Antibiotic Delivery in Sepsis: How Do We Improve?
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

A Simple But Often Ignored Formula to Improve Critical Care: “Telemedicine + Ultrasound = Tele-Ultrasound”
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 22, 2020 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 - May 22, 2020 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Extracorporeal Membrane Oxygenation Support Prior to Heart Transplantation: “Festina Lente” (“Make Haste Slowly”)
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 22, 2020 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 - May 22, 2020 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Concerns With the Accuracy of Activities of Daily Living Score at ICU Discharge
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Understanding Characteristics of Acute Brain Injury in Adult Extracorporeal Membrane Oxygenation: An Autopsy Study*
Conclusions: In the population who underwent postmortem neuropathologic evaluation, 68% of extracorporeal membrane oxygenation nonsurvivors developed acute brain injury. Hypoxic-ischemic brain injury was the most common type of injury suggesting that patients sustained acute brain injury as a consequence of cardiogenic shock and cardiac arrest. Further research with a systematic neurologic monitoring is necessary to define the timing of acute brain injury in patients with extracorporeal membrane oxygenation. (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Online Brief Report Source Type: research

Nebulized Poractant Alfa Reduces the Risk of Respiratory Failure at 72 Hours in Spontaneously Breathing Surfactant-Deficient Newborn Piglets
Conclusions: In newborn piglets with respiratory distress syndrome, the nebulization of 400 mg/kg of poractant alfa using a customized investigational eFlow-Neos nebulizer was found to be safe and effective in reducing the risk of respiratory failure in the 72 hours after treatment. (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Online Laboratory Investigation Source Type: research

Predicting Mortality in Children With Pediatric Acute Respiratory Distress Syndrome: A Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Study
Conclusions: We describe predictive models for mortality in pediatric acute respiratory distress syndrome using readily available variables from day 0 of pediatric acute respiratory distress syndrome which outperform severity of illness scores and which demonstrate utility for composite outcomes such as ventilator-free days. Models can assist with risk stratification for clinical trials. (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Deep Versus Lobar Intraparenchymal Hemorrhage: Seizures, Hyperexcitable Patterns, and Clinical Outcomes
Conclusions: Electrographic seizures are frequent in lobar intraparenchymal hemorrhage, occurring in one in six monitored patients, as opposed to only 5% in isolated deep intraparenchymal hemorrhage not extending to cortex/insula, subarachnoid, or subdural spaces. Patients with lobar intraparenchymal hemorrhage and lateralized rhythmic delta activity were six times as likely to have electrographic seizures, which were associated with 5.47 higher odds of a poor outcome. Coma, temporal lobe involvement, hematoma volume, and electrographic seizures predicted poor outcome in lobar intraparenchymal hemorrhage. (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Impact of Bilateral Infiltrates on Inflammatory Biomarker Levels and Clinical Outcomes of Children With Oxygenation Defect
Objectives: The 2015 definition for pediatric acute respiratory distress syndrome did not require the presence of bilateral infiltrates. We tested the hypothesis that pediatric patients meeting oxygenation criteria for pediatric acute respiratory distress syndrome but without bilateral infiltrates would have different inflammatory biomarker levels and clinical outcomes than those with bilateral infiltrates. Design: Secondary analysis of a prospective cohort study. Setting: Twenty-two PICUs. Patients: Four-hundred forty-six patients age 2 weeks to 17 years intubated for respiratory failure with oxygenation index ...
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Ketamine Use for Tracheal Intubation in Critically Ill Children Is Associated With a Lower Occurrence of Adverse Hemodynamic Events
Conclusions: Ketamine use for tracheal intubation is associated with fewer hemodynamic tracheal intubation–associated adverse events. (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Association of Hypoactive and Hyperactive Delirium With Cognitive Function After Critical Illness
Conclusions: Longer duration of hypoactive delirium was independently associated with worse long-term cognition. Assessing motoric subtypes of delirium in the ICU might aid in prognosis and intervention allocation. Future studies should consider delineating motoric subtypes of delirium. (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Prediction of Symptomatic Venous Thromboembolism in Critically Ill Patients: The ICU-Venous Thromboembolism Score*
Conclusions: Clinically diagnosed symptomatic venous thromboembolism occurred in 1.4% of this large population of ICU patients with high adherence to chemoprophylaxis. Central venous catheterization and immobilization are potentially modifiable risk factors for venous thromboembolism. The ICU-Venous Thromboembolism score can identify patients at increased risk for venous thromboembolism. (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19)
Conclusion: The Surviving Sepsis Campaign COVID-19 panel issued several recommendations to help support healthcare workers caring for critically ill ICU patients with COVID-19. When available, we will provide new evidence in further releases of these guidelines. (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Online Special Article Source Type: research

Brain Autopsy Findings in Adult Extracorporeal Membrane Oxygenation: Precipitating Event or Extracorporeal Membrane Oxygenation Treatment? Need More Data…*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Editorials Source Type: research

Venous Thromboembolism in Critically Ill Patients Requires Significant Reconsideration*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Editorials Source Type: research

Continuous Versus Intermittent Infusion of Vancomycin: Toward the End of the Controversy or Even Closer to the Swan Song?*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Editorials Source Type: research

Toward a Better Understanding of Burnout Syndrome: Lump less, Split More*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Editorials Source Type: research

Useful Ethics Committees: No Mandate Required*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Editorials Source Type: research

The Limits of Syndrome Recognition: Time to Look Beyond the Bedside to Drive Adoption of Low Tidal Volume Ventilation in Acute Respiratory Distress Syndrome?*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Editorials Source Type: research

Oncologic Sepsis on the ICU: Two Decades of Improving Outcomes*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Editorials Source Type: research

B-Cell Dysfunction in Septic Shock: Still Flying Below the Radar*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Editorials Source Type: research

Rationally Advancing the Critical Care Research Agenda*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Editorials Source Type: research

Evaluating the Effect of Policy Changes on Sepsis Outcomes*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Editorials Source Type: research

Continuous Versus Intermittent Infusion of Vancomycin and the Risk of Acute Kidney Injury in Critically Ill Adults: A Systematic Review and Meta-Analysis*
Conclusions: When administered via a continuous infusion, vancomycin is associated with a 53% reduction in the odds of acute kidney injury and a 2.6-fold higher odds of pharmacokinetic target attainment when compared with intermittent infusion without influencing overall mortality. (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Review Article Source Type: research

The Reemergence of Ketamine for Treatment in Critically Ill Adults
Conclusions: Ketamine has suggested potential benefit in several disease states impacting critically ill patients including pain, alcohol withdrawal syndrome, status epilepticus, and acute agitation. Further supporting evidence is needed to validate its use in the setting of critical illness. (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Concise Definitive Review Source Type: research

Sepsis Mandates Help Clinicians and Patients
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Viewpoints Source Type: research

Current Sepsis Mandates Are Overly Prescriptive, and Some Aspects May Be Harmful
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Viewpoints Source Type: research

Survival and Hemodynamics During Pediatric Cardiopulmonary Resuscitation for Bradycardia and Poor Perfusion Versus Pulseless Cardiac Arrest
The objective of this study was to compare survival outcomes and intra-arrest arterial blood pressures between children receiving cardiopulmonary resuscitation for bradycardia and poor perfusion and those with pulseless cardiac arrests. Design: Prospective, multicenter observational study. Setting: PICUs and cardiac ICUs of the Collaborative Pediatric Critical Care Research Network. Patients: Children ( (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Pediatric Critical Care Source Type: research

Burnout in Pediatric Critical Care Medicine Fellows*
Conclusions: Pediatric critical care medicine fellows in the United States are experiencing high levels of burnout, which appears to be influenced by demographics, fellow perceptions of their work environment, and satisfaction with career choice. The exclusion of fellows at 30% of the programs may have over or underestimated the actual level of burnout in these trainees. (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Pediatric Critical Care Source Type: research

Stress-Induced Behavioral Quiescence and Abnormal Rest-Activity Rhythms During Critical Illness
Conclusions: Critically ill patients rapidly enter a state of behavioral quiescence proportionate to their illness severity with concomitant disturbance of circadian and ultradian rest-activity rhythms and loss of phase coherence with the melatonin rhythm. Quiescence characteristics in rest-activity rhythms were not different in patients with and without delirium, suggesting them to be distinct phenomena. Animal models of severe physiologic stress have shown that specific neural pathway separate from the sleep-wake regulatory pathway induce behavioral quiescence and rest-activity arrhythmia, and facilitate recovery of ce...
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Neurologic Critical Care Source Type: research

Factors Disrupting Melatonin Secretion Rhythms During Critical Illness
Conclusions: Encephalopathy severity and adrenergic agonist medication exposure were the primary factors contributing to abnormal melatonin rhythms. Improvements in encephalopathy and medical stabilization did not rapidly normalize rhythms. Urinary 6-sulphatoxymelatonin is not a reliable measure of the central circadian rhythm in critically ill patients. (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Neurologic Critical Care Source Type: research

Policies for Mandatory Ethics Consultations at U.S. Academic Teaching Hospitals: A Multisite Survey Study*
Conclusions: Among top-ranked academic medical centers, the existence and content of official policies regarding situations that mandate ethics consultations are variable. This finding suggests that, despite recent critical care consensus guidelines recommending institutional review as standard practice in particular scenarios, formal adoption of such policies has yet to become widespread and uniform. (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Joint Society of Critical Care Medicine-Extracorporeal Life Support Organization Task Force Position Paper on the Role of the Intensivist in the Initiation and Management of Extracorporeal Membrane Oxygenation
Conclusions: The role of the intensivist in the care of patients on extracorporeal membrane oxygenation continues to evolve and grow, especially when knowledge and familiarity of the issues surrounding extracorporeal membrane oxygenation selection, cannulation, and management are applied. (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Clinician Recognition of the Acute Respiratory Distress Syndrome: Risk Factors for Under-Recognition and Trends Over Time*
Objectives: The acute respiratory distress syndrome is common in critically ill patients. Recognition is crucial because acute respiratory distress syndrome is associated with a high mortality rate, and low tidal volume ventilation improves mortality. However, acute respiratory distress syndrome often goes unrecognized. Risk factors for under-recognition and trends over time have not been fully described. Design: Retrospective chart review of patients with acute respiratory distress syndrome from a prospective cohort study of critically ill patients. For each patient’s ICU stay, we searched the chart for terms t...
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Sepsis and Septic Shock in Patients With Malignancies: A Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique Study*
Objectives: Cancer affects up to 20% of critically ill patients, and sepsis is one of the leading reasons for ICU admission in this setting. Early signals suggested that survival might be increasing in this population. However, confirmation studies have been lacking. The goal of this study was to assess trends in survival rates over time in cancer patients admitted to the ICU for sepsis or septic shock over the last 2 decades. Data Source: Seven European ICUs. Study Selection: A hierarchical model taking into account the year of admission and the source dataset as random variables was used to identify risk factors ...
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Alterations of B Cells in Immunosuppressive Phase of Septic Shock Patients*
Conclusions: Severe B-cell abnormalities are present in the immunosuppressive phase of septic shock and are associated with prognosis. (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

The Association Between Neighborhood Socioeconomic Disadvantage and Readmissions for Patients Hospitalized With Sepsis
Objectives: To evaluate associations between a readily availvable composite measurement of neighborhood socioeconomic disadvantage (the area deprivation index) and 30-day readmissions for patients who were previously hospitalized with sepsis. Design: A retrospective study. Setting: An urban, academic medical institution. Patients: The authors conducted a manual audit for adult patients (18 yr old or older) discharged with an International Classification of Diseases, 10th edition code of sepsis during the 2017 fiscal year to confirm that they met SEP-3 criteria. Interventions: None. Measurements and Main Resu...
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Morbidity and Mortality in Critically Ill Children. II. A Qualitative Patient-Level Analysis of Pathophysiologies and Potential Therapeutic Solutions*
Conclusions: Low cardiac output and cardiac arrest, inflammation-related organ failures, and CNS trauma were the most common pathophysiologies leading to morbidity and mortality in PICUs. A research agenda focused on better understanding and treatment of these conditions may have high potential to directly impact patient outcomes. (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Feature Articles Source Type: research

Morbidity and Mortality in Critically Ill Children. I. Pathophysiologies and Potential Therapeutic Solutions*
Conclusions: There was no single dominant pathophysiology or cluster of pathophysiologies responsible for poor pediatric critical care outcomes. Therapeutic needs often involved therapies that are not close to implementation such as cell regeneration, improved organ transplant, improved extracorporeal support and artificial organs, and improved drugs. (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Feature Articles Source Type: research

Implementation of the Affordable Care Act: A Comparison of Outcomes in Patients With Severe Sepsis and Septic Shock Using the National Inpatient Sample*
Objectives: Sepsis is the most common and costly diagnosis in U.S.’ hospitals. Despite quality improvement programs and heightened awareness, sepsis accounts for greater than 50% of all hospital deaths. A key modifier of outcomes is access to healthcare. The Affordable Care Act, passed in 2010, expanded access to health insurance coverage. The purpose of this study was to evaluate changes in insurance coverage and outcomes in patients with severe sepsis and septic shock as a result of the full implementation of the Affordable Care Act. Design: This retrospective study uses data from the Healthcare Cost and Utili...
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Feature Articles Source Type: research

SEP-1 Has Brought Much Needed Attention to Improving Sepsis Care…But Now Is the Time to Improve SEP-1
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 22, 2020 Category: Emergency Medicine Tags: Foreword Source Type: research

Argument for Personalized Vasopressors in Septic Shock
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - April 16, 2020 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Neuromuscular Blockers in Acute Respiratory Distress Syndrome: Flat Dose or Not. Are We Missing the Point?
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - April 16, 2020 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Association of Anticoagulation and Mortality Could Be Explained by the Confounding of Preexisting Comorbidities
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - April 16, 2020 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Biomarker Panel to Differentiate Brain Injury From Brain Dysfunction in Patients With Sepsis-Associated Encephalopathy
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - April 16, 2020 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 - April 16, 2020 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Clinical Trials in the Critically Ill
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - April 16, 2020 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 - April 16, 2020 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research