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Journal of Intensive Care

Moritoki Egi
This review is for Con side of "Pro-Con debate" on the optimal target of blood glucose levels in patients with chronic hyperglycemia (e.g. premorbid HbA1c level > 7%). Currently, international guideline recommended that blood glucose level ≤ 180 mg/dL in critically ill patients irrespective of presence or absence of premorbid diabetes. However, there are several studies to generate the hypothesis that liberal glycemic control (e.g., target blood glucose level 180-250 mg/dL) may be beneficial in critically ill patients with premorbid hyperglycemia...
2018: Journal of Intensive Care
Andrea Cortegiani, Giovanni Misseri, Teresa Fasciana, Anna Giammanco, Antonino Giarratano, Anuradha Chowdhary
Candida spp . infections are a major cause of morbidity and mortality in critically ill patients. Candida auris is an emerging multi-drug-resistant fungus that is rapidly spreading worldwide. Since the first reports in 2009, many isolates across five continents have been identified as agents of hospital-associated infections. Independent and simultaneous outbreaks of C. auris are becoming a major concern for healthcare and scientific community. Moreover, laboratory misidentification and multi-drug-resistant profiles, rarely observed for other non-albicans Candida species, result in difficult eradication and frequent therapeutic failures of C...
2018: Journal of Intensive Care
Toshiaki Iba, Hiroshi Ogura
Background: The advances of research on extracellular vesicles (EVs) are of particular interest to the clinicians as well as the researchers who are studying coagulation disorder in sepsis. Here, we intend to update the latest knowledge and currently unsolved problems that should be addressed. Main body: Secreted membrane-enclosed vesicles including apoptotic bodies, exosomes, ectosomes, microvesicles, and microparticles are generically called EVs. Though the basic structure of these vesicles is the same, i...
2018: Journal of Intensive Care
Friederike Sophie Magnet, Hannah Bleichroth, Sophie Emilia Huttmann, Jens Callegari, Sarah Bettina Schwarz, Claudia Schmoor, Wolfram Windisch, Jan Hendrik Storre
Background: Patients who require a prolonged weaning process comprise a highly heterogeneous group of patients amongst whom the outcome differs significantly. The present study aimed to identify the factors that predict whether the outcome for prolonged weaning will be successful or unsuccessful. Methods: Data from tracheotomised patients who underwent prolonged weaning on a specialised weaning unit were assessed retrospectively via an electronic and paper-bound patient chart...
2018: Journal of Intensive Care
Jaime L Speiser, Constantine J Karvellas, Geoffery Shumilak, Wendy I Sligl, Yazdan Mirzanejad, Dave Gurka, Aseem Kumar, Anand Kumar
Background: Pneumonia complicated by septic shock is associated with significant morbidity and mortality. Classification and regression tree methodology is an intuitive method for predicting clinical outcomes using binary splits. We aimed to improve the prediction of in-hospital mortality in patients with pneumonia and septic shock using decision tree analysis. Methods: Classification and regression tree models were applied to all patients with pneumonia-associated septic shock in the international, multicenter Cooperative Antimicrobial Therapy of Septic Shock database between 1996 and 2015...
2018: Journal of Intensive Care
Shigeaki Inoue, Masafumi Saito, Joji Kotani
Background: Several advanced and developing countries are now entering a superaged society, in which the percentage of elderly people exceeds 20% of the total population. In such an aging society, the number of age-related diseases such as malignant tumors, diabetes, and severe infections including sepsis is increasing, and patients with such disorders often find themselves in the ICU. Main body: Age-related diseases are closely related to age-induced immune dysfunction, by which reductions in the efficiency and specificity of the immune system are collectively termed "immunosenescence...
2018: Journal of Intensive Care
Hiroko Aoyama, Yoshitsugu Yamada, Eddy Fan
Background: Management of patients with acute respiratory distress syndrome (ARDS) remains supportive with lung protective mechanical ventilation. In this article, we discuss the physiological concept of driving pressure, current data, ongoing trials, and future directions needed to clarify the role of driving pressure in patients with ARDS. Body: Driving pressure is the plateau airway pressure minus PEEP. It can also be expressed as the ratio of tidal volume to respiratory system compliance, indicating the decreased functional size of the lung observed in patients with ARDS (i...
2018: Journal of Intensive Care
Richard J Nies, Carsten Müller, Roman Pfister, Philipp S Binder, Nicole Nosseir, Felix S Nettersheim, Kathrin Kuhr, Martin H J Wiesen, Matthias Kochanek, Guido Michels
Background: Analgosedation is a cornerstone therapy for mechanically ventilated patients in intensive care units (ICU). To avoid inadequate sedation and its complications, monitoring of analgosedation is of great importance. The aim of this study was to investigate whether monitoring of analgosedative drug concentrations (midazolam and sufentanil) might be beneficial to optimize analgosedation and whether drug serum concentrations correlate with the results of subjective (Richmond Agitation-Sedation Scale [RASS]/Ramsay Sedation Scale) and objective (bispectral (BIS) index) monitoring procedures...
2018: Journal of Intensive Care
Rajesh Kasimahanti, Sai Kandraju Satish, Mridu Anand
Background: Community-acquired gram-negative bacillary meningitis is rare to occur without preexisting conditions like trauma, organ dysfunction, and immunocompromised state, and very few case reports with Escherichia coli have been described in literature till now. Presence of ventriculitis along with meningitis makes the incidence further sparse. Case presentation: A review of literature identified a total of only 45 community-acquired E. coli meningitis from 1945 till to date...
2018: Journal of Intensive Care
Weerachai Chaijamorn, Taniya Charoensareerat, Nattachai Srisawat, Sutthiporn Pattharachayakul, Apinya Boonpeng
Background: Cefepime can be removed by continuous renal replacement therapy (CRRT) due to its pharmacokinetics. The purpose of this study is to define the optimal cefepime dosing regimens for critically ill patients receiving CRRT using Monte Carlo simulations (MCS). Methods: The CRRT models of cefepime disposition during 48 h with different effluent rates were developed using published pharmacokinetic parameters, patient demographic data, and CRRT settings. Pharmacodynamic target was the cumulative percentage of a 48-h period of at least 70% that free cefepime concentration exceeds the four times susceptible breakpoint of Pseudomonas aeruginosa (minimum inhibitory concentration, MIC of 8)...
2018: Journal of Intensive Care
Edward Litton, Stuart Baker, Wendy Erber, Shannon Farmer, Janet Ferrier, Craig French, Joel Gummer, David Hawkins, Alisa Higgins, Axel Hofmann, Bart De Keulenaer, Julie McMorrow, John K Olynyk, Toby Richards, Simon Towler, Robert Trengove, Steve Webb
Background: Both anaemia and red blood cell (RBC) transfusion are common and associated with adverse outcomes in patients admitted to the intensive care unit (ICU). The aim of this study was to determine whether serum hepcidin concentration, measured early after ICU admission in patients with anaemia, could identify a group in whom intravenous (IV) iron therapy decreased the subsequent RBC transfusion requirement. Methods: We conducted a prospective observational study nested within a multicenter randomized controlled trial (RCT) of IV iron versus placebo...
2018: Journal of Intensive Care
Jan Albert Nicolaas Groot, Leonore Ten Bokum, Hubertus Laurentius Antonius van den Oever
Background: Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) commonly used in the treatment of depression. While most intoxications with SSRI's have favorable outcomes and do not require interventions other than strict observation of vital signs and heart rhythm, clinicians should be aware of the life-threatening complications that may occur. Case presentation: A 61-year-old woman presented to the emergency department after an intentional multiple drug overdose...
2018: Journal of Intensive Care
Spyros D Mentzelopoulos, Hector Anninos, Sotirios Malachias, Spyros G Zakynthinos
Background: Recent, large trials of high-frequency oscillation (HFO) versus conventional ventilation (CV) in acute respiratory distress syndrome (ARDS) reported negative results. This could be explained by an HFO-induced right ventricular (RV) dysfunction/failure due to high intrathoracic pressures and hypercapnia. We hypothesized that HFO strategies aimed at averting/attenuating hypercapnia, such as "low-frequency" (i.e., 4 Hz) HFO and 4-Hz HFO with tracheal-gas insufflation (HFO-TGI), may result in an improved RV function relative to "high-frequency" (i...
2018: Journal of Intensive Care
Takayuki Ogura, Yoshihiko Nakamura, Kunihiko Takahashi, Kazuki Nishida, Daisuke Kobashi, Shigeyuki Matsui
Background: The aim of this study is to investigate the association between treatment in a closed ICU and survival at discharge in patients with sepsis. Methods: This is a post hoc analysis utilizing data from the Japan Septic Disseminated Intravascular Coagulation study, including data from patients with sepsis from 2011 to 2013. Multiple logistic regression analysis was used to estimate the association between ICU policy and survival at discharge, and propensity score matching analysis was performed including the same covariates as a sensitivity analysis...
2018: Journal of Intensive Care
Gabriela A Kuraim, Daniel Garros, Lindsay Ryerson, Fahimeh Moradi, Irina A Dinu, Gonzalo Garcia Guerra, Diane Moddemann, Gwen Y Bond, Charlene M T Robertson, Ari R Joffe
Background: We aimed to determine predictors of, and outcomes after, veno-arterial extracorporeal membrane oxygenation instituted within 48 h after cardiac surgery (early ECMO) in young infants. Methods: Patients ≤ 6 weeks old having cardiac surgery from 2003 to 2012 were enrolled prospectively. Patients cannulated pre-operatively, intra-operatively, or ≥ 48 h post-operatively were excluded. Variables at p  ≤ 0.1 on univariate regression were entered into multiple logistic regression to predict early ECMO...
2018: Journal of Intensive Care
Shinshu Katayama, Ken Tonai, Yuya Goto, Kansuke Koyama, Toshitaka Koinuma, Jun Shima, Masahiko Wada, Shin Nunomiya
Background: Intravenous glycerol treatment, usually administered in the form of a 5% fructose solution, can be used to reduce intracranial pressure. The administered fructose theoretically influences blood lactate levels, although little is known regarding whether intravenous glycerol treatment causes transient hyperlactatemia. This study aimed to evaluate blood lactate levels in patients who received intravenous glycerol or mannitol. Methods: This single-center prospective observational study was performed at a 14-bed general intensive care unit between August 2016 and January 2018...
2018: Journal of Intensive Care
Shigeaki Aoyagi, Tomokazu Kosuga, Kumiko Wada, Shin-Ichi Nata, Hiroshi Yasunaga
Background: Although chest compression is a standard technique in cardiopulmonary resuscitation, it is well recognized that manual chest compression causes various internal injuries, of which major injuries are often fatal. Similarly, when cardiac tamponade occurs in patients with type A acute aortic dissection, many patients die before reaching the hospital. We report a rare case in which chest compressions caused pericardial laceration that may have inadvertently played a life-saving role in releasing cardiac tamponade induced by acute aortic dissection...
2018: Journal of Intensive Care
Gianfranco Umberto Meduri, Reed A C Siemieniuk, Rachel A Ness, Samuel J Seyler
An updated meta-analysis incorporating nine randomized trials ( n  = 816) investigating low-to-moderate dose prolonged glucocorticoid treatment in acute respiratory distress syndrome (ARDS) show moderate-to-high quality evidence that glucocorticoid therapy is safe and reduces (i) time to endotracheal extubation, (ii) duration of hospitalization, and (iii) mortality (number to treat to save one life = 7), and increases the number of days free from (i) mechanical ventilation, (ii) intensive care unit stay, and (iii) hospitalization...
2018: Journal of Intensive Care
Simon Tilma Vistisen, Martin Buhl Krog, Thomas Elkmann, Mikael Fink Vallentin, Thomas W L Scheeren, Christoffer Sølling
Background: Fluid responsiveness prediction with continuously available monitoring is an unsettled matter for the vast majority of critically ill patients, and development of new and reliable methods is desired. We hypothesized that the post-ectopic beat, which is associated with increased preload, could be analyzed in relation to preceding sinus beats and that the change in cardiac performance (e.g., systolic blood pressure) at the post-ectopic beat could predict fluid responsiveness...
2018: Journal of Intensive Care
Yazan Z M Zayed, Ahmed M Y Aburahma, Mahmoud O Barbarawi, Kewan Hamid, Momen R N Banifadel, Laith Rashdan, Ghassan I Bachuwa
Objectives: Intravenous fluids are one of the most used medical therapy for patients, especially critically ill patients. We conducted a meta-analysis comparing between balanced crystalloids and normal saline in critically ill patients and its effect on various clinical outcomes. Design: Meta-analysis and systematic review of randomized clinical trials (RCTs). Methods and data source: Electronic search was performed using PubMed, Cochrane library, and clinical trials...
2018: Journal of Intensive Care
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