya, Dharmesh Shah, Amaresh K. Ranjan, Anil Gulati
Background Centhaquine is a resuscitative agent that acts on α2B adrenergic receptors to enhance venous return in hypovolemic shock. The effect of centhaquine on cardiac output in patients with hypovolemic shock has not been reported.
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Sedation practices in patients intubated in the emergency department compared to the intensive care unit. medRxiv. Intensive Care Crit. Med. Pub Date : 2024-03-27 Jariya Sereeyotin, Christopher Yarnell, Sangeeta Mehta
Purpose This study aimed to compare sedation management during and after intubation in the emergency department (ED) versus the intensive care unit (ICU). Methods This was a single-center retrospective cohort study of adults intubated in the ED or in the ICU and received mechanical ventilation between January 2018 and February 2022. We collected data from the electronic medical record. The primary
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The role of etiology in the identification of clinical markers of consciousness: comparing EEG alpha power, complexity, and spectral exponent medRxiv. Intensive Care Crit. Med. Pub Date : 2024-03-22 Charlotte Maschke, Laouen Belloli, Dragana Manasova, Jacobo D. Sitt, Stefanie Blain-Moraes
In the search for EEG markers of human consciousness, alpha power has long been considered a reliable marker which is fundamental for the assessment of unresponsive patients from all etiologies. However, recent evidence questioned the role of alpha power as a marker of consciousness and proposed the spectral exponent and spatial gradient as more robust and generalizable indexes. In this study, we analyzed
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Predictive validity of the simplified Radiographic Assessment of Lung Edema score for the mortality in critically ill COVID-19 patients with the B.1.617.2 (Delta) variant in Vietnam: a single-centre, cross-sectional study medRxiv. Intensive Care Crit. Med. Pub Date : 2024-03-22 Son Ngoc Do, Tuan Quoc Dang, Chinh Quoc Luong, My Ha Nguyen, Dung Thi Pham, Viet Khoi Nguyen, Tan Dang Do, Thai Quoc Nguyen, Vuong Minh Nong, Khoi Hong Vo, Tan Cong Nguyen, Nhung Hong Khuat, Quynh Thi Pham, Dat Tien Hoang, Anh Diep Nguyen, Phuong Minh Nguyen, Duong Dai Cao, Dung Thuy Pham, Dung Tuan Dang, Dat Tuan Nguyen, Vinh Duc Nguyen, Thuan Quang Le, Hung Duc Ngo, Dung Van Nguyen, Thach The Pham
Background Evaluating the prognosis of COVID-19 patients who may be at risk of mortality using the simple chest X-ray (CXR) severity scoring systems provides valuable insights for treatment decisions. This study aimed to assess how well the simplified Radiographic Assessment of Lung Edema (RALE) score could predict the death of critically ill COVID-19 patients in Vietnam. Methods From July 30 to October
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Multicenter Development and Prospective Validation of eCARTv5: A Gradient Boosted Machine Learning Early Warning Score medRxiv. Intensive Care Crit. Med. Pub Date : 2024-03-19 Matthew M. Churpek, Kyle A. Carey, Ashley Snyder, Christopher J. Winslow, Emily R. Gilbert, Nirav S. Shah, Brian W. Patterson, Majid Afshar, Alan Weiss, Devendra N. Amin, Deborah J. Rhodes, Dana P. Edelson
Rationale: Early detection of clinical deterioration using early warning scores may improve outcomes. However, most implemented scores were developed using logistic regression, only underwent retrospective internal validation, and were not tested in important patient subgroups. Objectives: To develop a gradient boosted machine model (eCARTv5) for identifying clinical deterioration and then validate
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Diversity and inclusion: A hidden additional benefit of Open Data medRxiv. Intensive Care Crit. Med. Pub Date : 2024-03-18 Marie-Laure Charpignon, Leo Anthony Celi, Marisa Cobanaj, Rene Eber, Amelia Fiske, Jack Gallifant, Chenyu Li, Gurucharan Lingamallu, Anton Petushkov, Robin Pierce
The recent imperative by the National Institutes of Health to share scientific data publicly underscores a significant shift in academic research. Effective as of January 2023, it emphasizes that transparency in data collection and dedicated efforts towards data sharing are prerequisites for translational research, from the lab to the bedside. Given the role of data access in mitigating potential bias
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Integrating Social Determinants of Health with SOFA Scoring to Enhance Mortality Prediction in Septic Patients: A Multidimensional Prognostic Model medRxiv. Intensive Care Crit. Med. Pub Date : 2024-03-15 Elie Sarraf, Alireza Vafaei Sadr, Vida Abedi, Anthony Bonavia
Background: The Sequential Organ Failure Assessment (SOFA) score is an established tool for monitoring organ failure and defining sepsis. However, its predictive power for sepsis mortality may not account for the full spectrum of influential factors. Recent literature highlights the potential impact of socioeconomic and demographic factors on sepsis outcomes. Objective: This study assessed the prognostic
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Forecasting Acute Kidney Injury and Resource Utilization in ICU patients using longitudinal, multimodal models medRxiv. Intensive Care Crit. Med. Pub Date : 2024-03-15 Yukun Tan, Merve Dede, Vakul Mohanty, Jinzhuang Dou, Holly Hill, Elmer Bernstam, Ken Chen
Background: Advances in artificial intelligence (AI) have realized the potential of revolutionizing healthcare, such as predicting disease progression via longitudinal inspection of Electronic Health Records (EHRs) and lab tests from patients admitted to Intensive Care Units (ICU). Although substantial literature exists addressing broad subjects, including the prediction of mortality, length-of-stay
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Does Intermittent Nutrition Enterally Normalise hormonal and metabolic responses to feeding in critically ill adults? A protocol for the DINE-Normal proof-of-concept randomised parallel group study. medRxiv. Intensive Care Crit. Med. Pub Date : 2024-03-15 Clodagh E Beattie, Matt Thomas, Borislava Borislavova, Harry A Smith, Michael Ambler, Paul White, Kati Hayes, Danielle Milne, Aravind V Ramesh, Javier T Gonzalez, James A Betts, Anthony E Pickering
Introduction: Over half of patients who spend >48 hours in the intensive care unit (ICU) are fed via a nasogastric (NG) tube. Current guidance recommends continuous delivery of feed throughout the day and night. Emerging evidence from healthy human studies shows that NG feeding in an intermittent pattern (rather than continuous) promotes phasic hormonal, digestive and metabolic responses that are important
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Clinical phenotypes and outcomes associated with SARS-CoV-2 Omicron variant JN.1 in critically ill COVID-19 patients: a prospective, multicenter cohort study medRxiv. Intensive Care Crit. Med. Pub Date : 2024-03-13 Nicolas de Prost, Etienne Audureau, Antoine Guillon, Lynda Handala, Sebastien Preau, Aurelie Guigon, Fabrice Uhel, Quentin Le Hingrat, Flora Delamaire, Claire Grolhier, Fabienne Tamion, Alice Moisan, Cedric Darreau, Jean Thomin, Damien Contou, Amandine Henry, Thomas Daix, Sebastien Hantz, Clement Saccheri, Valerie Giordanengo, Tai Pham, Amal Chaghouri, Pierre Bay, JeanMichel Pawlotsky, Slim Fourati
A notable increase in severe cases of COVID-19, with significant hospitalizations due to the emergence and spread of JN.1 was observed worldwide in late 2023 and early 2024. During the study period (November 2022-January 2024), 56 JN.1- and 126 XBB-infected patients were prospectively enrolled in 40 French intensive care units. JN.1-infected patients were more likely to be obese (35.7% vs 20.8%; p=0
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Assessment of Psychometric Vigilance on Neonatal Transport: A Western Australian Experience medRxiv. Intensive Care Crit. Med. Pub Date : 2024-03-09 Alexander Wilson, Kylie McDonald, Matthew Cooper, Paul Stevenson, Jonathan Davis, Sanjay Patole
Objectives To assess whether undertaking retrieval was associated with fatigue independent of sleep and circadian disruption. Background Fatigue is associated impaired clinician performance and safety. The association between shift work, sleep deprivation and circadian disruption is well established. No studies have specifi-cally assessed the independent effect of the retrieval environment on fatigue
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Corticosteroids for infectious critical illness: A multicenter target trial emulation stratified by predicted organ dysfunction trajectory medRxiv. Intensive Care Crit. Med. Pub Date : 2024-03-08 Suraj Rajendran, Zhenxing Xu, Weishen Pan, Chengxi Zang, Ilias Siempos, Lisa K Torres, Jie Xu, Jiang Bian, Edward J Schenck, Fei Wang
Corticosteroids decrease the duration of organ dysfunction in a range of infectious critical illnesses, but their risk and benefit are not fully defined using this construct. This retrospective multicenter study aimed to evaluate the association between usage of corticosteroids and mortality of patients with infectious critical illness by emulating a target trial framework. The study employed a novel
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Lower perceived social support is significantly associated with elevated levels of psychological distress in racially and ethnically diverse close family members of cardiac arrest survivors medRxiv. Intensive Care Crit. Med. Pub Date : 2024-02-27 Mina Yuan, Isabella M Tincher, Bhanvi Sachdeva, Sabine Abukhadra, Danielle A Rojas, Christine DeForge, Sachin Agarwal
Background: Poor perceived social support has been associated with worse psychological distress in close family members after their loved one hospitalization with prolonged mechanical ventilation, but never been tested after cardiac arrest. Methods: Close family members of consecutive cardiac arrest patients hospitalized at an academic tertiary care center were recruited before hospital discharge,
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Machine Learning Interpretability Methods to Characterize the Importance of Hematologic Biomarkers in Prognosticating Patients with Suspected Infection medRxiv. Intensive Care Crit. Med. Pub Date : 2024-02-19 Dipak P Upadhyaya, Yasir Tarabichi, Katrina Prantzalos, Salman Ayub, David C Kaelber, Satya S Sahoo
Abstract Early detection of sepsis in patients admitted to the emergency department (ED) is an important clinical objective as early identification and treatment can help reduce morbidity and mortality rate of 20% or higher. Hematologic changes during sepsis-associated organ dysfunction are well established and a new biomarker called Monocyte Distribution Width (MDW) has been recently approved by the
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Hybrid diffuse optical appraisal of peripheral and cerebral changes in critically ill patients receiving red blood cell transfusion medRxiv. Intensive Care Crit. Med. Pub Date : 2024-02-15 Susanna Tagliabue, Anna Rey-Perez, Lourdes Esposito, Andrés F. Jimenez, Sara Valles Angulo, Federica Maruccia, Jonas B. Fischer, Michal Kacprzak, Maria A. Poca, Turgut Durduran
Background Red blood cells transfusions (RBCT) are utilized to restore normal values of hemoglobin concentration and hematocrit percentage in anemic patients. As expected, RBCT often leads to local and global alteration of blood flow (BF) and blood/tissue oxygenation which could have local deleterious consequences. This complicates its use and its dosage and there is no consensus on liberal versus
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The genomic landscape of Acute Respiratory Distress Syndrome: a meta-analysis by information content of genome-wide studies of the host response. medRxiv. Intensive Care Crit. Med. Pub Date : 2024-02-14 Jonathan E Millar, Sara Clohisey-Hendry, Megan McManus, Marie Zechner, Bo Wang, Nicholas Parkinson, Melissa Jungnickel, Nureen Mohamad Zaki, Erola E Pairo-Castineira, Konrad Rawlik, Joshua Rogers, Clark D Russell, Lieuwe DJ Bos, Nuala J Meyer, Carolyn Calfee, Daniel F McAuley, Manu Shankar-Hari, J Kenneth Baillie
Acute respiratory distress syndrome (ARDS) is a clinically defined syndrome of acute hypoxaemic respiratory failure secondary to non-cardiogenic pulmonary oedema. It arises from a diverse set of triggers and encompasses marked biological heterogeneity, complicating efforts to develop effective therapies. An extensive body of recent work (including transcriptomics, proteomics, and genome-wide association
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Understanding staff needs for Improving End-of-life Care in Critical Care Units medRxiv. Intensive Care Crit. Med. Pub Date : 2024-02-13 Simon Tavabie, Stephen Pearson, Janet Balabanovic, Anna Batho, Manoj Juj, Priscilla Katsande, Joanne Bennetts, Emily Collis, Timothy Bonnici
Objectives: Critical care is a place of frequent death, up to a quarter of those admitted die during admission. Caring for dying people provides many challenges, practically, professionally and personally. The aim of this study was to better understand the perspectives of staff caring for dying people in critical care and identify their priorities for improvement. Method: Three multidisciplinary focus
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Daily variation in blood glucose levels during continuous enteral nutrition in patients on the Intensive Care Unit: a retrospective observational study medRxiv. Intensive Care Crit. Med. Pub Date : 2024-02-13 Floor W Hiemstra, Dirk Jan Stenvers, Andries Kalsbeek, Evert de Jonge, David J Westerloo, Laura Kervezee
Background The circadian timing system coordinates daily cycles in physiological functions, including glucose metabolism and insulin sensitivity. Here, the aim was to characterize the 24-hour variation in glucose levels in critically ill patients during continuous enteral nutrition after controlling for potential sources of bias. Methods Time-stamped clinical data from adult patients who stayed in
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Use of a Continuous Single Lead Electrocardiogram Analytic to Predict Patient Deterioration Requiring Rapid Response Team Activation medRxiv. Intensive Care Crit. Med. Pub Date : 2024-02-11 Sooin Lee, Bryce Benson, Ashwin Belle, Richard P. Medlin, David Jerkins, Foster Goss, Ashish K. Khanna, Michael A. DeVita, Kevin Ralph Ward
Identifying the onset of patient deterioration is challenging despite the potential to respond to patients earlier with better vital sign monitoring and rapid response team (RRT) activation. In this study an ECG based software as a medical device, the Analytic for Hemodynamic Instability Predictive Index (AHI-PI), was compared to the vital signs of heart rate, blood pressure, and respiratory rate,
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Nonlinear relationship between ionized calcium and 28-day mortality in patients with sepsis: A retrospective cohort study from MIMIC-IV database medRxiv. Intensive Care Crit. Med. Pub Date : 2024-02-08 Zhanyao Liang, Yunting Chen, Yuanshen Zhou, Congqi Hu, Lu Chen, Fangfang Zhu
Background This study aimed to investigate the linear and nonlinear relationships between ionized calcium levels and 28-day mortality in patients with sepsis in the intensive care unit (ICU) and to provide clinicians with a direction for laboratory index testing and a basis for a calcium supplementation program.
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An observational cohort study of bronchoalveolar lavage fluid galactomannan and Aspergillus culture positivity in patients requiring mechanical ventilation medRxiv. Intensive Care Crit. Med. Pub Date : 2024-02-07 Catherine A. Gao, Nikolay S. Markov, Chiagozie Pickens, Anna Pawlowski, Mengjia Kang, James M. Walter, Benjamin D. Singer, Richard G. Wunderink, NU SCRIPT Study Investigators
Rationale Critically ill patients who develop invasive pulmonary aspergillosis (IPA) have high mortality rates despite antifungal therapy. Diagnosis is difficult in these patients. Bronchoalveolar lavage (BAL) fluid galactomannan (GM) is a helpful marker of infection, although the optimal cutoff for IPA is unclear. We aimed to evaluate the BAL fluid GM and fungal culture results, demographics, and
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Causes, Diagnostic Testing, and Treatments Related to Clinical Deterioration Events among High-Risk Ward Patients medRxiv. Intensive Care Crit. Med. Pub Date : 2024-02-06 Matthew M. Churpek, Ryan Ingebritsen, Kyle A. Carey, Saieesh A Rao, Emily Murnin, Tonela Qyli, Madeline K. Oguss, Jamila Picart, Leena Penumalee, Benjamin D. Follman, Lily K Nezirova, Sean T. Tully, Charis Benjamin, Christopher Nye, Emily R. Gilbert, Nirav S. Shah, Christopher J. Winslow, Majid Afshar, Dana P. Edelson
OBJECTIVE Timely intervention for clinically deteriorating ward patients requires that care teams accurately diagnose and treat their underlying medical conditions. However, the most common diagnoses leading to deterioration and the relevant therapies provided are poorly characterized. Therefore, we aimed to determine the diagnoses responsible for clinical deterioration, the relevant diagnostic tests
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Can unguided machine learning re-discover physiologic signatures of neonatal sepsis? medRxiv. Intensive Care Crit. Med. Pub Date : 2024-02-04 Brynne A Sullivan, Ian G Mesner, Karen D Fairchild, Douglas E Lake, Randall Moorman
Background: Cardiorespiratory deterioration due to sepsis is a leading cause of morbidity and mortality for extremely premature infants with very low birth weight (VLBW, birthweight <1500g). Abnormal heart rate (HR) patterns precede the clinical diagnosis of late-onset sepsis in this population. Decades ago, clinicians recognized a pattern of reduced HR variability and increased HR decelerations in
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Consent in Canadian-Led Critical Care Research During the COVID-19 Pandemic: A Scoping Review medRxiv. Intensive Care Crit. Med. Pub Date : 2024-02-03 Karla Krewulak, Lisa Albrecht, Saoirse Cameron, Jessica Gibson, Dori-Ann Martin, Rebecca Porteous, Margaret Sampson, Katie O'Hearn
Introduction: Despite the importance of critical care research during the SARS-CoV-2 pandemic, several pandemic-related factors made the process of obtaining prior written informed consent for research infeasible. To overcome these challenges, research studies utilized alternate informed consent models suggested by available guidance. Objective: To describe the consent models used in Canadian intensive
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An Empirical Study on KDIGO-Defined Acute Kidney Injury Prediction in the Intensive Care Unit medRxiv. Intensive Care Crit. Med. Pub Date : 2024-02-03 Xinrui Lyu, Bowen Fan, Matthias Hüser, Philip Hartout, Thomas Gumbsch, Martin Faltys, Tobias M. Merz, Gunnar Rätsch, Karsten Borgwardt
Motivation: Acute kidney injury (AKI) is a syndrome that affects a large fraction of all critically ill patients, and early diagnosis to receive adequate treatment is as imperative as it is challenging to make early. Consequently, machine learning approaches have been developed to predict AKI ahead of time. However, the prevalence of AKI is often underestimated in state-of-the-art approaches, as they
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Generative AI Mitigates Representation Bias Using Synthetic Health Data medRxiv. Intensive Care Crit. Med. Pub Date : 2024-02-01 Nicolo Micheletti, Raffaele Marchesi, Nicholas I-Hsien Kuo, Sebastiano Barbieri, Giuseppe Jurman, Venet Osmani
Representation bias in health data can lead to unfair decisions, compromising the generalisability of research findings and impeding underrepresented subpopulations from benefiting from clinical discoveries. Several approaches have been developed to mitigate representation bias, ranging from simple resampling methods, such as SMOTE, to recent approaches based on generative adversarial networks (GAN)
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Association of sepsis and delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage medRxiv. Intensive Care Crit. Med. Pub Date : 2024-01-29 Franz-Simon Centner, Holger Wenz, Mariella Eliana Oster, Franz-Joseph Dally, Johannes Sauter-Servaes, Tanja Pelzer, Jochen Johannes Schoettler, Bianka Hahn, Amr Abdulazim, Katharina A.M. Hackenberg, Christoph Groden, Joerg Krebs, Manfred Thiel, Nima Etminan, Mate E. Maros
Background: Although sepsis and delayed cerebral ischemia (DCI) are severe complications in patients with aneurysmal subarachnoid hemorrhage (aSAH) and share pathophysiological features, their interrelation and additive effect on functional outcome is uncertain. We investigated the association of sepsis with DCI and their cumulative effect on functional outcome in patients with aSAH using current sepsis-3
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Person-Centred Care: Lessons from a service evaluation medRxiv. Intensive Care Crit. Med. Pub Date : 2024-01-26 Stephen Pearson, Anna Petsas, Janet Balabanovic, Manoj Juj, Wendy Harris, Timothy Bonnici
Context: Critical care encompasses intensive care, intensive therapy and high dependency care and is operationalised when patients require specialised monitoring and intervention following complex surgery, or a life-threatening illness or injury. Background: During the pandemic, the Critical Care Department at UCLH formed a family liaison team to bridge the connection gap between patients, families
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A comprehensive ML-based Respiratory Monitoring System for Physiological Monitoring & Resource Planning in the ICU medRxiv. Intensive Care Crit. Med. Pub Date : 2024-01-23 Matthias Hüser, Xinrui Lyu, Martin Faltys, Alizée Pace, Marine Hoche, Stephanie L. Hyland, Hugo Yèche, Manuel Burger, Tobias M. Merz, Gunnar Rätsch
Respiratory failure (RF) is a frequent occurrence in critically ill patients and is associated with significant morbidity and mortality as well as resource use. To improve the monitoring and management of RF in intensive care unit (ICU) patients, we used machine learning to develop a monitoring system covering the entire management cycle of RF, from early detection and monitoring, to assessment of
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Drivers of Decision-Making for Adult Tracheostomy for Prolonged Mechanical Ventilation: A Qualitative Study medRxiv. Intensive Care Crit. Med. Pub Date : 2024-01-21 Anuj B Mehta, Steven Lockhart, Allison V Lange, Daniel D Matlock, Ivor S Douglas, Megan A Morris
Background Decision-making about tracheostomy and prolonged mechanical ventilation (PMV) is emotionally complex. Expectations of surrogate decision-makers and physicians rarely align. Little is known about what surrogates need to make goal-concordant decisions. We sought to identify drivers of tracheostomy and PMV decision-making.
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The impact of PEEP on hemodynamics, respiratory mechanics, and oxygenation of children with PARDS medRxiv. Intensive Care Crit. Med. Pub Date : 2024-01-21 Fernanda Monteiro Diniz Junqueira, Isabel de Siqueira Ferraz, Fábio Joly Campos, Toshio Matsumoto, Marcelo Barciela Brandão, Roberto José Negrão Nogueira, Tiago Henrique de Souza
Objective To assess the impact of increasing positive end-expiratory pressure (PEEP) on hemodynamics, respiratory system mechanics, and oxygenation in children with pediatric acute respiratory distress syndrome (PARDS).
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Intracranial pressure-flow relationships in traumatic brain injury patients expose gaps in the tenets of models and pressure-oriented management medRxiv. Intensive Care Crit. Med. Pub Date : 2024-01-18 JN Stroh, Brandon Foreman, Tellen D Bennett, Jennifer K Briggs, Soojin Park, David J Albers
Background The protocols and therapeutic guidance established for treating traumatic brain injuries (TBI) in neurointensive care focus on managing cerebral blood flow (CBF) and brain tissue oxygenation based on pressure signals. The decision support process relies on assumed relationships between cerebral perfusion pressure (CPP) and blood flow, pressure-flow relationships (PFRs), and shares this framework
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Is there a difference in the satisfaction levels between professionals who have participated and those who have not participated in the TeleUTIP telemedicine project regarding their engagement in tele-education activities? medRxiv. Intensive Care Crit. Med. Pub Date : 2024-01-17 Hilda M. R. Moleda Constant, Vanessa Cristina Jacovas, Maria Eulália Vinadé Chagas, Maria Cristina Cotta Matte, Emanuele König Klever, Luciane Cunha, João Ronaldo Mafalda Krauzer, Taís de Campos Moreira, Felipe Cezar Cabral
Objective The aim of this study is to introduce a distance education program and assess the satisfaction of health professionals.
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The Post-Septic Peripheral Myeloid Compartment Reveals Unexpected Diversity in Myeloid-Derived Suppressor Cells medRxiv. Intensive Care Crit. Med. Pub Date : 2024-01-07 Evan L. Barrios, John Leary, Dijoia B. Darden, Jaimar C. Rincon, Micah Willis, Valerie E. Polcz, Gwendolyn S. Gillies, Jennifer A. Munley, Marvin L. Dirain, Ricardo Ungaro, Dina C. Nacionales, Marie-Pierre L. Gauthier, Shawn D. Larson, Laurence Morel, Tyler J. Loftus, Alicia M. Mohr, Robert Maile, Michael P. Kladde, Clayton E. Mathews, Maigan A. Brusko, Todd M. Brusko, Lyle L. Moldawer, Rhonda Bacher
Sepsis engenders distinct host immunologic changes that include the expansion of myeloid-derived suppressor cells (MDSCs). These cells play a physiologic role in tempering acute inflammatory responses but can persist in patients who develop chronic critical illness. The origins and lineage of these MDSC subpopulations were previously assumed to be discrete and unidirectional; however, these cells exhibit
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Cognitive impairment is a risk factor for long-term outcomes in septic patients: A retrospective observational study medRxiv. Intensive Care Crit. Med. Pub Date : 2024-01-07 Hiroyuki Koami, Yuichiro Sakamoto, Yutaro Furukawa, Kosuke Mouri, Ayaka Matsuoka, Kota Shinada, Kento Nakayama, Sachiko Iwanaga, Shogo Narumi, Mayuko Koba
The importance of long-term outcomes after sepsis has been increasingly emphasized in recent years; however, little is known about the relationship between pre-sepsis patient characteristics and long-term outcomes. This study examined the impact of patient characteristics pre-admission, specifically physical, cognitive, and emotional disorders, on long-term clinical outcomes of sepsis. From August
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Artificial Intelligence (AI) Based Prediction of Mortality, ICU Admission and Ventilation Support Requirement for COVID-19 Patients Using 122 Clinical and Demographic Parameters medRxiv. Intensive Care Crit. Med. Pub Date : 2024-01-04 Mahbubunnabi Tamal, Mohammad Marufur Rahman, Maryam Alhasim, Mobarak Al Mulhim, Mohamed Deriche
Introduction COVID-19 can rapidly lead to severe respiratory problems and can result in an overwhelming burden on healthcare systems worldwide, making it imperative to identify high-risk patients and predict survival and need for intensive care (ICU). Most of the proposed modes are not well reported making them less reproducible and prone to high risk of bias.
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Detecting Goals of Care Conversations in Clinical Notes with Active Learning medRxiv. Intensive Care Crit. Med. Pub Date : 2024-01-04 Davy Weissenbacher, Katherine Courtright, Siddharth Rawal, Andrew Crane-Droesch, Karen O’Connor, Nicholas Kuhl, Corinne Merlino, Anessa Foxwell, Lindsay Haines, Joseph Puhl, Graciela Gonzalez-Hernandez
Objective Goals Of Care (GOC) discussions are an increasingly used quality metric in serious illness care and research. Wide variation in documentation practices within the Electronic Health Record (EHR) presents challenges for reliable measurement of GOC discussions. Novel natural language processing approaches are needed to capture GOC discussions documented in real-world samples of seriously ill
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HOW ARE RAPID RESPONSE SERVICES IMPLEMENTED OR CHANGED, AND HOW IS THEIR SUCCESS MEASURED? medRxiv. Intensive Care Crit. Med. Pub Date : 2024-01-02 R. Rowley, A. L. Poulter, A. Smith, E. Pollock, D. Bush, P. Patel, M. Lam, L. Webb, D. Jones, A. Delaney
Introduction Rapid Response Teams (RRT) exist in many different formats. With escalating rapid response calls, RRT services need to adapt to meet demand. We will describe how RRT service changes are implemented, either as a novel service or service redesign, and how the success of the implementation is measured.
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Addressing the aftermath of the COVID-19 pandemic: A quality improvement collaborative to optimize the use of antibacterials in Argentine Intensive Care Units medRxiv. Intensive Care Crit. Med. Pub Date : 2023-12-29 Facundo Jorro-Barón, Cecilia Loudet, Wanda Cornistein, Inés Suárez-Anzorena, Pilar Arias-López, Carina Balasini, Laura Cabana, Eleonora Cunto, Rodrigo Corral, Luz Gibbons, Marina Guglielmino, Gabriela Izzo, Marianela Lescano, Claudia Meregalli, Cristina Orlandi, Fernando Perre, María Elena Ratto, Mariano Rivet, Ana Paula Rodríguez, Viviana M. Rodríguez, Paula Romina Villegas, Emilse Vitar, Javier Roberti
Background Reducing antimicrobial resistance is a global priority that become even more important after the COVID-19 pandemic. To date there is a scarce volume of evidence from antimicrobial stewardship programs from less resourced settings where this phenomenon is bigger. Our aim was to improve the quality of antibacterials prescription in intensive care units (ICUs) in a middle-income country.
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Noninvasive vs Invasive Respiratory Support for Patients with Acute Hypoxemic Respiratory Failure medRxiv. Intensive Care Crit. Med. Pub Date : 2023-12-28 Jarrod M Mosier, Vignesh Subbian, Sarah Pungitore, Devashri Prabhudesai, Patrick Essay, Edward J Bedrick, Jacqueline C. Stocking, Julia M Fisher
Rationale Noninvasive respiratory support modalities are common alternatives to mechanical ventilation for patients with early acute hypoxemic respiratory failure. These modalities include noninvasive positive pressure ventilation, using either continuous or bilevel positive airway pressure, and nasal high flow using a high flow nasal cannula system. However, outcomes data historically compare noninvasive
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Validation of SeptiCyte RAPID to discriminate sepsis from non-infectious systemic inflammation medRxiv. Intensive Care Crit. Med. Pub Date : 2023-12-28 Robert Balk, Annette M. Esper, Greg S. Martin, Russell R. Miller, Bert K. Lopansri, John P. Burke, Mitchell Levy, Steven Opal, Richard E. Rothman, Franco R. D’Alessio, Venkataramana K. Sidhaye, Neil R. Aggarwal, Jared A. Greenberg, Mark Yoder, Gourang Patel, Emily Gilbert, Jorge P. Parada, Majid Afshar, Jordan A. Kempker, Tom van der Poll, Marcus J. Schultz, Brendon P. Scicluna, Peter M.C. Klein Klouwenberg
(1) Background SeptiCyte RAPID is a molecular test for discriminating sepsis from non-infectious systemic inflammation, and for estimating sepsis probabilities. The objective of this study was the clinical validation of SeptiCyte RAPID, based on testing retrospective banked and prospectively collected patient samples.
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Effect of Heparin and Tocilizumab in Patients with Severe COVID-19: The HEPMAB Randomized Clinical Trial medRxiv. Intensive Care Crit. Med. Pub Date : 2023-12-27 Lucas Trindade Cantú Ribeiro, Lucas Trindade Cantú Ribeiro, Giovanni Landoni, Vinícius Caldeira Quintão, Marcus Vinicius Guimaraes de Lacerda, Stephanie Itala Rizk, Isabela Bispo Santos da Silva Costa, Fernanda Thereza de Almeida Andrade, Edielle de Sant’Anna Melo, Nestor Cordeiro dos Santos Neto, Thalita Barbosa de González, Laisse Barreto Ferreira Reis, Valmir de Freitas Costa, Theuran Inahja Vicente
Background Clinical presentation of severe Coronavirus disease 2019 (COVID-19) is associated to an intense inflammatory response and thrombogenesis. The benefits of the association of interleukin-6 receptor blockade (tocilizumab) and therapeutic-dose anticoagulation remains unclear. We aimed to assess whether heparin and tocilizumab could effectively reduce inflammation and thrombogenesis in severe
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Healthcare-associated Urinary tract infection and its determinants among Adult Patients Admitted to Intensive Care Units of Addis Ababa Public Governmental Hospital, Ethiopia; 2020 medRxiv. Intensive Care Crit. Med. Pub Date : 2023-12-05 Wondimagegn Genaneh Shiferaw, Tigist Nega Alemu, Hindu Argeta Hailemariam, Silenat Gashaw Adibaru, Eyouel Shimeles Demissie
Back ground Urinary tract infections are common bacterial infections that affect almost 150 million people internationally each year. A catheter-associated urinary tract infection arises when germs enter the urinary tract via a urinary catheter, leading to infection and have been linked with increased mortality, morbidity, healthcare costs in intensive care units. It is one of the highest prevalent
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Long-term survival, psychiatric, physiological, and functional outcomes of critically ill patients requiring prolonged mechanical ventilation: a systematic review medRxiv. Intensive Care Crit. Med. Pub Date : 2023-11-27 Jarryd Ludski, Conor Honeywill
Purpose Invasive mechanical ventilation is utilized in over 50% of Australian Intensive Care Unit patients, with rates increasing world-wide. Prolonged mechanical ventilation is associated with increased length of hospital stay and in-hospital mortality compared with patients ventilated under the time threshold. Previous studies have highlighted mortality rates, but much remains unknown regarding the
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Randomised, controlled, feasibility trial comparing vasopressor infusion administered via peripheral cannula versus central venous catheter for critically ill adults: a study protocol medRxiv. Intensive Care Crit. Med. Pub Date : 2023-11-22 Stacey Watts, Yogesh Apte, Thomas Holland, April Hatt, Alison Craswell, Frances Lin, Alexis Tabah, Robert S Ware, Joshua Byrnes, Christopher Anstey, Gerben Keijzers, Mahesh Ramanan
Background When clinicians need to administer a vasopressor infusion, they are faced with the choice of administration via either peripheral intravenous catheter (PIVC) or central venous catheter (CVC). Vasopressor infusions have traditionally been administered via central venous catheters (CVC) rather than Peripheral Intra Venous Catheters (PIVC), primarily due to concerns of extravasation and resultant
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Skin Pigmentation and Pulse Oximeter Accuracy in the Intensive Care Unit: a Pilot Prospective Study medRxiv. Intensive Care Crit. Med. Pub Date : 2023-11-17 Ashraf Fawzy, Harith Ali, Peter H. Dziedzic, Niteesh Potu, Eusebia Calvillo, Sherita H. Golden, Theodore J. Iwashyna, Jose I. Suarez, David N. Hager, Brian T Garibaldi
Rationale: Despite multiple reports of pulse oximeter inaccuracy among hospitalized Black individuals, regulatory testing of pulse oximeters is performed on healthy volunteers. Objective: Evaluate pulse oximeter accuracy among intensive care unit patients with diverse skin pigmentation. Methods: Skin pigmentation was measured using a chromameter in 12 patients and individual typology angle (ITA), a
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Clinical Characteristics and Laboratory Biomarkers in ICU-admitted Septic Patients with and without Bacteremia: A Predictive Analysis medRxiv. Intensive Care Crit. Med. Pub Date : 2023-11-16 Sangwon Baek, Seungjun Lee
Background: Few studies have investigated the diagnostic utilities of biomarkers for predicting bacteremia among septic patients admitted to intensive care units (ICU). Therefore, this study evaluated the prediction power of laboratory biomarkers to utilize those markers with high performance to optimize the predictive model for bacteremia. Methods: A retrospective cross-sectional study was conducted
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Association Between Beta Blocker and Clinical Outcome in Adult Patients with Sepsis or Septic Shock: Protocol of a Systematic Review and Meta- Analysis of Randomized Controlled Trials medRxiv. Intensive Care Crit. Med. Pub Date : 2023-11-15 Sulagna Bhattacharjee, Emmanuel Easterson Ernest, Souvik Maitra
Use of beta-blockers as a part of heart rate control strategy is sepsis and septic shock patients is of great debate. Despite of early encouraging results, no large trial was performed and several subsequent small studies reported conflicting results. This meta-analysis and systematic review will be conducted and published as per PRISMA guidelines. In this review, randomized controlled trials comparing
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A Protocol Describing A Scoping Review to Characterise ICU Admission Criteria medRxiv. Intensive Care Crit. Med. Pub Date : 2023-10-25 James Roland Soares, Christopher Andersen
Introduction: Effectively identifying deteriorated patients is vital to the development and validation of automated systems designed to predict clinical deterioration. Existing outcome measures used for this purpose have significant limitations. Published criteria for admission to high acuity inpatient areas may represent markers of patient deterioration and could inform the development of alternate
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Variation in monitoring: Glucose measurement in the ICU as a case study to preempt spurious correlations medRxiv. Intensive Care Crit. Med. Pub Date : 2023-10-13 Khushboo Teotia, Yueran Jia, Naira Link Woite, Leo Anthony Celi, Joao Matos, Tristan Struja
Objective: Health inequities can be influenced by demographic factors such as race and ethnicity, proficiency in English, and biological sex. Disparities may manifest as differential likelihood of testing which correlates directly with the likelihood of an intervention to address an abnormal finding. Our retrospective observational study evaluated the presence of variation in glucose measurements in
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ChatGPT achieves comparable accuracy to specialist physicians in predicting the efficacy of high-flow oxygen therapy medRxiv. Intensive Care Crit. Med. Pub Date : 2023-10-12 Taotao Liu, Yaocong Duan, Yanchun Li, Yingying Hu, Lingling Su, Aiping Zhang
Objectives To investigate the accuracy of ChatGPT in predicting the risk of endotracheal intubation within 48 hours after HFNC therapy and compare it with the predictive accuracy of specialist and non-specialist physicians. Methods We conducted a prospective multicenter cohort study based on the data of 71 adult patients who received HFNC therapy. We recorded patient baseline data, the results of blood
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Generalisability of AI-based scoring systems in the ICU: a systematic review and meta-analysis medRxiv. Intensive Care Crit. Med. Pub Date : 2023-10-12 Patrick Rockenschaub, Ela Maria Akay, Benjamin Gregory Carlisle, Adam Hilbert, Falk Meyer-Eschenbach, Anatol-Fiete Näher, Dietmar Frey, Vince Istvan Madai
Background: Machine learning (ML) is increasingly used to predict clinical deterioration in intensive care unit (ICU) patients through scoring systems. Although promising, such algorithms often overfit their training cohort and perform worse at new hospitals. Thus, external validation is a critical but frequently overlooked step to establish the reliability of predicted risk scores to translate them