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Journal of Intensive Care Medicine

Tyler Finocchio, William Coolidge, Thomas Johnson
The management of patients with human immunodeficiency virus (HIV) can be a complicated specialty within itself, made even more complex when there are so many unanswered questions regarding the care of critically ill patients with HIV. The lack of consensus on the use of antiretroviral medications in the critically ill patient population has contributed to an ongoing clinical debate among intensivists. This review focuses on the pharmacological complications of antiretroviral therapy (ART) in the intensive care setting, specifically the initiation of ART in patients newly diagnosed with HIV, immune reconstitution inflammatory syndrome (IRIS), continuation of ART in those who were on a complete regimen prior to intensive care unit admission, barriers of drug delivery alternatives, and drug-drug interactions...
October 11, 2018: Journal of Intensive Care Medicine
Kara Stoudt, Sanjay Chawla
Stress hyperglycemia is the transient increase in blood glucose as a result of complex hormonal changes that occur during critical illness. It has been described in the critically ill for nearly 200 years; patient harm, including increases in morbidity, mortality, and lengths of stay, has been associated with hyperglycemia, hypoglycemia, and glucose variability. However, there remains a contentious debate regarding the optimal glucose ranges for this population, most notably within the past 15 years. Recent landmark clinical trials have dramatically changed the treatment of stress hyperglycemia in the intensive care unit (ICU)...
October 11, 2018: Journal of Intensive Care Medicine
Amanda Korenoski, Angela Li, Sandra L Kane-Gill, Amy L Seybert, Pamela L Smithburger
PURPOSE: Conflicting data exists on the pharmacologic management of intensive care unit (ICU) delirium. This review appraises the current evidence of pharmacologic management of ICU delirium. MATERIALS AND METHODS: A systematic literature search of MEDLINE and Embase was conducted to answer the population, intervention, comparison, and outcome (PICO) question of: "Does the use of a pharmacologic agent compared to standard of care or placebo improve ICU delirium in a critically ill patient population?" RESULTS: After application of the PICO question and the inclusion and exclusion criteria, 13 articles were included...
October 11, 2018: Journal of Intensive Care Medicine
Chintan Dave, Jennifer Shen, Dipayan Chaudhuri, Brent Herritt, Shannon M Fernando, Peter M Reardon, Peter Tanuseputro, Kednapa Thavorn, David Neilipovitz, Erin Rosenberg, Dalibor Kubelik, Kwadwo Kyeremanteng
Static indices, such as the central venous pressure, have proven to be inaccurate predictors of fluid responsiveness. An emerging approach uses dynamic assessment of fluid responsiveness (FT-DYN), such as stroke volume variation (SVV) or surrogate dynamic variables, as more accurate measures of volume status. Recent work has demonstrated that goal-directed therapy guided by FT-DYN was associated with reduced intensive care unit (ICU) mortality; however, no study has specifically assessed this in surgical ICU patients...
October 11, 2018: Journal of Intensive Care Medicine
Barret Rush, Katie Wiskar, Clark Fruhstorfer, Leo Anthony Celi, Keith R Walley
OBJECTIVE: The impact of chronic exposure to air pollution on mortality in patients with sepsis is unknown. We attempted to quantify the relationship between air pollution, notably excess ozone, and particulate matter (PM), with in-hospital mortality in patients with sepsis nationwide. METHODS: The 2011 Nationwide Inpatient Sample (NIS) was linked with ambient air pollution data from the Environmental Protection Agency for both 8-hour ozone exposure and annual mean 2...
October 7, 2018: Journal of Intensive Care Medicine
Christian von Loeffelholz, Daniel Thomas-Rüddel, Michael Bauer, Andreas Birkenfeld
No abstract text is available yet for this article.
October 7, 2018: Journal of Intensive Care Medicine
Seth Lotterman
No abstract text is available yet for this article.
October 7, 2018: Journal of Intensive Care Medicine
Sarika Gupta, Areesha Alam
BACKGROUND: Aim of the study was to analyze the association of shock index (SI) from 0 to 6 hours with early mortality in severe sepsis/septic shock and to explore its age-specific cut-off values. To investigate association of change in SI over first 6 hours with early mortality. METHODS: A prospective cohort study of children (<14 years) admitted in emergency department, tertiary care hospital with severe sepsis or septic shock, divided into 3 groups: group 1: 1 month to <1 year; group 2: 1 to <6 years; group 3: 6 to 12 years...
October 2, 2018: Journal of Intensive Care Medicine
Zinat Heidary, Hossein Khalili
No abstract text is available yet for this article.
October 1, 2018: Journal of Intensive Care Medicine
Young Su Kim, Yang Hyun Cho, Kiick Sung, Jeong-Am Ryu, Chi Ryang Chung, Gee Young Suh, Jeong Hoon Yang, Ji-Hyuk Yang
PURPOSE: Target temperature management (TTM) and extracorporeal cardiopulmonary resuscitation (ECPR) have been established as important interventions during cardiopulmonary arrest. However, the impact of combined TTM and ECPR on clinical outcomes has not been studied in detail. METHODS: We reviewed the records of 245 patients who received extracorporeal life support (ECLS) between January 2012 and June 2015. Exclusion criteria were as follows: Extracorporeal life support performed for reasons other than cardiac arrest, age less than 18 years, and death within 24 hours...
October 1, 2018: Journal of Intensive Care Medicine
Somnath Bose, Alistair E W Johnson, Ari Moskowitz, Leo Anthony Celi, Jesse D Raffa
OBJECTIVE: Patients often overstay in intensive care units (ICU) after they are deemed discharge ready. The objective of this study was to examine the impact of such discharge delays (DD) on subsequent in-hospital morbidity and mortality. DESIGN: Retrospective cohort study. SETTING: Single tertiary academic medical center. PATIENTS: Adult patients admitted to the medical ICU between 2005 and 2011. INTERVENTIONS: For all patients, DD (ie, time between request for a ward bed and time of ICU discharge) was calculated...
October 1, 2018: Journal of Intensive Care Medicine
Qing-Quan Lyu, Qi-Hong Chen, Rui-Qiang Zheng, Jiang-Quan Yu, Xiao-Hua Gu
BACKGROUND: The efficacy of low-dose hydrocortisone therapy in the management of septic shock remains controversial in critical care for many years. Hence, we performed this meta-analysis of randomized controlled trials (RCTs) with trial sequential analysis (TSA) to evaluate its effect on clinical outcome among adult patients with septic shock. METHODS: We identified relevant RCTs published from inception to March 7, 2018 comparing low-dose hydrocortisone with placebo or no intervention in adults admitted to the intensive care unit (ICU) for septic shock...
October 1, 2018: Journal of Intensive Care Medicine
J Dermot Frengley, Giorgio R Sansone, Robert J Kaner
OBJECTIVE: To determine whether burdens of chronic comorbid illnesses can predict the clinical course of prolonged mechanical ventilation (PMV)patients in a long-term, acute-care hospital (LTACH). METHODS: Retrospective study of 866 consecutive PMV patients whose burdens of chronic comorbid illnesses were quantified using the Cumulative Illness Rating Scale (CIRS). Based on increasing CIRS scores, 6 groups were formed and compared: group A (≤25; n = 97), group B (26-28; n = 105), group C (29-31; n = 181), group D (32-34; n = 208), group E (35-37; n = 173), and group F (>37; n = 102)...
October 1, 2018: Journal of Intensive Care Medicine
Ulrich Mayr, Leonie Fahrenkrog-Petersen, Gonzalo Batres-Baires, Sebastian Rasch, Alexander Herner, Roland M Schmid, Wolfgang Huber, Tobias Lahmer
INTRODUCTION: A 25-hydroxyvitamin D, 25(OH)D, deficiency is common among critically ill patients and correlated with increased mortality. Furthermore, deficiency is associated with advanced liver disease. However, there are no studies available comparing the dimensions and consequences of a 25(OH)D deficiency between patients with and without liver cirrhosis in the setting of intensive care units (ICUs). This study focuses on differences in 25(OH)D status between critically ill noncirrhosis patients and patients with cirrhosis (primary end point), hypothesizing that deficiency and its impact on mortality risk are even more pronounced in patients with cirrhosis...
October 1, 2018: Journal of Intensive Care Medicine
Kristen M Nelson, Gourang P Patel, Drayton A Hammond
PURPOSE: To compare the development of clinically significant hemodynamic event (ie, hypotension or bradycardia) in adults with septic shock receiving either propofol or dexmedetomidine. MATERIALS AND METHODS: A retrospective cohort study of adults with septic shock admitted to an intensive care unit (ICU) at an academic medical center between July 2013 and July 2017. RESULTS: Patients in the propofol (n = 35) and dexmedetomidine (n = 37) groups developed a clinically significant hemodynamic event at similar frequencies (31...
September 27, 2018: Journal of Intensive Care Medicine
Teresa A Allison, Pei Jen Lin, Jennifer A Gass, Kenneth Chong, Samuel J Prater, Miguel A Escobar, Heather D Hartman
OBJECTIVE: This study investigated the percentage of patients who achieved hemostasis with 4-factor prothrombin complex concentrate (4-factor PCC) 35 U/kg. The primary end point was to determine the effect of 4-factor PCC 35 U/kg on bleeding progression, assessed using computed tomography. METHODS: This was a retrospective, observational, single-center study conducted in patients with a major bleed admitted to a level 1 trauma center from May 1, 2013, to June 15, 2015, who received 4-factor PCC 35 U/kg for reversal of a direct factor Xa inhibitor taken prior to admission...
September 24, 2018: Journal of Intensive Care Medicine
Erik Folch, Fayez Kheir, Amit Mahajan, Daniel Alape, Omar Ibrahim, Eugene Shostak, Adnan Majid
BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) tube placement is a procedure frequently done in the intensive care unit. The use of a traditional endoscope can be difficult in cases of esophageal stenosis and theoretically confers an increased risk of infection due to its complex architecture. We describe a technique using the bronchoscope, which allows navigation through stenotic esophageal lesions and also minimizes the risk of endoscopy-associated infections. METHODS: Prospective series of patients who had PEG tube placement guided by a bronchoscope...
September 24, 2018: Journal of Intensive Care Medicine
Jiahui Zhang, Na Cui, Hao Wang, Wen Han, Yuanfei Li, Meng Xiao, Dawei Liu
OBJECTIVES: This study aimed to investigate the distinguishing ability of lymphocyte subtyping for diagnosis and prognosis of invasive fungal disease (IFD). METHODS: We assessed lymphocyte subtyping and evaluated the quantitative changes in key immunological parameters at intensive care unit (ICU) admission in critically ill patients at high risk and their potential influence on diagnosis and outcome of IFD. The primary outcome was 28-day mortality. RESULTS: Among the 124 critically ill patients with mean Candida score 3...
September 19, 2018: Journal of Intensive Care Medicine
Jacob Bell, Munish Goyal, Sallie Long, Anagha Kumar, Joseph Friedrich, Jonathan Garfinkel, Suzi Chung, Shimae Fitzgibbons
BACKGROUND: Central venous catheter (CVC) complication rates reflecting the application of modern insertion techniques to a clinically heterogeneous patient populations are needed to better understand procedural risk attributable to the 3 common anatomic insertion sites: internal jugular, subclavian, and femoral veins. We sought to define site-specific mechanical and duration-associated CVC complication rates across all hospital inpatients. METHODS: A retrospective chart review was conducted over 9 months at Georgetown University Hospital and Washington Hospital Center...
September 19, 2018: Journal of Intensive Care Medicine
Andreas Keyser, Alois Philipp, Florian Zeman, Matthias Lubnow, Dirk Lunz, Markus Zimmermann, Christof Schmid
BACKGROUND: Extracorporeal life support systems are well-established devices for treating patients with acute cardiopulmonary failure. Severe or morbid obesity may result in complications such as limb ischemia, bleeding, unsuccessful cannulation, or infection at the cannulation sites. This article reports on our experience with cannulation and associated complications in severely and morbidly obese patients. METHODS: Between January 2006 and September 2016, 153 severely or morbidly obese patients with a body mass index >35 kg/m2 were cannulated percutaneously for extracorporeal life support at our center...
September 19, 2018: Journal of Intensive Care Medicine
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