Outcomes in Patients with Vasodilatory Shock and Renal Replacement Therapy Treated with Intravenous Angiotensin II: Erratum
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Online Erratum Source Type: research

The authors reply
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

How Would You Evaluate the Quality of Uncontrolled Studies in a Meta-Analysis?
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

The authors reply
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Prevent Thrombus Formation: What We Are Doing
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

The authors reply
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Uncertainty in Diagnosis Leads to Underestimates of Performance
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

The authors reply
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Is the Tail Wagging the Dog in Sepsis?
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

The authors reply
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Fluid Responsiveness: Goal-Directed Care or Resuscitative Guide to Salt Water Drowning?
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

The authors reply
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

When Simply Informing May Not Suffice
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Delayed Cerebral Injury in Adults With Bacterial Meningitis: A Novel Complication of Adjunctive Steroids?*
Conclusions: Delayed cerebral injury occurred in 4.1% of adults with bacterial meningitis, and it was associated with the use of adjunctive steroids. Future studies should explore the etiology and prevention of this devastating complication. (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Online Brief Report Source Type: research

Inhibition of Vascular Endothelial Cell Leak Following Escherichia coli Attachment in an Experimental Model of Sepsis
Conclusions: Inhibition of E. coli binding to endothelial cell αVβ3 by cilengitide prevents endothelial dysfunction and may, therefore, present as a novel early therapeutic for the treatment of sepsis. (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Online Laboratory Investigations Source Type: research

Cecal Ligation and Puncture Alters Glucocorticoid Receptor Expression
The objective of this study is to determine the effects of cecal ligation and puncture on glucocorticoid receptor isoform abundance. Design: Determination of effects of cecal ligation and puncture on glucocorticoid receptor isoform subtype abundance in C57BL/6 mice. Examination of glucocorticoid receptor isoform abundance in tissues harvested from patients immediately after death from sepsis or nonseptic critical illness. Setting: Research laboratory. Subjects: C57BL/6 mice and human tissue sections from recently deceased critically ill patients. Interventions: C57BL/6 mice were subjected to cecal ligation and ...
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Online Laboratory Investigations Source Type: research

Niacin and Selenium Attenuate Brain Injury After Cardiac Arrest in Rats by Up-Regulating DJ-1-Akt Signaling
Conclusions: The combination therapy of clinically relevant doses of niacin and selenium attenuated brain injury and improved neurologic outcome in cardiac arrest rats. Its benefits were associated with reactive oxygen species reduction and subsequent DJ-1-Akt signaling up-regulation. (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Online Laboratory Investigations Source Type: research

Blue Light Enhances Bacterial Clearance and Reduces Organ Injury During Sepsis*
Conclusions: Modifying the spectrum of light may offer therapeutic utility in sepsis. (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Online Laboratory Investigations Source Type: research

Reversible Microvascular Hyporeactivity to Acetylcholine During Diabetic Ketoacidosis
Objectives: Metabolic acidosis is commonly observed in critically ill patients. Experimental studies suggested that acidosis by itself could impair vascular function, but this has been poorly investigated in human. Design: Prospective observational study. Setting: Medical ICU in a tertiary teaching hospital. Patients: To assess the relationship between metabolic acidosis severity and microvascular reactivity, we included adult diabetic patients admitted in ICU for ketoacidosis. Microvascular response to acetylcholine iontophoresis was measured at admission (baseline) and after correction of metabolic acidosis (2...
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Adjunct Ketamine Use in the Management of Severe Ethanol Withdrawal
Objectives: Ketamine offers a plausible mechanism with favorable kinetics in treatment of severe ethanol withdrawal. The purpose of this study is to determine if a treatment guideline using an adjunctive ketamine infusion improves outcomes in patients suffering from severe ethanol withdrawal. Design: Retrospective observational cohort study. Setting: Academic tertiary care hospital. Patients: Patients admitted to the ICU and diagnosed with delirium tremens by Diagnostic and Statistical Manual of Mental Disorders V criteria. Interventions: Pre and post guideline, all patients were treated in a symptom-triggere...
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Changes in MicroRNA Expression Level of Circulating Platelets Contribute to Platelet Defect After Cardiopulmonary Bypass
Conclusions: Expressions of several microRNAs in circulating platelets significantly changed between pre and post cardiopulmonary bypass. Overexpressions of mir-10b and mir-96 decreased glycoprotein 1b and vesicle-associated membrane protein 8 messenger RNA as well as protein, possibly causing platelet defect after cardiopulmonary bypass. (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Cardiac Arrest in Patients Managed for Convulsive Status Epilepticus: Characteristics, Predictors, and Outcome
Objectives: Cardiac arrest is a catastrophic event that may arise during the management of convulsive status epilepticus. We aimed to report the clinical characteristics, outcomes, and early predictors of convulsive status epilepticus–related cardiac arrest. Design: Retrospective multicenter study. Setting: Seventeen university or university affiliated participating ICUs in France and Belgium. Patients: Consecutive patients admitted to the participating ICUs for management of successfully resuscitated out-of-hospital cardiac arrest complicating the initial management of convulsive status epilepticus betwee...
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Effect of a Perioperative Intra-Aortic Balloon Pump in High-Risk Cardiac Surgery Patients: A Randomized Clinical Trial
Conclusions: In high-risk patients undergoing cardiac surgery, the perioperative use of an intra-aortic balloon pump did not reduce the occurrence of a composite outcome of 30-day mortality and major complications compared with usual care alone. (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Effect of Body Temperature on Cerebral Autoregulation in Acutely Comatose Neurocritically Ill Patients
Objectives: Impaired cerebral autoregulation following neurologic injury is a predictor of poor clinical outcome. We aimed to assess the relationship between body temperature and cerebral autoregulation in comatose patients. Design: Retrospective analysis of prospectively collected data. Setting: Neurocritical care unit of the Johns Hopkins Hospital. Patients: Eighty-five acutely comatose patients (Glasgow Coma Scale score of ≤ 8) admitted between 2013 and 2017. Interventions: None. Measurement and Main Results: Cerebral autoregulation was monitored using multimodal monitoring with near-infrared spectro...
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

The Potential Role of Steroid-Induced Cerebral Vasospasm in the Pathogenesis of Delayed Cerebral Injury in Bacterial Meningitis*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Editorials Source Type: research

Blue Light Illuminates a Novel Sepsis Treatment*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Editorials Source Type: research

Improving Evidence-Based Medical Care in Developing Countries*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Editorials Source Type: research

Sepsis—The “Gift” That Keeps on Giving, Regardless of Age*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Editorials Source Type: research

Sepsis Redefined…Again*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Editorials Source Type: research

Body Composition After Critical Illness: Fat in All the Wrong Places?*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Editorials Source Type: research

Trends for Palliative Care Use in the Prolonged Mechanically Ventilated Patient: Are We Moving Toward a Proactive Approach?*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Editorials Source Type: research

Glucose Monitoring in the ICU: What Is Really Needed?*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Editorials Source Type: research

Making the Medicine Go Down: Salt or Sugar?*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Editorials Source Type: research

What Matters Most When Considering Noninvasive Ventilation for Patients With Do-Not-Intubate or Comfort-Measures-Only Orders?*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Editorials Source Type: research

Increasing Evidence-Based Interventions in Patients with Acute Infections in a Resource-Limited Setting: A Before-and-After Feasibility Trial in Gitwe, Rwanda
Objective: To evaluate whether a focused education program and implementation of a treatment bundle increases the rate of early evidence-based interventions in patients with acute infections. Design: Single-center, prospective, before-and-after feasibility trial. Setting: Emergency department of a sub-Saharan African district hospital. Patients: Patients> 28 days of life admitted to the study hospital for an acute infection. Interventions: The trial had three phases (each of four months). Interventions took place during the second (educational program followed by implementation of the treatment bundle) and...
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Special Articles Source Type: research

Surviving Sepsis Campaign: Research Priorities for Sepsis and Septic Shock
Conclusions: While the Surviving Sepsis Campaign guidelines give multiple recommendations on the treatment of sepsis, significant knowledge gaps remain, both in bedside issues directly applicable to clinicians, as well as understanding the fundamental mechanisms underlying the development and progression of sepsis. The priorities identified represent a roadmap for research in sepsis and septic shock. (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Special Articles Source Type: research

Early Interventions for the Prevention of Posttraumatic Stress Symptoms in Survivors of Critical Illness: A Qualitative Systematic Review
Conclusions: Despite a paucity of high-quality clinical investigations, the preponderance of evidence to date suggests that 1) posttraumatic stress disorder among survivors of critical illness may be preventable and 2) early interventions may be the most effective. (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Review Articles Source Type: research

Criteria to Identify a Potential Deceased Organ Donor: A Systematic Review
Conclusions: Use of the clinical criteria sets reported will reduce ambiguity associated with the deceased organ donor identification and the subsequent referral process, potentially reducing the number of missed donors and saving lives globally through increased transplantation. (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Review Articles Source Type: research

Platelet Transfusion Practices in Critically Ill Children
Conclusions: The majority of platelet transfusions are given as prophylaxis to nonbleeding children, and significant variation in platelet thresholds exists. Studies are needed to clarify appropriate indications, with focus on prophylactic transfusions. (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Pediatric Critical Care Source Type: research

Clinical Factors Associated With ICU-Specific Care Following Supratentoral Brain Tumor Resection and Validation of a Risk Prediction Score
Conclusions: Less than 10% of patients required ICU-specific care following supratentorial tumor resection. A simple clinical scoring system may aid clinicians in stratifying the risk of requiring ICU care and could inform triage decisions when ICU bed availability is limited. (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Neurologic Critical Care Source Type: research

The Effect of IV Amino Acid Supplementation on Mortality in ICU Patients May Be Dependent on Kidney Function: Post Hoc Subgroup Analyses of a Multicenter Randomized Trial
Conclusions: In this post hoc, hypothesis-generating, subgroup analysis, we observed reduced mortality and improved estimated glomerular filtration rate in ICU patients with normal kidney function who were randomly allocated to receive increased protein intake (up to 2.0 g/kg/d). We strongly recommend confirmation of these results in trials with low risk of bias before this treatment is recommended for routine care. (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Dynamic Contrast-Enhanced Ultrasound Identifies Microcirculatory Alterations in Sepsis-Induced Acute Kidney Injury
Conclusions: In our lipopolysaccharide model, with resuscitation targeted at blood pressure, contrast-enhanced ultrasound imaging can identify renal microvascular alterations by showing prolonged contrast enhancement in microcirculation during shock, worsened by resuscitation with fluids. Concomitant analysis of sublingual microcirculation mirrored those observed in the renal microcirculation. (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Predictive Validity of Sepsis-3 Definitions and Sepsis Outcomes in Critically Ill Patients: A Cohort Study in 49 ICUs in Argentina
Conclusions: Increasing severity of Sepsis-3 categories adequately tracks mortality; cardiovascular dysfunction subgroup, not included in Sepsis-3, has distinct characteristics. Sequential Organ Failure Assessment score shows adequate prognosis accuracy─contrary to systemic inflammatory response syndrome. This study supports the predictive validity of Sepsis-3 definitions. (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Long-Term Survival of Young Patients Surviving ICU Admission With Severe Sepsis*
Objectives: Sepsis remains a disease with a high mortality rate. The study goal was to assess long-term survival of severe sepsis in young patients. Design: Retrospective cohort study. Setting: Patients admitted with sepsis to ICUs in seven tertiary hospitals between 2003 and 2011. Patients: A total of 409 patients less than 45 years who survived to hospital discharge were age and sex matched with 818 patients with infectious disease without sepsis selected from internal medicine or surgical department admissions. Interventions: None. Measurements and Main Results: The median age in sepsis patients and the...
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Duration of Respiratory Failure After Trauma Is Not Associated With Increased Long-Term Mortality
Conclusions: Duration of mechanical ventilation in the critically injured is not associated with 1-year mortality. Duration of ventilation following injury should not be used to predict long-term survival. (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

A Multicenter Observational Study of Family Participation in ICU Rounds
Conclusions: Our results suggest family attendance in ICU rounds is associated with longer duration of rounds, but not the frequency of trainee teaching, discussions of prognosis, or quality of rounds. Family attendance in rounds may enhance communication and complement family conferences. (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Mortality Measures to Profile Hospital Performance for Patients With Septic Shock*
Conclusions: Risk-standardized septic shock mortality rates varied considerably between hospitals, suggesting that septic shock is an important performance target. However, efforts to profile hospital performance were sensitive to septic shock case definitions, suggesting that septic shock mortality is not currently ready for widespread use as a hospital quality measure. (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Evaluating Muscle Mass in Survivors of Acute Respiratory Distress Syndrome: A 1-Year Multicenter Longitudinal Study*
This study examines survivors’ body composition in the year after acute respiratory distress syndrome and tests associations of patient characteristics, hospital exposures, and survivors’ strength and physical functioning with whole body percent lean mass. Design: Prospective cohort study with 6- and 12-month follow-up. Setting: National study enrolling patients from five study centers. Patients: Acute respiratory distress syndrome survivors (n = 120). Interventions: None. Measurements and Main Results: Lean and fat mass from dual energy x-ray absorptiometry. On average, survivors gained whole bo...
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

National Trends (2009–2013) for Palliative Care Utilization for Patients Receiving Prolonged Mechanical Ventilation*
We examined the trend in the utilization of palliative care among adults who require prolonged mechanical ventilation. Primary objectives were to determine the trend in palliative care utilization over time, predictors for palliative care utilization, and palliative care impact on hospital length of stay. Design: Retrospective, cross-sectional study. Setting: The National Inpatient Sample data between 2009 and 2013 was used for this study. Patients: Adults (age ≥ 18 yr) who underwent prolonged mechanical ventilation (≥ 96 consecutive hr) were studied. Measurements and Main Results: Palliative care and mec...
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Near-Continuous Glucose Monitoring Makes Glycemic Control Safer in ICU Patients*
Objectives: Tight glycemic control using intermittent blood glucose measurements is associated with a risk of hypoglycemia. Glucose concentrations can now be measured near continuously (every 5–15 min). We assessed the quality and safety of glycemic control guided by a near-continuous glucose monitoring system in ICU patients. Design: Prospective, cluster-randomized, crossover study. Setting: Thirty-five–bed medico-surgical department of intensive care with four separate ICUs. Patients: Adult patients admitted to the department and expected to stay for at least 3 days were considered for inclu...
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research