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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
Michael J Lanspa, Rebecca E Burk, Emily L Wilson, Eliotte L Hirshberg, Colin K Grissom, Samuel M Brown
Objective: Echocardiography is often used to guide septic shock resuscitation, but without evidence for efficacy. We conducted an intensive care unit (ICU)-based randomized controlled feasibility trial comparing echocardiography-guided septic shock resuscitation (ECHO) with early goal-directed therapy (EGDT). Methods: We conducted a single center, randomized controlled feasibility trial at a 468-bed academic tertiary care center in Utah, USA. Adult patients with early septic shock were assessed and treated at defined intervals over 6 h using an echocardiogram-guided resuscitation protocol or a slightly modified EGDT protocol...
2018: Journal of Intensive Care
Armin Ahmed, Afzal Azim
Background: Endotracheal intubation in critically ill is a high-risk procedure requiring significant expertise in airway handling as well as understanding of pathophysiology of the disease process. Main body: Critically ill patients are prone for hypotension and hypoxemia in the immediate post-intubation phase due to blunting of compensatory sympathetic response. Preoxygenation without NIV is frequently suboptimal, as alveolar flooding cause loss of alveolar capillary interface in many of these patients...
2018: Journal of Intensive Care
Kent Doi, Osamu Nishida, Takashi Shigematsu, Tomohito Sadahiro, Noritomo Itami, Kunitoshi Iseki, Yukio Yuzawa, Hirokazu Okada, Daisuke Koya, Hideyasu Kiyomoto, Yugo Shibagaki, Kenichi Matsuda, Akihiko Kato, Terumasa Hayashi, Tomonari Ogawa, Tatsuo Tsukamoto, Eisei Noiri, Shigeo Negi, Koichi Kamei, Hirotsugu Kitayama, Naoki Kashihara, Toshiki Moriyama, Yoshio Terada
Acute kidney injury (AKI) is a syndrome which has a broad range of etiologic factors depending on different clinical settings. Because AKI has significant impacts on prognosis in any clinical settings, early detection and intervention are necessary to improve the outcomes of AKI patients. This clinical guideline for AKI was developed by a multidisciplinary approach with nephrology, intensive care medicine, blood purification, and pediatrics. Of note, clinical practice for AKI management which was widely performed in Japan was also evaluated with comprehensive literature search...
2018: Journal of Intensive Care
Farzad Momenfar, Alireza Abdi, Nader Salari, Ali Soroush, Behzad Hemmatpour
Background: The main problem of hospitalized patients in intensive care units is feeding, and if the patient does not receive the daily caloric intake required to his body, he will have malnutrition and problems related to it. Abdominal massage is a method used to improve digestive function in various studies, but few studies have been conducted in intensive care units, and sometimes, contradictory results have been obtained. Therefore, the present study is conducted with the aim of determining the effect of abdominal massage on the gastric residual volume in patients hospitalized in intensive care units...
2018: Journal of Intensive Care
Fumiaki Tokioka, Hiroshi Okamoto, Akio Yamazaki, Akihiro Itou, Tadashi Ishida
Background: Quick Sepsis-related Organ Failure Assessment (qSOFA) is a new screening system for sepsis. The prognostic performance of qSOFA for patients with suspected infections outside the intensive care unit (ICU) is similar to that of full SOFA; however, its performance for community-acquired pneumonia (CAP) has not yet been evaluated in detail.The objectives of the present study were to compare the prognostic performance of qSOFA with existing pneumonia severity scores, such as CURB-65 (confusion, blood urea nitrogen > 19 mg/dL, respiratory rate ≥ 30/min, systolic blood pressure < 90 mmHg, or diastolic blood pressure ≤ 60 mmHg, age ≥ 65 years) and the pneumonia severity index (PSI), and examine its usefulness for predicting mortality and ICU admission in patients with CAP of high severity and mortality that requires hospitalization...
2018: Journal of Intensive Care
Yasuhiro Norisue, Yoshihisa Fujimoto, Kazuma Nakagawa
Background: Because of the complex pathophysiological processes involved, neurocritical care has been driven by anecdotal experience and physician preferences, which has led to care variation worldwide. Standardization of practice has improved outcomes for many of the critical conditions encountered in the intensive care unit. Main body: In this review article, we introduce preliminary guideline- and pathophysiology-based protocols for (1) prompt shivering management, (2) traumatic brain injury and intracranial pressure management, (3) neurological prognostication after cardiac arrest, (4) delayed cerebral ischemia after subarachnoid hemorrhage, (5) nonconvulsive status epilepticus, and (6) acute or subacute psychosis and seizure...
2018: Journal of Intensive Care
Yugo Okabe, Takehiko Asaga, Sayuri Bekku, Hiromi Suzuki, Kanae Kanda, Takeshi Yoda, Tomohiro Hirao, Gotaro Shirakami
Background: Extubation failure is associated with mortality and morbidity in the intensive care unit. Ventilator weaning protocols have been introduced, and extubation is conducted based on the results of a spontaneous breathing trial. Room for improvement still exists in extubation management, and additional objective indices may improve the safety of the weaning and extubation process. Static lung-thorax compliance reflects lung expansion difficulty that is caused by several conditions, such as atelectasis, fibrosis, and pleural effusion...
2018: Journal of Intensive Care
Satoshi Kodama, Noritoshi Arai, Akiyoshi Hagiwara, Akio Kimura, Sousuke Takeuchi
Background: New-onset refractory status epilepticus (NORSE) is a newly defined critical disease entity characterized by prolonged periods of refractory epileptic seizure with no readily identifiable cause in otherwise healthy individuals. Its etiology is uncertain, but autoimmune encephalitis is a possible candidate for the underlying cause of this condition. Immunotherapies could be considered for this condition, but its efficacy is not established. Case presentation: A 31-year-old man with no prior history presented with refractory status epilepticus...
2018: Journal of Intensive Care
Fahad Alroumi, Ahmed Abdul Azim, Rachel Kergo, Yuxiu Lei, James Dargin
Background: To assess, in the setting of severe sepsis and septic shock, whether current smokers have worse outcomes compared to non-smokers. Methods: This is a retrospective analysis of immunocompetent adult patients with severe sepsis and septic shock at a tertiary medical center. The primary outcome was the effect of active smoking on hospital mortality. Chi-square test and logistic regression were used to assess categorical outcomes. Wilcoxon rank-sum was utilized to test the differences in continuous outcomes among the varied smoking histories...
2018: Journal of Intensive Care
Taiga Itagaki, Yoshitoyo Ueno, Nobuto Nakanishi, Jun Oto
Reverse triggering is respiratory entrainment triggered by the ventilator especially seen among heavily sedated patients. We confirmed reverse triggering induced by auto-triggering in lightly sedated patient through an esophageal pressure monitoring. The reverse triggering frequently caused breath stacking with increased tidal volume. Physicians should be aware, even at an optimal level of sedation, that reverse triggering can develop, possibly caused by auto-triggering.
2018: Journal of Intensive Care
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