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Critical Care Medicine

Sterling B Ortega, Poornima Pandiyan, Jana Windsor, Vanessa O Torres, Uma M Selvaraj, Amy Lee, Michael Morriss, Fenghua Tian, Lakshmi Raman, Ann M Stowe
OBJECTIVES: Extracorporeal membrane oxygenation provides short-term cardiopulmonary life support, but is associated with peripheral innate inflammation, disruptions in cerebral autoregulation, and acquired brain injury. We tested the hypothesis that extracorporeal membrane oxygenation also induces CNS-directed adaptive immune responses which may exacerbate extracorporeal membrane oxygenation-associated brain injury. DESIGN: A single center prospective observational study...
January 10, 2019: Critical Care Medicine
Adrian Wong, Laura Galarza, Frantisek Duska
OBJECTIVES: Critical care ultrasonography has become established within ICUs as a diagnostic tool and to guide management strategies and practical procedures. Following an international consensus statement in 2011, various national professional societies and organizations have sought to develop and deliver training programmes. The aim of this review was to assess the similarities and differences among these postgraduate intensive care/critical care training programmes. DATA SOURCES: A systematic review was performed in two steps...
January 10, 2019: Critical Care Medicine
Pinchas Halpern, Tru Dang, Yoram Epstein, Diana Van Stijn - Bringas Dimitriades, Kristi L Koenig
OBJECTIVES: Manual ventilation of intubated patients is a common intervention. It requires skill as well as physical effort and is typically restricted to brief periods. Prolonged manual ventilation may be unavoidable in some scenarios, for example, extreme mass casualty incidents. The present study tested whether nurses are capable of appropriately manually ventilating patients for 6 hours. DESIGN: Volunteers performed ventilation on an electronic simulator for 6 hours while their own cardiorespiratory variables and the quality of the delivered ventilation were measured and recorded...
January 10, 2019: Critical Care Medicine
Ithan D Peltan, Justin Poll, Jeffrey Sorensen, David Guidry, Marni Chandler, William Beninati, Samuel M Brown
OBJECTIVES: Evaluate clinicians' sentiments about participating in cardiac arrest resuscitations and identify factors associated with confidence in resuscitation of cardiac arrest. DESIGN: Electronic survey. SETTING: Twenty-one hospitals in Utah and Idaho. SUBJECTS: All attending physicians, residents, and nurses in a multilevel healthcare system likely to participate in an in-hospital cardiac arrest resuscitation at least once every 2 years...
January 7, 2019: Critical Care Medicine
Jesús Villar, Alfonso Ambrós, Fernando Mosteiro, Domingo Martínez, Lorena Fernández, Carlos Ferrando, Demetrio Carriedo, Juan A Soler, Dácil Parrilla, Mónica Hernández, David Andaluz-Ojeda, José M Añón, Anxela Vidal, Elena González-Higueras, Carmen Martín-Rodríguez, Ana M Díaz-Lamas, Jesús Blanco, Javier Belda, Francisco J Díaz-Domínguez, Jesús Rico-Feijoó, Carmen Martín-Delgado, Miguel A Romera, Jesús M González-Martín, Rosa L Fernández, Robert M Kacmarek
OBJECTIVES: Incomplete or ambiguous evidence for identifying high-risk patients with acute respiratory distress syndrome for enrollment into randomized controlled trials has come at the cost of an unreasonable number of negative trials. We examined a set of selected variables early in acute respiratory distress syndrome to determine accurate prognostic predictors for selecting high-risk patients for randomized controlled trials. DESIGN: A training and testing study using a secondary analysis of data from four prospective, multicenter, observational studies...
January 7, 2019: Critical Care Medicine
Hyunjo Lee, Moshe A Mizrahi, Jed A Hartings, Sameer Sharma, Laura Pahren, Laura B Ngwenya, Brian D Moseley, Michael Privitera, Frank C Tortella, Brandon Foreman
OBJECTIVES: After traumatic brain injury, continuous electroencephalography is widely used to detect electrographic seizures. With the development of standardized continuous electroencephalography terminology, we aimed to describe the prevalence and burden of ictal-interictal patterns, including electrographic seizures after moderate-to-severe traumatic brain injury and to correlate continuous electroencephalography features with functional outcome. DESIGN: Post hoc analysis of the prospective, randomized controlled phase 2 multicenter INTREPID study (ClinicalTrials...
January 7, 2019: Critical Care Medicine
Nancy Kentish-Barnes, Zoé Cohen-Solal, Virginie Souppart, Gaëlle Cheisson, Liliane Joseph, Laurent Martin-Lefèvre, Anne Gaelle Si Larbi, Gérald Viquesnel, Sophie Marqué, Stéphane Donati, Julien Charpentier, Nicolas Pichon, Benjamin Zuber, Olivier Lesieur, Martial Ouendo, Anne Renault, Pascale Le Maguet, Stanislas Kandelman, Marie Thuong, Bernard Floccard, Chaouki Mezher, Jacques Duranteau, Elie Azoulay
OBJECTIVES: Family members of brain dead patients experience an unprecedented situation in which not only they are told that their loved one is dead but are also asked to consider organ donation. The objective of this qualitative study was to determine 1) what it means for family members to make the decision and to take responsibility, 2) how they interact with the deceased patient in the ICU, 3) how family members describe the impact of the process and of the decision on their bereavement process...
January 2, 2019: Critical Care Medicine
Marc Pineton de Chambrun, Philippe Cluzel, Isabelle Brocheriou, Nicolas Bréchot, Guillaume Hékimian, Mohamed-Wafik Turki, Guillaume Franchineau, Philippe Rouvier, Simon Bourcier, Côme Bureau, Ania Nieszkowska, Loïc Le Guennec, Alexis Mathian, Zahir Amoura, Matthieu Schmidt, Alain Combes, Charles-Edouard Luyt
OBJECTIVES: Transvenous renal biopsy is an alternative way to obtain kidney samples from patients with bleeding risk factors (e.g., antiplatelet therapy and anticoagulation or coagulation disorders). This study was undertaken to determine the safety and diagnostic yield of transvenous renal biopsy of critically ill patients. DESIGN: Monocenter, retrospective, observational cohort study. SETTING: A 26-bed French tertiary ICU. PATIENTS: All patients undergoing in-ICU transvenous renal biopsy between January 2002 and February 2018...
January 2, 2019: Critical Care Medicine
Sebastian Bunte, Friederike Behmenburg, Franziska Eckelskemper, Felix Mohr, Martin Stroethoff, Annika Raupach, André Heinen, Markus W Hollmann, Ragnar Huhn
OBJECTIVES: Remote ischemic preconditioning (RIPC) is a practicable and noninvasive method to protect the heart against ischemia reperfusion injury. Unfortunately results from clinical studies are not convincing. Propofol is suggested to be an inhibiting factor of cardioprotection by RIPC, but the underlying mechanism is still unknown. We investigated whether after RIPC the release of humoral factors and/or the direct cardioprotective effect at the myocardium is inhibited by propofol...
January 2, 2019: Critical Care Medicine
Annika Reintam Blaser, Adrian Regli, Bart De Keulenaer, Edward J Kimball, Liis Starkopf, Wendy A Davis, Patrick Greiffenstein, Joel Starkopf
OBJECTIVES: To identify the prevalence, risk factors, and outcomes of intra-abdominal hypertension in a mixed multicenter ICU population. DESIGN: Prospective observational study. SETTING: Fifteen ICUs worldwide. PATIENTS: Consecutive adult ICU patients with a bladder catheter. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Four hundred ninety-one patients were included...
January 2, 2019: Critical Care Medicine
Zoran Trogrlić, Mathieu van der Jagt, Hester Lingsma, Diederik Gommers, Huibert H Ponssen, Jeannette F J Schoonderbeek, Frodo Schreiner, Serge J Verbrugge, Servet Duran, Jan Bakker, Erwin Ista
OBJECTIVES: Implementation of delirium guidelines at ICUs is suboptimal. The aim was to evaluate the impact of a tailored multifaceted implementation program of ICU delirium guidelines on processes of care and clinical outcomes and draw lessons regarding guideline implementation. DESIGN: A prospective multicenter, pre-post, intervention study. SETTING: ICUs in one university hospital and five community hospitals. PATIENTS: Consecutive medical and surgical critically ill patients were enrolled between April 1, 2012, and February 1, 2015...
January 2, 2019: Critical Care Medicine
Jason N Batten, Katherine E Kruse, Stephanie A Kraft, Bela Fishbeyn, David C Magnus
OBJECTIVES: To explore how nonphysicians and physicians interpret the word "treatable" in the context of critical illness. DESIGN: Qualitative study using in-depth interviews. SETTING: One academic medical center. SUBJECTS: Twenty-four nonphysicians (patients and community members) purposively sampled for variation in demographic characteristics and 24 physicians (attending physicians and trainees) purposively sampled from four specialties (critical care, palliative care, oncology, and surgery)...
December 21, 2018: Critical Care Medicine
Guus P Leijte, Dorien Kiers, Wouter van der Heijden, Aron Jansen, Jelle Gerretsen, Verin Boerrigter, Mihai G Netea, Matthijs Kox, Peter Pickkers
OBJECTIVE: To investigate immunostimulatory effects of acetylsalicylic acid during experimental human endotoxemia and in sepsis patients. DESIGN: Double-blind, randomized, placebo-controlled study in healthy volunteers and ex vivo stimulation experiments using monocytes of septic patients. SETTING: Intensive care research unit of an university hospital. SUBJECTS: Thirty healthy male volunteers and four sepsis patients...
December 21, 2018: Critical Care Medicine
Anuj B Mehta, Allan J Walkey, Douglas Curran-Everett, Daniel Matlock, Ivor S Douglas
OBJECTIVES: Prior studies investigating hospital mechanical ventilation volume-outcome associations have had conflicting findings. Volume-outcome relationships within contemporary mechanical ventilation practices are unclear. We sought to determine associations between hospital mechanical ventilation volume and patient outcomes. DESIGN: Retrospective cohort study. SETTING: The California Patient Discharge Database 2016. PATIENTS: Adult nonsurgical patients receiving mechanical ventilation...
December 21, 2018: Critical Care Medicine
Mabel Chung, Yuansong Zhao, Jordan B Strom, Changyu Shen, Robert W Yeh
OBJECTIVES: Increasing age is a well-recognized risk factor for in-hospital mortality in patients receiving extracorporeal membrane oxygenation for cardiogenic shock, but the shape of this relationship is unknown. In addition, the impact of age on hospital length of stay, patterns of patient disposition, and costs has been incompletely characterized. DESIGN: Retrospective analysis of the National Inpatient Sample. SETTING: U.S. nonfederal hospitals, years 2004-2016...
December 21, 2018: Critical Care Medicine
Benjamin R Griffin, Anna Jovanovich, Zhiying You, Paul Palevsky, Sarah Faubel, Diana Jalal
OBJECTIVES: Thrombocytopenia is common in critically ill patients with severe acute kidney injury and may be worsened by the use of renal replacement therapy. In this study, we evaluate the effects of renal replacement therapy on subsequent platelet values, the prognostic significance of a decrease in platelets, and potential risk factors for platelet decreases. DESIGN: Post hoc analysis of the Acute Renal Failure Trial Network Study. SETTING: The Acute Renal Failure Trial Network study was a multicenter, prospective, randomized, parallel-group trial of two strategies for renal replacement therapy in critically ill patients with acute kidney injury conducted between November 2003 and July 2007 at 27 Veterans Affairs and university-affiliated medical centers...
December 21, 2018: Critical Care Medicine
Andrea Polito, Angelo Polito, Eléonore Bouchereau, Guy Moneger, Thomas Ritzenthaler, Djillali Annane, Nicholas Heming, Tarek Sharshar
OBJECTIVES: Acute respiratory failure is a frequent complication of Guillain-Barré syndrome, associated with high morbidity and mortality. Adjuvant treatments are needed to improve the outcome of Guillain-Barré syndrome. Since dysglycemia is a risk factor for development of axonal polyneuropathy in critically ill patients and since insulin therapy may be neuroprotective, we sought to explore the association between dysglycemia and neurologic status in Guillain-Barré syndrome patients...
December 21, 2018: Critical Care Medicine
Ian J Barbash, Billie Davis, Jeremy M Kahn
OBJECTIVES: The Centers for Medicare and Medicaid Services requires hospitals to report compliance with a sepsis treatment bundle as part of its Inpatient Quality Reporting Program. We used recently released data from this program to characterize national performance on the sepsis measure, known as SEP-1. DESIGN: Cross-sectional study of United States hospitals participating in the Centers for Medicare and Medicaid Services Hospital Inpatient Quality Reporting Program linked to Centers for Medicare and Medicaid Services' Healthcare Cost Reporting Information System...
December 21, 2018: Critical Care Medicine
Kathryn A Artis, James Bordley, Vishnu Mohan, Jeffrey A Gold
OBJECTIVES: Incomplete patient data, either due to difficulty gathering and synthesizing or inappropriate data filtering, can lead clinicians to misdiagnosis and medical error. How completely ICU interprofessional rounding teams appraise the patient data set that informs clinical decision-making is unknown. This study measures how frequently physician trainees omit data from prerounding notes ("artifacts") and verbal presentations during daily rounds. DESIGN: Observational study...
December 20, 2018: Critical Care Medicine
Daniel E Leisman
No abstract text is available yet for this article.
December 12, 2018: Critical Care Medicine
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