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Critical Care Medicine

Tamas Szakmany, Angharad M Walters, Richard Pugh, Ceri Battle, Damon M Berridge, Ronan A Lyons
OBJECTIVES: Clear understanding of the long-term consequences of critical care survivorship is essential. We investigated the care process and individual factors associated with long-term mortality among ICU survivors and explored hospital use in this group. DESIGN: Population-based data linkage study using the Secure Anonymised Information Linkage databank. SETTING: All ICUs between 2006 and 2013 in Wales, United Kingdom. PATIENTS: We identified 40,631 patients discharged alive from Welsh adult ICUs...
November 16, 2018: Critical Care Medicine
Kerong Hai, Guo Chen, Xueyan Gou, Haixia Jang, Deying Gong, Yan Cheng, Chansheng Gong, Xinghuan Li, Yuqi Liu, Huan Li, Gang Zhang, Linghui Yang, Bowen Ke, Jin Liu
OBJECTIVES: Monoacylglycerol lipase participates in organ protection by regulating the hydrolysis of the endocannabinoid 2-arachidonoylglycerol. This study investigated whether blocking monoacylglycerol lipase protects against postresuscitation myocardial injury and improves survival in a rat model of cardiac arrest and cardiopulmonary resuscitation. DESIGN: Prospective randomized laboratory study. SETTING: University research laboratory. SUBJECTS: Male Sprague-Dawley rat (n = 96)...
November 13, 2018: Critical Care Medicine
Philippa A McIlroy, Rebecca S King, Maité Garrouste-Orgeas, Alexis Tabah, Mahesh Ramanan
OBJECTIVES: To evaluate the effect of ICU diaries on posttraumatic stress disorder symptoms in ICU survivors and their relatives. Secondary objectives were to determine the effect on anxiety, depression, and health-related quality of life in patients and their relatives. DATA SOURCES: We searched online databases, trial registries, and references of relevant articles. STUDY SELECTION: Studies were included if there was an ICU diary intervention group which was compared with a group without a diary...
November 13, 2018: Critical Care Medicine
Chanu Rhee, Maximilian S Jentzsch, Sameer S Kadri, Christopher W Seymour, Derek C Angus, David J Murphy, Greg S Martin, Raymund B Dantes, Lauren Epstein, Anthony E Fiore, John A Jernigan, Robert L Danner, David K Warren, Edward J Septimus, Jason Hickok, Russell E Poland, Robert Jin, David Fram, Richard Schaaf, Rui Wang, Michael Klompas
OBJECTIVES: Administrative claims data are commonly used for sepsis surveillance, research, and quality improvement. However, variations in diagnosis, documentation, and coding practices for sepsis and organ dysfunction may confound efforts to estimate sepsis rates, compare outcomes, and perform risk adjustment. We evaluated hospital variation in the sensitivity of claims data relative to clinical data from electronic health records and its impact on outcome comparisons. DESIGN, SETTING, AND PATIENTS: Retrospective cohort study of 4...
November 13, 2018: Critical Care Medicine
Stavros Dimopoulos, Holly Joyce, Luigi Camporota, Guy Glover, Nicholas Ioannou, Christopher J Langrish, Andrew Retter, Christopher I S Meadows, Nicholas A Barrett, Stephen Tricklebank
OBJECTIVES: To investigate the safety of percutaneous dilatational tracheostomy in severe respiratory failure patients during veno-venous extracorporeal membrane oxygenation support. DESIGN: A single-center, retrospective, observational cohort study. SETTING: Tertiary referral severe respiratory failure center, university teaching hospital. PATIENTS: Severe respiratory failure patients consecutively admitted and supported with veno-venous extracorporeal membrane oxygenation between January 2010 and December 2015...
November 13, 2018: Critical Care Medicine
Joanne McPeake, Eliotte L Hirshberg, Leeann M Christie, Kelly Drumright, Kimberley Haines, Catherine L Hough, Joel Meyer, Dorothy Wade, Adair Andrews, Rita Bakhru, Samantha Bates, John A Barwise, Julie Bastarache, Sarah J Beesley, Leanne M Boehm, Sheryl Brown, Alison S Clay, Penelope Firshman, Steven Greenberg, Wendy Harris, Christopher Hill, Carol Hodgson, Clare Holdsworth, Aluko A Hope, Ramona O Hopkins, David C J Howell, Anna Janssen, James C Jackson, Annie Johnson, Erin K Kross, Daniela Lamas, Belinda MacLeod-Smith, Ruth Mandel, John Marshall, Mark E Mikkelsen, Megan Nackino, Tara Quasim, Carla M Sevin, Andrew Slack, Rachel Spurr, Mary Still, Carol Thompson, Gerald Weinhouse, M Elizabeth Wilcox, Theodore J Iwashyna
OBJECTIVES: Patients and caregivers can experience a range of physical, psychologic, and cognitive problems following critical care discharge. The use of peer support has been proposed as an innovative support mechanism. DESIGN: We sought to identify technical, safety, and procedural aspects of existing operational models of peer support, among the Society of Critical Care Medicine Thrive Peer Support Collaborative. We also sought to categorize key distinctions between these models and elucidate barriers and facilitators to implementation...
November 12, 2018: Critical Care Medicine
Antonio Francisco Oliveira-Neto, Mary Angela Parpinelli, Maria Laura Costa, Renato Teixeira Souza, Carolina Ribeiro do Valle, Maria Helena Sousa, José Guilherme Cecatti
OBJECTIVE: World Health Organization recommends the use of maternal near miss as a tool to monitor and improve quality of obstetric care. Severe maternal outcome corresponds to the sum of maternal near miss and maternal death cases. This study was aimed at validating Acute Physiology and Chronic Health Evaluation II and IV, Simplified Acute Physiology Score III, and Sequential Organ Failure Assessment in pregnant and postpartum women in predicting severe maternal outcome. DESIGN: A retrospective cohort study...
November 12, 2018: Critical Care Medicine
Kathleen L Meert, Anne-Marie Guerguerian, Ryan Barbaro, Beth S Slomine, James R Christensen, John Berger, Alexis Topjian, Melania Bembea, Sarah Tabbutt, Ericka L Fink, Steven M Schwartz, Vinay M Nadkarni, Russell Telford, J Michael Dean, Frank W Moler
OBJECTIVE: To describe neurobehavioral outcomes and investigate factors associated with survival and survival with good neurobehavioral outcome 1 year after in-hospital cardiac arrest for children who received extracorporeal cardiopulmonary resuscitation. DESIGN: Secondary analysis of the Therapeutic Hypothermia after Pediatric Cardiac Arrest In-Hospital trial. SETTING: Thirty-seven PICUs in the United States, Canada, and the United Kingdom...
November 12, 2018: Critical Care Medicine
Pierre-Marie Bertrand, Bruno Pereira, Mireille Adda, Jean-François Timsit, Michel Wolff, Gilles Hilbert, Didier Gruson, Maïté Garrouste-Orgeas, Laurent Argaud, Jean-Michel Constantin, Russel Chabanne, Jean-Pierre Quenot, Julien Bohe, Claude Guerin, Laurent Papazian, Olivier Jonquet, Kada Klouche, Arnaud Delahaye, Beatrice Riu, Laurent Zieleskiewicz, Michaël Darmon, Elie Azoulay, Bertrand Souweine, Alexandre Lautrette
OBJECTIVES: To compare the assessment of decision-making capacity of ICU patients by attending clinicians (physicians, nurses, and residents) with a capacity score measured by the Mini-Mental Status Examination, completed by Aid to Capacity Evaluation if necessary. The primary outcome was agreement between physicians' assessments and the score. Secondary outcomes were agreement between nurses' or residents' assessments and the score and identification of factors associated with disagreement...
November 9, 2018: Critical Care Medicine
Andrew M Morris, Anthony Bai, Lisa Burry, Linda D Dresser, Niall D Ferguson, Stephen E Lapinsky, Neil M Lazar, Mark McIntyre, John Matelski, Brian Minnema, Katie Mok, Sandra Nelson, Susan M Poutanen, Jeffrey M Singh, Miranda So, Marilyn Steinberg, Chaim M Bell
OBJECTIVES: Antimicrobial stewardship is advocated to reduce antimicrobial resistance in ICUs by reducing unnecessary antimicrobial consumption. Evidence has been limited to short, single-center studies. We evaluated whether antimicrobial stewardship in ICUs could reduce antimicrobial consumption and costs. DESIGN: We conducted a phased, multisite cohort study of a quality improvement initiative. SETTING: Antimicrobial stewardship was implemented in four academic ICUs in Toronto, Canada beginning in February 2009 and ending in July 2012...
November 7, 2018: Critical Care Medicine
Ari Moskowitz, Catherine E Ross, Lars W Andersen, Anne V Grossestreuer, Katherine M Berg, Michael W Donnino
OBJECTIVES: Clinical providers have access to a number of pharmacologic agents during in-hospital cardiac arrest. Few studies have explored medication administration patterns during in-hospital cardiac arrest. Herein, we examine trends in use of pharmacologic interventions during in-hospital cardiac arrest both over time and with respect to the American Heart Association Advanced Cardiac Life Support guideline updates. DESIGN: Observational cohort study. SETTING: Hospitals contributing data to the American Heart Association Get With The Guidelines-Resuscitation database between 2001 and 2016...
November 7, 2018: Critical Care Medicine
Wafa Ibn Saied, Bruno Mourvillier, Yves Cohen, Stephane Ruckly, Jean Reignier, Guillaume Marcotte, Shidasp Siami, Lila Bouadma, Michael Darmon, Etienne de Montmollin, Laurent Argaud, Hatem Kallel, Maité Garrouste-Orgeas, Lilia Soufir, Carole Schwebel, Bertrand Souweine, Dany Glodgran-Toledano, Laurent Papazian, Jean-François Timsit
OBJECTIVES: To investigate the respective impact of ventilator-associated pneumonia and ICU-hospital-acquired pneumonia on the 30-day mortality of ICU patients. DESIGN: Longitudinal prospective studies. SETTING: French ICUs. PATIENTS: Patients at risk of ventilator-associated pneumonia and ICU-hospital-acquired pneumonia. INTERVENTIONS: The first three episodes of ventilator-associated pneumonia or ICU-hospital-acquired pneumonia were handled as time-dependent covariates in Cox models...
November 7, 2018: Critical Care Medicine
Vatsal Trivedi, Helena Bleeker, Navot Kantor, Sarah Visintini, Daniel I McIsaac, Bernard McDonald
OBJECTIVES: Compared with noncardiac critical illness, critically ill postoperative cardiac surgical patients have different underlying pathophysiologies, are exposed to different processes of care, and thus may experience different outcome trajectories. Our objective was to systematically review the outcomes of cardiac surgical patients requiring prolonged intensive care with respect to survival, residential status, functional recovery, and quality of life in both hospital and long-term follow-up...
November 5, 2018: Critical Care Medicine
Palash Kar, Mark P Plummer, Yasmine Ali Abdelhamid, Emma J Giersch, Matthew J Summers, Luke M Weinel, Mark E Finnis, Liza K Phillips, Karen L Jones, Michael Horowitz, Adam M Deane
OBJECTIVES: Stress hyperglycemia occurs in critically ill patients and may be a risk factor for subsequent diabetes. The aims of this study were to determine incident diabetes and prevalent prediabetes in survivors of critical illness experiencing stress hyperglycemia and to explore underlying mechanisms. DESIGN: This was a prospective, single center, cohort study. At admission to ICU, hemoglobin A1c was measured in eligible patients. Participants returned at 3 and 12 months after ICU admission and underwent hemoglobin A1c testing and an oral glucose tolerance test...
November 5, 2018: Critical Care Medicine
Rodrigo Octavio Deliberato, Ary Serpa Neto, Matthieu Komorowski, David J Stone, Stephanie Q Ko, Lucas Bulgarelli, Carolina Rodrigues Ponzoni, Renato Carneiro de Freitas Chaves, Leo Anthony Celi, Alistair E W Johnson
OBJECTIVES: Although one third or more of critically ill patients in the United States are obese, obesity is not incorporated as a contributing factor in any of the commonly used severity of illness scores. We hypothesize that selected severity of illness scores would perform differently if body mass index categorization was incorporated and that the performance of these score models would improve after consideration of body mass index as an additional model feature. DESIGN: Retrospective cohort analysis from a multicenter ICU database which contains deidentified data for more than 200,000 ICU admissions from 208 distinct ICUs across the United States between 2014 and 2015...
November 1, 2018: Critical Care Medicine
Keith R Walley, John H Boyd, HyeJin Julia Kong, James A Russell
OBJECTIVES: Low low-density lipoprotein levels are associated with increased mortality in sepsis. Whether low low-density lipoprotein levels contribute causally to adverse sepsis outcome is unknown. DESIGN: Retrospective analysis of two sepsis patient cohorts using a Mendelian Randomization strategy. SETTING: Sepsis patients enrolled into clinical research cohorts at tertiary care teaching hospitals. PATIENTS: The first cohort included 200 sepsis patients enrolled in an observational study in a hospital Emergency Department...
November 1, 2018: Critical Care Medicine
Yugeesh R Lankadeva, Junko Kosaka, Naoya Iguchi, Roger G Evans, Lindsea C Booth, Rinaldo Bellomo, Clive N May
OBJECTIVES: To examine the effects of fluid bolus therapy on systemic hemodynamics, renal blood flow, intrarenal perfusion and oxygenation, PO2, renal function, and fluid balance in experimental early septic acute kidney injury. DESIGN: Interventional study. SETTING: Research institute. SUBJECTS: Adult Merino ewes. INTERVENTIONS: Implantation of flow probes on the pulmonary and renal arteries and laser Doppler oxygen-sensing probes in the renal cortex, medulla, and within a bladder catheter in sheep...
October 31, 2018: Critical Care Medicine
François Grolleau, Gary S Collins, Andrei Smarandache, Romain Pirracchio, Clément Gakuba, Isabelle Boutron, Jason W Busse, P J Devereaux, Yannick Le Manach
OBJECTIVES: The Fragility Index, which represents the number of patients responsible for a statistically significant finding, has been suggested as an aid for interpreting the robustness of results from clinical trials. A small Fragility Index indicates that the statistical significance of a trial depends on only a few events. Our objectives were to calculate the Fragility Index of statistically significant results from randomized controlled trials of anesthesia and critical care interventions and to determine the frequency of distorted presentation of results or "spin"...
October 31, 2018: Critical Care Medicine
Fahad Y Edrees, Sreelatha Katari, Jack D Baty, Anitha Vijayan
OBJECTIVES: Acute kidney injury requiring renal replacement therapy is associated with high morbidity and mortality. Complications of renal replacement therapy include hemodynamic instability with ensuing shortened treatments, inadequate ultrafiltration, and delay in renal recovery. Studies have shown that lowering dialysate temperature in patients with end-stage renal disease is associated with a decrease in the frequency of intradialytic hypotension. However, data regarding mitigation of hypotension by lowering dialysate temperature in patients with acute kidney injury are scarce...
October 31, 2018: Critical Care Medicine
Andrea Morelli, Filippo Sanfilippo, Philip Arnemann, Michael Hessler, Tim G Kampmeier, Annalia D'Egidio, Alessandra Orecchioni, Cristina Santonocito, Giacomo Frati, Ernesto Greco, Martin Westphal, Sebastian W Rehberg, Christian Ertmer
OBJECTIVES: Propofol-based sedation may increase hemodynamic instability by decreasing vascular tone and venous return. Incremental exogenous catecholamines doses may be required to counteract such effects, aggravating the deleterious effects of sympathetic overstimulation. α-2 adrenergic agonists have been reported to decrease norepinephrine requirements in experimental septic shock. The aim of the present study is to test the hypothesis that switching from sedation with propofol to the α-2 agonist dexmedetomidine may decrease norepinephrine doses in septic shock...
October 31, 2018: Critical Care Medicine
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