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Quantitative SARS-CoV-2 RT-PCR and Bronchoalveolar Cytokine Concentrations Redefine the COVID-19 Phenotypes in Critically Ill Patients J. Intensive Care Med. (IF 3.1) Pub Date : 2024-04-17 M. Cristina Vazquez Guillamet, Rodrigo Vazquez Guillamet, Ashraf Rjob, Daniel Reynolds, Bijal Parikh, Vladimir Despotovic, Derek E. Byers, Ali H. Ellebedy, Marin H. Kollef, Philip A. Mudd
RationaleRecent studies suggest that both hypo- and hyperinflammatory acute respiratory distress syndrome (ARDS) phenotypes characterize severe COVID-19-related pneumonia. The role of lung Severe Acute Respiratory Syndrome – Coronavirus 2 (SARS-CoV-2) viral load in contributing to these phenotypes remains unknown.ObjectivesTo redefine COVID-19 ARDS phenotypes when considering quantitative SARS-CoV-2
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Pilot Study on the Impact of Early Subcutaneous Basal Insulin Administration in Diabetic Ketoacidosis J. Intensive Care Med. (IF 3.1) Pub Date : 2024-04-17 Danielle S. Murray, Brian W. Gilbert, Tessa R. Cox
Purpose/Background: Recent studies have shown improved outcomes with the initiation of earlier subcutaneous (SQ) basal insulin. The purpose of this study was to examine the effects of early SQ basal insulin administration on hospital length of stay in patients with mild to moderate diabetic ketoacidosis (DKA). Methods: This was a retrospective, single-center study from a large community teaching hospital
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Impact of Delirium Onset and Duration on Mortality in Patients With Cancer Admitted to the ICU J. Intensive Care Med. (IF 3.1) Pub Date : 2024-04-17 Jing Tao, Kenneth P. Seier, Sanjay Chawla, Kay See Tan, Amanda Wheeler, Joanna Sanzone, Carina B. Marasigan-Stone, Justina-Sheila S. Simondac, Analin V. Pascual, Natalie T. Kostelecky, Louis P. Voigt
BackgroundLittle is known on the effects of delirium onset and duration on outcome in critically ill patients with cancer.ObjectivesTo determine the impact of delirium onset and duration on intensive care unit (ICU) and hospital mortality and length of stay (LOS) in patients with cancer.MethodsOf the 915 ICU patients admitted in 2018, 371 were included for analysis after excluding for terminal disease
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A Guide to the Use of Vasopressors and Inotropes for Patients in Shock J. Intensive Care Med. (IF 3.1) Pub Date : 2024-04-13 Anaas Moncef Mergoum, Abigail Rebecca Rhone, Nicholas James Larson, David J Dries, Benoit Blondeau, Frederick Bolles Rogers
Shock is a life-threatening circulatory failure that results in inadequate tissue perfusion and oxygenation. Vasopressors and inotropes are vasoactive medications that are vital in increasing systemic vascular resistance and cardiac contractility, respectively, in patients presenting with shock. To be well versed in using these agents is an important skill to have in the critical care setting where
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A Narrative Review of Aconite Poisoning and Management J. Intensive Care Med. (IF 3.1) Pub Date : 2024-04-13 Christine Lawson, Daniel J. McCabe, Ryan Feldman
Aconite poisoning refers to toxicity resulting from plants belonging to the Aconitum genus, which comprises over 350 different species of perennial flowering plants that grow in temperate mountainous areas of the northern hemisphere (North America, Europe, Asia). These plants contain a group of toxins known as aconite alkaloids, which encompass numerous closely related toxic compounds. Conventional
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Intravenous Antibiotics in the Management of H. pylori Infection: A Systematic Review J. Intensive Care Med. (IF 3.1) Pub Date : 2024-04-11 Yau-Lam Alex Chau, Tessa Milic, Jerrold Perrott
Background: Helicobacter pylori is implicated in the development of gastritis, ulcers, and various gastric cancers, representing significant morbidity, mortality, and healthcare spending. Patients with H. pylori infection have traditionally been treated with oral antibiotics, however, oral therapy is not feasible in all clinical situations. We examined the available evidence supporting the use of intravenous
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Parenteral Nutrition in the Critically Ill Adult: A Narrative Review J. Intensive Care Med. (IF 3.1) Pub Date : 2024-04-11 Christopher Nguyen, Gaurav Singh, Karen Rubio, Karen Mclemore, Ware Kuschner
Malnutrition in adult intensive care unit patients is associated with poor clinical outcomes. Providing adequate nutritional support to the critically ill adult should be an important goal for the intensivist. This narrative review aims to delineate the role of parenteral nutrition (PN) in meeting nutritional goals. We examined the data regarding the safety and efficacy of PN compared to enteral nutrition
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What Are the Real Issues in Providing Extracorporeal Membrane Oxygenation (ECMO) Support: A Survey J. Intensive Care Med. (IF 3.1) Pub Date : 2024-04-04 Shahla Siddiqui, Lovkesh Arora, Monica I. Lupei, S. Veena Satyapriya, Michael Wall, Miguel Cobas, Samuel Justice, Raquel R. Bartz
IntroductionBy using a novel survey our study aimed to assess the challenges ECMO and Critical Care (CC) teams face when initiating and managing patient's ECMO support.MethodsA qualitative survey-based observational study was performed of members of 2 Critical Care Medicine organizations involved in decision-making around the practice of Extracorporeal Membrane Oxygenation (ECMO). The range of exploratory
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Noninvasive Ventilation in the Cardiac Intensive Care Unit J. Intensive Care Med. (IF 3.1) Pub Date : 2024-04-04 Christopher S. Schenck, Fouad Chouairi, David M. Dudzinski, P. Elliott Miller
Over the last several decades, the cardiac intensive care unit (CICU) has seen an increase in the complexity of the patient population and etiologies requiring CICU admission. Currently, respiratory failure is the most common reason for admission to the contemporary CICU. As a result, noninvasive ventilation (NIV), including noninvasive positive-pressure ventilation and high-flow nasal cannula, has
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Association Between In-hospital Mortality and the Institutional Factors of Intensive Care Units with a Focus on the Intensivist- to-bed Ratio: A Retrospective Cohort Study J. Intensive Care Med. (IF 3.1) Pub Date : 2024-04-03 Hideki Endo, Hiroshi Okamoto, Satoru Hashimoto, Hiroaki Miyata
Purpose: To elucidate the relationship between in-hospital mortality and the institutional factors of intensive care units (ICUs), with a focus on the intensivist-to-bed ratio. Methods: A retrospective cohort study was conducted using a Japanese ICU database, including adult patients admitted between April 1, 2020 and March 31, 2021. We used a multilevel logistic regression model to investigate the
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Improving 1-Year Mortality Following Intensive Care Unit Admission in Adults with HIV: A 20-Year Observational Study J. Intensive Care Med. (IF 3.1) Pub Date : 2024-04-02 Tanmay Kanitkar, Nicholas Bakewell, Oshani Dissanayake, Maggie Symonds, Stephanie Rimmer, Amit Adlakha, Marc C. I. Lipman, Sanjay Bhagani, Banwari Agarwal, Caroline A. Sabin, Robert F. Miller
BackgroundDespite widespread use of combination antiretroviral therapy, people with HIV (PWH) continue to have an increased risk of admission to and mortality in the intensive care unit (ICU). Mortality risk after hospital discharge is not well described. Using retrospective data on adult PWH (≥18 years) admitted to ICU from 2000-2019 in an HIV-referral centre, we describe trends in 1-year mortality
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Analysis of Vancomycin Dosage and Plasma Levels in Critically Ill Adult Patients Requiring Extracorporeal Membrane Oxygenation (ECMO) J. Intensive Care Med. (IF 3.1) Pub Date : 2024-04-01 Andrés Ferre, Andrés Giglio, Brenda Zylbersztajn, Rodolfo Valenzuela, Nicolette Van Sint Jan, Christian Fajardo, Andres Reccius, Jorge Dreyse, Pablo Hasbun
Introduction: Critically ill patients undergoing extracorporeal membrane oxygenation (ECMO) exhibit unique pharmacokinetics. This study aimed to assess the achievement of vancomycin therapeutic targets in these patients. Methods: This retrospective cohort study included patients on ECMO treated with vancomycin between January 2010 and December 2018. Ninety patients were analyzed based on ECMO connection
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Incidence of Symptomatic Venous Thromboembolisms in Stroke Patients J. Intensive Care Med. (IF 3.1) Pub Date : 2024-03-26 Mostafa AL Turk, Michael Abraham
Venous thromboembolism (VTE) is a common but preventable complication observed in critically ill patients. Deep vein thrombosis (DVT) is the most common type of VTE, with clinical significance based on location and symptoms. There is an increased incidence of DVT and pulmonary embolism (PE) in ischemic stroke patients using unfractionated heparin (UFH) for VTE prophylaxis compared with those using
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When Our Best Friend Becomes Our Worst Enemy: The Mitochondrion in Trauma, Surgery, and Critical Illness J. Intensive Care Med. (IF 3.1) Pub Date : 2024-03-20 May-Kristin Torp, Kåre-Olav Stensløkken, Jarle Vaage
Common for major surgery, multitrauma, sepsis, and critical illness, is a whole-body inflammation. Tissue injury is able to trigger a generalized inflammatory reaction. Cell death causes release of endogenous structures termed damage associated molecular patterns (DAMPs) that initiate a sterile inflammation. Mitochondria are evolutionary endosymbionts originating from bacteria, containing molecular
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Vascular Reactivity Index as an Effective Predictor of Mortality in Patients With Septic Shock: A Retrospective Study J. Intensive Care Med. (IF 3.1) Pub Date : 2024-03-11 Sun Jingyi, Gao Cunliang, Chen Biao, Xie Yingguang, Ma Jinluan, Cao Xiaohua, Li Wenqiang
BackgroundSepsis is a serious complication that occurs after trauma, burns, and infections, and it is an important cause of death in intensive care unit (ICU) patients. Despite many new measures being proposed for sepsis treatment, its mortality rate remains high; sepsis has become a serious threat to human health, and there is an urgent need to carry out in-depth clinical research related to sepsis
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Early Beta-Blocker Utilization in Critically Ill Patients With Moderate-Severe Traumatic Brain Injury: A Retrospective Cohort Study J. Intensive Care Med. (IF 3.1) Pub Date : 2024-03-07 Margot Kelly-Hedrick, Sunny Yang Liu, Jordan Komisarow, Jordan Hatfield, Tetsu Ohnuma, Miriam M. Treggiari, Katharine Colton, Evangeline Arulraja, Monica S. Vavilala, Daniel T. Laskowitz, Joseph P. Mathew, Adrian Hernandez, Michael L. James, Karthik Raghunathan, Vijay Krishnamoorthy
BackgroundThere is limited evidence that beta-blockers may provide benefit for patients with moderate-severe traumatic brain injury (TBI) during the acute injury period. Larger studies on utilization patterns and impact on outcomes in clinical practice are lacking.ObjectiveThe present study uses a large, national hospital claims-based dataset to examine early beta-blocker utilization patterns and its
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Nephrotoxic Risk Associated With Combination Therapy of Vancomycin and Piperacillin-Tazobactam in Critically Ill Patients With Chronic Kidney Disease J. Intensive Care Med. (IF 3.1) Pub Date : 2024-02-28 Tamyah Pipkin, Stuart Pope, Alley Killian, Sarah Green, Benjamin Albrecht, Katherine Nugent
Background: The combination of vancomycin and piperacillin-tazobactam (VPT) has been associated with acute kidney injury (AKI) in hospitalized patients when compared to similar combinations. Additional studies examining this nephrotoxic risk in critically ill patients have not consistently demonstrated the aforementioned association. Furthermore, patients with baseline renal dysfunction have been excluded
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Epidemiology and Outcomes of Critical Illness and Novel Predictors of Mortality in an Ethiopian Medical Intensive Care Unit J. Intensive Care Med. (IF 3.1) Pub Date : 2024-02-28 Aschalew Worku, Deborah Haisch, Madhavi Parekh, Amir Sultan, Abebe Shumet, Kibrom G/Selassie, Max O’Donnell, Amsalu Binegdie, Charles B. Sherman, Neil W. Schluger
Low- and middle-income countries (LMICs) bear most of the global burden of critical illness. Managing this burden requires improved understanding of epidemiology and outcomes in LMIC intensive care units (ICUs), including LMIC-specific mortality prediction scores. This study was a retrospective observational study at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia, examining all consecutive
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Updated Review of Radiologic Imaging and Intervention for Acute Pancreatitis and Its Complications J. Intensive Care Med. (IF 3.1) Pub Date : 2024-02-28 Joshua Willis, Eric vanSonnenberg
This is a current update on radiologic imaging and intervention of acute pancreatitis and its complications. In this review, we define the various complications of acute pancreatitis, discuss the imaging findings, as well as the timing of when these complications occur. The various classification and scoring systems of acute pancreatitis are summarized. Advantages and disadvantages of the 3 primary
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Study of Empiric Antibiotic Prescription Patterns and Microbiological Isolates in Hemodynamically Stable and Unstable ICU Patients With Community-Acquired Sepsis J. Intensive Care Med. (IF 3.1) Pub Date : 2024-02-26 Mahuya Bhattacharyya, Ananya Saha, Subhash Todi
Background: The efficacy of combination empiric antibiotic therapy for all intensive care unit (ICU) patients with community-acquired sepsis is a subject of ongoing debate in the era of increasing antibiotic resistance. This study was conducted to evaluate the patterns of antibiotic usage and microbial resistance in sepsis patients admitted to the ICU with both hemodynamically stable (HS) and unstable
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Comparison of Clinical Characteristics and Outcomes in Intensive Care Units Between Patients with Coronavirus Disease 2019 (COVID-19) and Patients with Influenza: A Systematic Review and Meta-Analysis J. Intensive Care Med. (IF 3.1) Pub Date : 2024-02-26 Zhuan Zhong, Xin Wang, Jia Guo, Xingzhao Li, Yingying Han
BackgroundSevere infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or influenza virus can cause patients to be admitted to intensive care units (ICUs). It is necessary to understand the differences in clinical characteristics and outcomes between these two types of critically ill patients.MethodsWe searched Embase, PubMed, and Web of Science for articles and performed a meta-analysis
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Comparing Simulation Training of Bronchoscopy-Guided Percutaneous Dilatational Tracheostomy Using Conventional Versus 3D Printed Simulators (TRAC-Sim Study) J. Intensive Care Med. (IF 3.1) Pub Date : 2024-02-26 Moritz Wegner, Fabian Dusse, Finnard Beeser, Nicolas Leister, Marian Lefarth, Simon-Richard Finke, Bernd W. Böttiger, Bernhard Dorweiler, Sandra Emily Stoll
Background: Individual implementation rate of bronchoscopy-guided percutaneous dilatational tracheostomy (PDT) varies among intensivists. Simulation training (ST) can increase the safety of medical procedures by reducing stress levels of the performing team. The aim of this study was to evaluate the benefit of ST in PDT regarding procedural time, quality of performance, and percepted feelings of safety
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Association of Shock Indices with Peri-Intubation Hypotension and Other Outcomes: A Sub-Study of the KEEP PACE Trial J. Intensive Care Med. (IF 3.1) Pub Date : 2024-02-26 Nathan J. Smischney, Mohamed O. Seisa, Darrell R. Schroeder
BackgroundBased on current evidence, there appears to be an association between peri-intubation hypotension and patient morbidity and mortality. Studies have identified shock indices as possible pre-intubation risk factors for peri-intubation hypotension. Thus, we sought to evaluate the association between shock index (SI), modified shock index (MSI), and diastolic shock index (DSI) and peri-intubation
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The Impact of Fluid Balance on Acute Kidney Injury in Nontraumatic Subarachnoid Hemorrhage J. Intensive Care Med. (IF 3.1) Pub Date : 2024-02-20 Dante Merrill, Jack M. Craven, Scott Silvey, Daniel Gouger, Chen Wang, Rishi Patel, Vishal Yajnik
Background: Nontraumatic subarachnoid hemorrhage (SAH) can lead to poor neurologic outcomes, particularly when delayed cerebral ischemia (DCI) occurs. Maintenance of euvolemia following SAH is thought to reduce the risk of DCI. However, attempts at maintaining euvolemia often err on the side of hypervolemia. In this study, we assessed the relationship between fluid balance and acute kidney injury (AKI)
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Ten Influential Point-of-Care Ultrasound Papers: 2023 in Review J. Intensive Care Med. (IF 3.1) Pub Date : 2024-02-20 Scott J. Millington, Mangala Narasimhan, Paul H. Mayo, Antoine Vieillard-Baron
In an effort to help keep busy clinicians up to date with the latest ultrasound research, our group of experts has selected 10 influential papers from the past 12 months and provided a short summary of each. We hope to provide emergency physicians, intensivists, and other acute care providers with a succinct update concerning some key areas of ultrasound interest.
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Continuous Versus Intermittent Control Cuff Pressure for Preventing Ventilator-Associated Pneumonia: An Updated Meta-Analysis J. Intensive Care Med. (IF 3.1) Pub Date : 2024-02-20 Yanshuo Wu, Yanan Li, Meirong Sun, Jingjing Bu, Congcong Zhao, Zhenjie Hu, Yanling Yin
ObjectiveThis study aimed to evaluate the effect of continuous control cuff pressure (CCCP) versus intermittent control cuff pressure (ICCP) for the prevention of ventilator-associated pneumonia (VAP) in critically ill patients.MethodsRelevant literature was searched in several databases, including PubMed, Embase, Web of Science, ProQuest, the Cochrane Library, Wanfang Database and China National Knowledge
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Prognostic Implications of the Timing of ST-Elevation Myocardial Infarction Development in Relation to COVID-19 Infection J. Intensive Care Med. (IF 3.1) Pub Date : 2024-02-20 Aleksandra D. Milošević, Marija M. Polovina, Dario D. Jelic, Damjan D. Simic, Mihajlo M. Viduljevic, Dragan M. Matic, Milenko M. Tomic, Tatjana N. Adzic, Milika R. Asanin
Background: Patients with ST-segment elevation myocardial infarction (STEMI) and COVID-19 infection have a worse clinical course and prognosis. The prognostic significance of the timing of STEMI in relation to COVID-19 infection was not investigated. Objectives: To assess whether the time of STEMI development in relation to COVID-19 infection (concurrent or following the infection) influenced the short-term
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Family Perceptions of Virtual Family-Centered Rounds in a Quaternary Cardiac Intensive Care Unit J. Intensive Care Med. (IF 3.1) Pub Date : 2024-02-20 Paolo Ramirez, Ariel Mueller, Ken Shelton, David M. Dudzinski, Annie Colbert, Juliet Jacobsen, Jeffrey L. Greenwald, Jonathan Ludmir
Background: Family-centered rounds (FCR) reduce the risk of psychological comorbidities of family members and improve the quality of communication between providers and families. Materials and methods: We conducted a pilot quality improvement study analyzing family perceptions of virtual FCR. Family members of previously admitted cardiac ICU patients who participated in at least one session of virtual
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Efficacy and Safety of Nirmatrelvir/Ritonavir in Severe Hospitalized Patients with COVID-19 and in Patients at High Risk for Progression to Critical Illness: A Real-World Study J. Intensive Care Med. (IF 3.1) Pub Date : 2024-02-15 Xiaohua Chen, Ying Zhu, Leer Shen, Dan Zhou, Nannan Feng, Qiang Tong
Background: Nirmatrelvir/Ritonavir is an orally administered anti-SARS-Cov-2 drug used in mild-to-moderate COVID-19 patients. Our retrospective cohort study aims to evaluate the efficacy and safety of Nirmatrelvir/Ritonavir in severe hospitalized patients with Omicron infection, as well as in patients at high risk for progression to critical illness in real-world settings. Methods: A total of 350 patients
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Association of Body Mass Index with Multiple Organ Failure in Hospitalized Patients with COVID-19: A Multicenter Retrospective Cohort Study J. Intensive Care Med. (IF 3.1) Pub Date : 2024-02-12 Timothy Phillips, Abdallah Mughrabi, Levindo J. Garcia, Christopher El Mouhayyar, Laith Hattar, Hocine Tighiouart, Andrew H. Moraco, Claudia Nader, Bertrand L. Jaber
Purpose: This study examines whether excessive adipose tissue, as measured by the body mass index (BMI), is associated with higher systemic markers of inflammation and higher risk of severe acute organ failure among patients with coronavirus disease 2019 (COVID-19). Methods: This was a multicenter retrospective cohort study of 1370 hospitalized adults (18 years or older) with COVID-19 during the first
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Clinical Characteristics, Outcomes, and Risk Factors for Mortality in Pregnant/Puerperal Women with COVID-19 Admitted to ICU in Turkey: A Multicenter, Retrospective Study from a Middle-Income Country J. Intensive Care Med. (IF 3.1) Pub Date : 2024-02-07 Nur Baykara, Nur Baykara, Mustafa Kemal Arslantaş, Volkan Hancı, Halis Akalın, Oktay Demirkıran, Suha Bozbay, Dursun Fırat Ergül, Reyhan Arslantaş, Sibel Balcı, Volkan Alparslan, Serra Topal, Gülbahar Çalışkan, Esra Yakışık, Seval İzdeş, Deniz erdem, Ali Fuat Erdem, Yaşar Cırdı, Özge Kuzgun, Gökhan Akdağ, Şerife Bektaş, Mehmet Yılmaz, Devrim Akdağ, Didem Sözütek Akkoyun, Adnan Ata, Engin Haftacı, Aynur
BackgroundCoronaviruses have been the cause of 3 major outbreaks during the last 2 decades. Information on coronavirus diseases in pregnant women is limited, and even less is known about seriously ill pregnant women. Data are also lacking regarding the real burden of coronavirus disease 2019 (COVID-19) infection in pregnant women from low/middle-income countries. The aim of this study was to determine
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Management of Immunosuppressive Therapy in Kidney Transplant Recipients with Sepsis: A Multicenter Retrospective Study J. Intensive Care Med. (IF 3.1) Pub Date : 2024-02-07 Hyung Duk Kim, Byung Ha Chung, Chul Woo Yang, Seok Chan Kim, Kyung Hoon Kim, Shin Young Kim, Kyu Yean Kim, Jongmin Lee
BackgroundUp to 6% of kidney transplant recipients (KTRs) experience life-threatening complications requiring intensive care unit (ICU) admission, and one of the most common medical complications requiring ICU admission is infection. This study aimed to evaluate the effect of immunosuppressive therapy (IST) modification on prognosis of KTRs with sepsis.MethodsWe conducted a multicenter retrospective
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Reintubation Rate and Mortality After Emergent Airway Management Outside the Operating Room J. Intensive Care Med. (IF 3.1) Pub Date : 2024-02-02 Uzung Yoon, Jeffrey Mojica, Matthew Wiltshire, Marc Torjman
BackgroundLittle is known about reintubations outside of the operating room. The objective of this study was to evaluate the reintubation rate and mortality after emergent airway management outside operating room (OR), including intensive care unit (ICU) and nonICU settings.MethodsA retrospective cohort study. The primary outcome measures were reintubation rate and mortality. Secondary outcome measures
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Hypotension During Vasopressor Infusion Occurs in Predictable Clusters: A Multicenter Analysis J. Intensive Care Med. (IF 3.1) Pub Date : 2024-01-29 Daisuke Horiguchi, Sungtae Shin, Jeremy A. Pepino, Jeffrey T. Peterson, Iain E. Kehoe, Joshua N. Goldstein, Jarone Lee, Brian K. Kwon, Jin-Oh Hahn, Andrew T. Reisner
Background: Published evidence indicates that mean arterial pressure (MAP) below a goal range (hypotension) is associated with worse outcomes, though MAP management failures are common. We sought to characterize hypotension occurrences in ICUs and consider the implications for MAP management. Methods: Retrospective analysis of 3 hospitals’ cohorts of adult ICU patients during continuous vasopressor
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Characteristics and Clinical Prognosis of Septic Patients With Persistent Lymphopenia J. Intensive Care Med. (IF 3.1) Pub Date : 2024-01-16 Juanjuan Jing, Yushan Wei, Xue Dong, Dandan Li, Chenyang Zhang, Zhiyao Fang, Jia Wang, Xianyao Wan
Background: Septic patients with persistent lymphopenia may be in an immunosuppressed state. Therefore, we evaluated and compared the clinical characteristics and outcomes of septic patients with persistent lymphopenia (≥2d) and those with nonpersistent lymphopenia. Methods: A retrospective cohort study was designed. A total of 1306 patients with sepsis who were attended to the First Affiliated Hospital
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Accuracy of Noninvasive Blood Pressure Monitoring in Critically Ill Adults J. Intensive Care Med. (IF 3.1) Pub Date : 2024-01-12 Erin N. Haber, Rajiv Sonti, Suzanne M. Simkovich, C. William Pike, Christian L. Boxley, Allan Fong, William S. Weintraub, Nathan K. Cobb
BackgroundBlood pressure (BP) is routinely invasively monitored by an arterial catheter in the intensive care unit (ICU). However, the available data comparing the accuracy of noninvasive methods to arterial catheters for measuring BP in the ICU are limited by small numbers and diverse methodologies.PurposeTo determine agreement between invasive arterial blood pressure monitoring (IABP) and noninvasive
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Cardiogenic Shock and Utilization of Mechanical Circulatory Support in Pregnancy J. Intensive Care Med. (IF 3.1) Pub Date : 2024-01-11 Anna C. O’Kelly, Amy Sarma, Emily Naoum, Sarah Rae Easter, Katherine Economy, Jonathan Ludmir
Maternal mortality rates are rising in the United States, a trend which is in contrast to that seen in other high-income nations. Cardiovascular disease and hypertensive disorders of pregnancy are consistently the leading causes of maternal mortality both in the United States and globally, accounting for about one-quarter to one-third of maternal and peripartum deaths. A large proportion of cardiovascular
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Long-Term Mortality and Health-Related Quality of Life After Continuous Versus Intermittent Renal Replacement Therapy in ICU Survivors: A Secondary Analysis of the Quality of Life After ICU Study J. Intensive Care Med. (IF 3.1) Pub Date : 2024-01-10 Mariana Martins Siqueira Santos, Daniel Sganzerla, Isabel Jesus Pereira, Regis Goulart Rosa, Cristina Granja, Cassiano Teixeira, Luís Azevedo
Purpose: We assessed long-term outcomes in intensive care unit (ICU) survivors with acute kidney injury (AKI) submitted to intermittent or continuous renal replacement therapy (RRT) for comparisons between groups. Methods: The multicenter prospective cohort study included 195 adult ICU survivors with an ICU stay >72 h in 10 ICUs that had at least one episode of AKI treated with intermittent RRT (IRRT)
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Impact of Sedation Practices on Mortality in COVID-19-Associated Adult Respiratory Distress Syndrome Patients: A Multicenter Retrospective Descriptive Study J. Intensive Care Med. (IF 3.1) Pub Date : 2024-01-09 Mahmoud Alwakeel, Yan Wang, Heather Torbic, Gretchen L. Sacha, Xiaofeng Wang, Francois Abi Fadel, Abhijit Duggal
Background: Reduction in sedation exposure is an important metric in intensive care unit (ICU) patients. However, challenges arose during the coronavirus disease-2019 (COVID-19) pandemic in adhering to this practice, driven by concerns on transmission and disease severity issues. Accordingly, diverse sedation approaches emerged, although the effect on mortality has not been studied thoroughly. Methods:
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Time and Risk Factors of Trauma-Related Mortality: A 5-Year Retrospective Analysis From a National Level I Trauma Center J. Intensive Care Med. (IF 3.1) Pub Date : 2024-01-09 Mohammad Asim, Ayman El-Menyar, Husham Abdelrahman, Rafael Consunji, Tariq Siddiqui, Ahad Kanbar, Ibrahim Taha, Sandro Rizoli, Hassan Al-Thani
Background: We aimed to analyze in-hospital timing and risk factors for mortality in a level 1 trauma center. Methods: This is a retrospective analysis of all trauma-related mortality between 2013 and 2018. Patients were divided and analyzed based on the time of mortality (early (≤48 h) vs late (>48 h)), and within different age groups. Multivariate regression analysis was performed to predict in-hospital
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POCUS in the PICU: A Narrative Review of Evidence-Based Bedside Ultrasound Techniques Ready for Prime-Time in Pediatric Critical Care J. Intensive Care Med. (IF 3.1) Pub Date : 2024-01-09 Catherine E. Naber, Michael D. Salt
Point-of-care ultrasound (POCUS) is an accessible technology that can identify and treat life-threatening pathology in real time without exposing children to ionizing radiation. We aim to review current evidence supporting the use of POCUS by pediatric intensivists with novice-level experience with bedside ultrasound. Current evidence supports the universal adoption of POCUS-guided internal jugular
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Simultaneous Venous-Arterial Doppler Ultrasound During Early Fluid Resuscitation to Characterize a Novel Doppler Starling Curve: A Prospective Observational Pilot Study J. Intensive Care Med. (IF 3.1) Pub Date : 2024-01-08 Jon-Émile S. Kenny, Ross Prager, Philippe Rola, Korbin Haycock, Stanley O. Gibbs, Delaney H. Johnston, Christine Horner, Joseph K. Eibl, Vivian C. Lau, Benjamin O. Kemp
Background: The likelihood of a patient being preload responsive—a state where the cardiac output or stroke volume (SV) increases significantly in response to preload—depends on both cardiac filling and function. This relationship is described by the canonical Frank-Starling curve. Research Question: We hypothesize that a novel method for phenotyping hypoperfused patients (ie, the “Doppler Starling
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Postarrest Care Bundle Improves Quality of Care and Clinical Outcomes in the Normothermia Era J. Intensive Care Med. (IF 3.1) Pub Date : 2024-01-05 Andrew J. Caddell, Dave Nagpal, Ahmed F. Hegazy
PurposeTemperature targets in patients with cardiac arrest and return of spontaneous circulation (ROSC) have changed. Changes to higher temperature targets have been associated with higher breakthrough fevers and mortality. A post-ROSC normothermia bundle was developed to improve compliance with temperature targets.MethodsIn August 2021, “ad hoc” normothermia at the discretion of the attending intensivist
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Novel Oxygenation and Saturation Indices for Mortality Prediction in COVID-19 ARDS Patients: The Impact of Driving Pressure and Mechanical Power J. Intensive Care Med. (IF 3.1) Pub Date : 2024-01-05 Sinan Aşar, Fatih Rahim, Payam Rahimi, Özlem Acicbe, Furkan Tontu, Zafer Çukurova
Background: The oxygenation index (OI) and oxygen saturation index (OSI) are proven mortality predictors in pediatric and adult patients, traditionally using mean airway pressure (Pmean). We introduce novel indices, replacing Pmean with DP (ΔPinsp), MPdyn, and MPtot, assessing their potential for predicting COVID-19 acute respiratory distress syndrome (ARDS) mortality, comparing them to traditional
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Early Autocalibrated Arterial Waveform Analysis for the Management of Burn Shock—A Cohort Study J. Intensive Care Med. (IF 3.1) Pub Date : 2024-01-04 Marianne Kruse, Konrad Ernst Liesenborghs, David Josuttis, Philip Plettig, Denis Guembel, Ida Katinka Lenz, Claas Guethoff, Volker Gebhardt, Marc Dominik Schmittner
Adequate fluid therapy is crucial for resuscitation after major burns. To adapt this to individual patient demands, standard is adjustment of volume to laboratory parameters and values of enhanced hemodynamic monitoring. To implement calibrated parameters, patients must have reached the intensive care unit (ICU). The aim of this study was, to evaluate the use of an auto-calibrated enhanced hemodynamic
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Thrombolytics in Cardiac Arrest from Pulmonary Embolism: A Systematic Review and Meta Analysis. J. Intensive Care Med. (IF 3.1) Pub Date : 2023-11-30 Jordan Feltes,Margarita Popova,Yasir Hussein,Ayal Pierce,David Yamane
BACKGROUND During cardiopulmonary resuscitation, intravenous thrombolytics are commonly used for patients whose underlying etiology of cardiac arrest is presumed to be related to pulmonary embolism (PE). METHODS We performed a systematic review and meta-analysis of the existing literature that focused on the use of thrombolytics for cardiac arrest due to presumed or confirmed PE. Outcomes of interest
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Right Heart Failure in the Intensive Care Unit: Etiology, Pathogenesis, Diagnosis, and Treatment. J. Intensive Care Med. (IF 3.1) Pub Date : 2023-11-29 Elizabeth Tarras,Akhil Khosla,Paul M Heerdt,Inderjit Singh
Right heart (RH) failure carries a high rate of morbidity and mortality. Patients who present with RH failure often exhibit complex aberrant cardio-pulmonary physiology with varying presentations. The treatment of RH failure almost always requires care and management from an intensivist. Treatment options for RH failure patients continue to evolve rapidly with multiple options available, including
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Neurological Complications of the Lower Extremities After Femoral Cannulated Extracorporeal Membrane Oxygenation: A Systematic Review. J. Intensive Care Med. (IF 3.1) Pub Date : 2023-11-28 Frauke Johannes,Rahel Frohofer-Vollenweider,Yvonne Teuschl
BACKGROUND Femoral cannulated extracorporeal membrane oxygenation (ECMO) has been associated with neurologic complications in the lower extremity ipsilateral to the cannulation. There is uncertainty about the prevalence of these complications and their mechanisms of development. OBJECTIVE Aim of this systematic review was to investigate the prevalence of neurological complications after ECMO and to
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Important Considerations in the Intensive Care Management of Acute Leukemias. J. Intensive Care Med. (IF 3.1) Pub Date : 2023-11-21 Hoda Pourhassan,Waasil Kareem,Vaibhav Agrawal,Ibrahim Aldoss
In the realm of hematologic disorders, acute leukemia is approached as an emergent disease given the multitude of complications and challenges that present both as a result of inherent disease pathology and adverse events associated with antineoplastic therapies and interventions. The heavy burden of leukemic cells may lead to complications including tumor lysis syndrome, hyperleukocytosis, leukostasis
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Thrombotic Microangiopathy After Hematopoietic Stem Cell and Solid Organ Transplantation: A Review for Intensive Care Physicians. J. Intensive Care Med. (IF 3.1) Pub Date : 2023-11-21 Sanober Nusrat,Hugh Davis,Kira MacDougall,James N George,Ryotaro Nakamura,Azra Borogovac
Intensive care physicians may assume the primary care of patients with transplant-associated thrombotic microangiopathy (TA-TMA), an uncommon but potentially critical complication of hematopoietic stem cell transplants (HSCTs) and solid organ transplants. TA-TMA can have a dramatic presentation with multiple organ dysfunction syndrome (MODS) associated with high morbidity and mortality. The typical
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A Need for a Novel Survival Risk Scoring System for Intensive Care Admissions Due to Sepsis in Pediatric Hematology/Oncology Patients. J. Intensive Care Med. (IF 3.1) Pub Date : 2023-11-19 Talya Wittmann Dayagi,Ronit Nirel,Galia Avrahami,Shira Amar,Sarah Elitzur,Salvador Fisher,Gil Gilead,Oded Gilad,Tracie Goldberg,Shai Izraeli,Gili Kadmon,Eytan Kaplan,Aviva Krauss,Orli Michaeli,Jerry Stein,Orna Steinberg-Shemer,Hannah Tamary,Osnat Tausky,Helen Toledano,Avichai Weissbach,Joanne Yacobovich,Asaf D Yanir,Jessica Zon,Elhanan Nahum,Shlomit Barzilai-Birenboim
Background: Children with hemato-oncological diseases or following stem cell transplantation (SCT) are at high risk for life-threatening infections; sepsis in this population constitutes a substantial proportion of pediatric intensive care unit (PICU) admissions. The current pediatric prognostic scoring tools to evaluate illness severity and mortality risk are designed for the general pediatric population
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Comparison of SAT and SBT Conduct During the ABC Trial and PILOT Trial. J. Intensive Care Med. (IF 3.1) Pub Date : 2023-11-19 Tuqa Alkhateeb,Matthew W Semler,Timothy D Girard,E Wesley Ely,Joanna L Stollings
BACKGROUND Implementation of the "B" element-both spontaneous awakening trials (SATs) and spontaneous breathing trials (SBTs)-of the ABCDEF bundle improves the outcomes for mechanically ventilated patients. In 2021, the Pragmatic Investigation of optimal Oxygen Targets (PILOT) trial investigating optimal oxygenation targets in patients on mechanical ventilation was completed. OBJECTIVES To compare
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The State of the Union: Trauma System Development in the United States. J. Intensive Care Med. (IF 3.1) Pub Date : 2023-11-19 Frederick B Rogers,Nicholas J Larson,David J Dries,Barbara A Olson-Bullis,Benoît Blondeau
Injury is both a national and international epidemic that affects people of all age, race, religion, and socioeconomic class. Injury was the fourth leading cause of death in the United States (U.S.) in 2021 and results in an incalculable emotional and financial burden on our society. Despite this, when prevention fails, trauma centers allow communities to prepare to care for the traumatically injured
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Neurally Adjusted Ventilatory Assist Versus Pressure Support Ventilation: A Comprehensive Review. J. Intensive Care Med. (IF 3.1) Pub Date : 2023-11-15 Saikiran Mandyam,Muhammad Qureshi,Yamini Katamreddy,Devam Parghi,Priyanka Patel,Vidhi Patel,Fnu Anshul
Mechanical ventilation serves as crucial life support for critically ill patients. Although it is life-saving prolonged ventilation carries risks and complications like barotrauma, Ventilator-associated pneumonia, sepsis, and many others. Optimizing patient-ventilator interactions and facilitating early weaning is necessary for improved intensive care unit (ICU) outcomes. Traditionally Pressure support
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Development and Validation of a Predictive Model for Acute Kidney Injury in Sepsis Patients Based on Recursive Partition Analysis. J. Intensive Care Med. (IF 3.1) Pub Date : 2023-11-15 Kunmei Lai,Guo Lin,Caiming Chen,Yanfang Xu
BACKGROUND Sepsis-associated acute kidney injury (SA-AKI) is a critical condition with significant clinical implications, yet there is a need for a predictive model that can reliably assess the risk of its development. This study is undertaken to bridge a gap in healthcare by creating a predictive model for SA-AKI with the goal of empowering healthcare providers with a tool that can revolutionize patient
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Predicting Hospital Survival in Patients Admitted to ICU with Pulmonary Embolism. J. Intensive Care Med. (IF 3.1) Pub Date : 2023-11-15 Martin J Ryll,Aurelia Zodl,Toby N Weingarten,Alejandro A Rabinstein,David O Warner,Darrell R Schroeder,Juraj Sprung
OBJECTIVE The Pulmonary Embolism Severity Index (PESI) and simplified PESI (sPESI) predict mortality for patients with PE. We compared PESI/sPESI to the Acute Physiology and Chronic Health Evaluation IV (APACHE-IV) in predicting mortality in patients with PE admitted to the intensive care unit (ICU). Additionally, we assessed the performance of a novel ICU-sPESI score created by adding three clinical
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Update on Management and Outcomes of Congenital Diaphragmatic Hernia. J. Intensive Care Med. (IF 3.1) Pub Date : 2023-11-06 K Taylor Wild,Holly L Hedrick,Anne M Ades,Maria V Fraga,Catherine M Avitabile,Juliana S Gebb,Edward R Oliver,Kristen Coletti,Erin M Kesler,K Taylor Van Hoose,Howard B Panitch,Sandy Johng,Renee P Ebbert,Lisa M Herkert,Casey Hoffman,Deanna Ruble,Sabrina Flohr,Tom Reynolds,Melissa Duran,Audrey Foster,Rebecca S Isserman,Emily A Partridge,Natalie E Rintoul
Infants with congenital diaphragmatic hernia (CDH) benefit from comprehensive multidisciplinary teams that have experience in caring for the unique and complex issues associated with CDH. Despite prenatal referral to specialized high-volume centers, advanced ventilation strategies and pulmonary hypertension management, and extracorporeal membrane oxygenation, mortality and morbidity remain high. These
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Utility of Bedside Ultrasound in Percutaneous Tracheostomy. J. Intensive Care Med. (IF 3.1) Pub Date : 2023-11-06 Simon Meredith,Zein Kattih,Brenda Garcia,Viera Lakticova,Bushra Mina,Margarita Oks,Anup Singh
Background: Percutaneous tracheostomy placement is a common procedure performed in the intensive care unit. The use of an anterior neck ultrasound exam is routinely performed preprocedure, allowing for vessel visualization in determining the safety and feasibility of performing the procedure bedside. This prospective observational cohort study was conducted to determine whether vasculature in the anterior
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Impact of Positive End-Expiratory Pressure and FiO2 on Lung Mechanics and Intrapulmonary Shunt in Mechanically Ventilated Patients with ARDS Due to COVID-19 Pneumonia. J. Intensive Care Med. (IF 3.1) Pub Date : 2023-11-05 Gaetano Florio,Alberto Zanella,Douglas Slobod,Amedeo Guzzardella,Ilaria Protti,Eleonora Carlesso,Arif Canakoglu,Jacopo Fumagalli,Vittorio Scaravilli,Sebastiano M Colombo,Alessio Caccioppola,Matteo Brioni,Antonio M Pesenti,Giacomo Grasselli
Purpose: This study aimed to investigate the effects of inspired oxygen fraction (FiO2) and positive end-expiratory pressure (PEEP) on gas exchange in mechanically ventilated patients with COVID-19. Methods: Two FiO2 (100%, 40%) were tested at 3 decreasing levels of PEEP (15, 10, and 5 cmH2O). At each FiO2 and PEEP, gas exchange, respiratory mechanics, hemodynamics, and the distribution of ventilation
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Correlation of Sedation Depth During Critical Care Transport and Hospitalization. J. Intensive Care Med. (IF 3.1) Pub Date : 2023-10-30 Matthew A Roginski,Matthew C Carroll,Micah L Trautwein,Evan D Watkins,Alyson M Esteves
Purpose: We aim to assess the impact of the exposure to deep versus light sedation by a critical care transport agency during prehospital and interhospital transport on hospital sedation levels, medication exposure, and outcomes of mechanically ventilated patients. Materials and Methods: Retrospective cohort review of mechanically ventilated adult critical care transport patients from January 1, 2019