The authors reply
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 25, 2021 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Anesthetics and Clock Genes Expression in Critically Ill Patients
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 25, 2021 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 - February 25, 2021 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Does Norepinephrine Exhibit a Time-Dose Relationship in Septic Shock?
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 25, 2021 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 - February 25, 2021 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Changes in Venoarterial Extracorporeal Membrane Oxygenation Management Over Time Could Explain a More Frequent Diagnosis of Neurological Complications in That Population
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 25, 2021 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 - February 25, 2021 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Fragility Index and Trial Sequential Analysis for Randomized Controlled Studies Comparing High-Flow Nasal Cannula and Noninvasive Ventilation With Conventional Oxygen Therapy
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 25, 2021 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 - February 25, 2021 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Impact of Serum Chloride and Sodium in Patients With Decompensated Cirrhosis
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 25, 2021 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 - February 25, 2021 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Early or Late Tracheostomy in Patients With Traumatic Brain Injury
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 25, 2021 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 - February 25, 2021 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Stellate Ganglion Blockade Should Be Considered for Patients With Drug-Refractory Electrical Storm on Venoarterial Extracorporeal Membrane Oxygenation
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 25, 2021 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Deciphering Survival in Electrical Storm on Extracorporeal Membrane Oxygenation: “A Posteriori” (“From Effect to Cause”)
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 25, 2021 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

The Relationship Between Heart Rate and Body Temperature in Critically Ill Patients
OBJECTIVE: The presence of tachycardia in critically ill patients is frequently used as an indication of severity of illness and to guide treatment decisions but can be influenced by body temperature, thus confounding its interpretation. There are few data available on the relationship between body temperature and heart rate in critically ill patients. DESIGN: Retrospective analysis of prospectively collected data. SETTING: Mixed medical-surgical university hospital ICU. PATIENTS: All patients admitted to the ICU between November 2006 and August 2019. MEASUREMENTS AND MAIN RESULTS: Body temp...
Source: Critical Care Medicine - February 25, 2021 Category: Emergency Medicine Tags: Online Brief Report Source Type: research

Catecholaminergic Vasopressors Reduce Toll-Like Receptor Agonist-Induced Microvascular Endothelial Cell Permeability But Not Cytokine Production
CONCLUSIONS: Our findings demonstrate that treatment with epinephrine or norepinephrine strongly reduces endothelial permeability induced by agonists of multiple Toll-like receptors (Toll-like receptor-2, Toll-like receptor-3, Toll-like receptor-4) in vitro. Our studies suggest that both β1- and β2-adrenergic receptors mediate the stabilizing effects of epinephrine and norepinephrine on the endothelial barrier. (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 25, 2021 Category: Emergency Medicine Tags: Online Laboratory Investigation Source Type: research

Awareness With Paralysis in Mechanically Ventilated Patients in the Emergency Department and ICU: A Systematic Review and Meta-Analysis*
CONCLUSIONS: The incidence of awareness with paralysis in mechanically ventilated patients in the emergency department and ICU, as evaluated in a small number of qualifying studies from this comprehensive systematic review, appears much higher than that reported from the operating room. Given the clinical and statistical heterogeneity, caution is warranted in the interpretation of these findings. Further high-quality studies are needed to both define the true incidence and to target the prevention of awareness with paralysis in this vulnerable patient cohort. (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 25, 2021 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Life-Threatening Hemoptysis in a Pediatric Referral Center
We describe hemoptysis-associated ICU admissions, including those who were critically ill at hemoptysis onset or who became critically ill as a result of hemoptysis, and identify predictors of mortality. DESIGN: Retrospective cohort study. Demographics, hemoptysis location, and management were collected. Pediatric Logistic Organ Dysfunction-2 score within 24 hours of hemoptysis described illness severity. Primary outcome was inhospital mortality. SETTING: Quaternary pediatric referral center between July 1, 2010, and June 30, 2017. PATIENTS: Medical/surgical (PICU), cardiac ICU, and term neonatal ICU a...
Source: Critical Care Medicine - February 25, 2021 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Derivation and Validation of an Ensemble Model for the Prediction of Agitation in Mechanically Ventilated Patients Maintained Under Light Sedation
This study aimed to develop and prospectively validate an ensemble machine learning model for the prediction of agitation on a daily basis. DESIGN: Variables collected in the early morning were used to develop an ensemble model by aggregating four machine learning algorithms including support vector machines, C5.0, adaptive boosting with classification trees, and extreme gradient boosting with classification trees, to predict the occurrence of agitation in the subsequent 24 hours. SETTING: The training dataset was prospectively collected in 95 ICUs from 80 Chinese hospitals on May 11, 2016, and the validation...
Source: Critical Care Medicine - February 25, 2021 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Prone Position Ventilation in Neurologically Ill Patients: A Systematic Review and Proposed Protocol
CONCLUSIONS: Although elevations in intracranial pressure and reductions in cerebral perfusion pressure do occur during proning, they may not occur to a degree that would warrant exclusion of prone ventilation as a treatment modality for patients with acute respiratory distress syndrome and concomitant neurologic diagnoses. In cases where intracranial pressure, cerebral perfusion pressure, and brain tissue oxygenation can be monitored, prone position ventilation should be considered a safe and viable therapy. (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 25, 2021 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Racial Disparities in Readmissions Following Initial Hospitalization for Sepsis
OBJECTIVES: To assess whether Black race is associated with a higher rate of all-cause readmission compared with White race following community-onset sepsis. DESIGN: Retrospective cohort study. SETTING: One-thousand three-hundred bed urban academic medical centers. PATIENTS: Three-thousand three-hundred ninety patients hospitalized with community-onset sepsis between January 1, 2010, and December 31, 2017. INTERVENTIONS: Community-onset sepsis was defined as patients admitted through the emergency department with an International Classification of Disease, ninth revision, Clinical Modificati...
Source: Critical Care Medicine - February 25, 2021 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Effects of the Level and Duration of Mobilization Therapy in the Surgical ICU on the Loss of the Ability to Live Independently: An International Prospective Cohort Study
OBJECTIVES: It is unclear whether early mobilization in the surgical ICU helps improve patients’ functional recovery to a level that enables independent living. We assessed dose of mobilization (level + duration). We tested the research hypotheses that dose of mobilization predicts adverse discharge and that both duration of mobilization and maximum mobilization level predict adverse discharge. DESIGN: International, prospective cohort study. SETTING: Study conducted in five surgical ICUs at four different institutions. PATIENTS: One hundred fifty patients who were functionally independent be...
Source: Critical Care Medicine - February 25, 2021 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Efficacy of Early Prophylaxis Against Catheter-Associated Thrombosis in Critically Ill Children: A Bayesian Phase 2b Randomized Clinical Trial*
CONCLUSIONS: These findings suggest the efficacy and safety of early prophylaxis that should be validated in a pivotal randomized clinical trial. (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 25, 2021 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Surviving Sepsis Campaign Guidelines on the Management of Adults With Coronavirus Disease 2019 (COVID-19) in the ICU: First Update
CONCLUSION: The Surviving Sepsis Campaign Coronavirus Diease 2019 panel issued several recommendations to guide healthcare professionals caring for adults with critical or severe coronavirus disease 2019 in the ICU. Based on a living guideline model the recommendations will be updated as new evidence becomes available. (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 25, 2021 Category: Emergency Medicine Tags: Online Special Article Source Type: research

Online Editorial Board Acknowledgment
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 25, 2021 Category: Emergency Medicine Tags: Online Editorial Board Acknowledgment Source Type: research

Septic Until Proven Otherwise
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 25, 2021 Category: Emergency Medicine Tags: Editorials Source Type: research

Mr. Sandman, Bring Me a Dream*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 25, 2021 Category: Emergency Medicine Tags: Editorials Source Type: research

Catheter-Associated Deep Venous Thrombosis Prevention: Which Path to Choose?*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 25, 2021 Category: Emergency Medicine Tags: Editorials Source Type: research

Prone Positioning Works: But for How Long and to What End Point?*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 25, 2021 Category: Emergency Medicine Tags: Editorials Source Type: research

The Complex Issue of Race and Coronavirus Disease 2019 in the ICU*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 25, 2021 Category: Emergency Medicine Tags: Editorials Source Type: research

Is Goal-Directed Fluid Therapy so FAB?*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 25, 2021 Category: Emergency Medicine Tags: Editorials Source Type: research

The Pandemic Paradox: A Celebrated Exhaustion
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 25, 2021 Category: Emergency Medicine Tags: Editorials Source Type: research

Direction and Magnitude of Change in Plateau From Peak Pressure During Inspiratory Holds Can Identify the Degree of Spontaneous Effort and Elastic Workload in Ventilated Patients
OBJECTIVES: Inspiratory holds with measures of airway pressure to estimate driving pressure (elastic work) are often limited to patients without respiratory effort. We sought to evaluate if measures of airway pressure during inspiratory holds could be used for patients with spontaneous respiratory effort during mechanical ventilation to estimate the degree of spontaneous effort and elastic work. DESIGN: We compared the direction and degree of change in airway pressure during inspiratory holds versus esophageal pressure through secondary analysis of physiologic data. SETTING: ICUs at Children’s Hospi...
Source: Critical Care Medicine - February 25, 2021 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Core Outcome Measures for Trials in People With Coronavirus Disease 2019: Respiratory Failure, Multiorgan Failure, Shortness of Breath, and Recovery
CONCLUSIONS: The coronavirus disease 2019 core outcome set recommended core outcome measures have content validity and are considered the most feasible and acceptable among existing measures. Implementation of the core outcome measures in trials in coronavirus disease 2019 will ensure consistency and relevance of the evidence to inform decision-making and care of patients with coronavirus disease 2019. (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 25, 2021 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Safety and Outcomes of Prolonged Usual Care Prone Position Mechanical Ventilation to Treat Acute Coronavirus Disease 2019 Hypoxemic Respiratory Failure*
CONCLUSIONS: Prolonged prone position ventilation was feasible and relatively safe with implications for wider adoption in treating critically ill coronavirus disease 2019 patients and acute respiratory distress syndrome of other etiologies. (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 25, 2021 Category: Emergency Medicine Tags: Feature Articles Source Type: research

Racial Differences in a Detroit, MI, ICU Population of Coronavirus Disease 2019 Patients
CONCLUSIONS: In critically ill patients infected with coronavirus disease 2019, people of color had a lower 28-day mortality than Whites with no difference in hospital mortality, ICU length of stay, or rates of intubation. These findings are contrary to previously held beliefs surrounding the pandemic. (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 25, 2021 Category: Emergency Medicine Tags: Feature Articles Source Type: research

Choosing Wisely For Critical Care: The Next Five
CONCLUSIONS: Five new recommendations to reduce waste and enhance value in the practice of critical care address invasive devices, proactive liberation from mechanical ventilation, antibiotic stewardship, early mobilization, and providing goal-concordant care. These recommendations supplement the initial critical care recommendations from the “Choosing Wisely” campaign. (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 25, 2021 Category: Emergency Medicine Tags: Feature Articles Source Type: research

Opioid Use After Intensive Care: A Nationwide Cohort Study
OBJECTIVE: To describe opioid use after ICU admission, identify factors associated with chronic opioid use after critical care, and determine if chronic opioid use is associated with an increased risk of death. DESIGN: Retrospective cohort study. SETTING: Sweden including all registered ICU admissions between 2010 and 2018. PATIENTS: Adults surviving the first two quarters after ICU admission were eligible for inclusion. A total of 265,496 patients were screened and 61,094 were ineligible. INTERVENTIONS: Admission to intensive care. MEASUREMENTS AND MAIN RESULTS: Among 204,402 individ...
Source: Critical Care Medicine - February 25, 2021 Category: Emergency Medicine Tags: Late Breaker Articles Source Type: research

A Multicenter, Open-Label, Randomized Controlled Trial of a Conservative Fluid Management Strategy Compared With Usual Care in Participants After Cardiac Surgery: The Fluids After Bypass Study*
This study aimed to determine if a protocolized strategy known to reduce fluid administration when compared with usual care reduced ICU length of stay following cardiac surgery. DESIGN: Prospective, multicenter, parallel-group, randomized clinical trial. SETTING: Five cardiac surgical centers in New Zealand conducted from November 2016 to December 2018 with final follow-up completed in July 2019. PATIENTS: Seven-hundred fifteen patients undergoing cardiac surgery; 358 intervention and 357 usual care. INTERVENTIONS: Randomization to protocol-guided strategy utilizing stroke volume variation to gu...
Source: Critical Care Medicine - February 25, 2021 Category: Emergency Medicine Tags: Late Breaker Articles Source Type: research

Outcomes of Patients With Coronavirus Disease 2019 Receiving Organ Support Therapies: The International Viral Infection and Respiratory Illness Universal Study Registry
CONCLUSIONS: Coronavirus disease 2019 prognosis varies by age and level of organ support. Interhospital variation in mortality of mechanically ventilated patients was not explained by patient characteristics and requires further evaluation. (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 25, 2021 Category: Emergency Medicine Tags: Late Breaker Articles Source Type: research

Severe Acute Respiratory Syndrome Coronavirus-2 Infections in Critical Care Staff: Beware the Risks Beyond the Bedside
OBJECTIVES: Critical care workers were considered to be at high risk of severe acute respiratory syndrome coronavirus-2 infection from patients during the first wave of the pandemic. Staff symptoms, previous swab testing, and antibody prevalence were correlated with patient admissions to investigate this assumption. DESIGN: Cross-sectional study. SETTING: A large critical care department in a tertiary-care teaching hospital in London, United Kingdom. SUBJECTS: Staff working in critical care. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Participants completed a questionnaire and...
Source: Critical Care Medicine - February 25, 2021 Category: Emergency Medicine Tags: Late Breaker Articles Source Type: research

Coronavirus Disease 2019 Immediately Increases Burnout Symptoms in ICU Professionals: A Longitudinal Cohort Study*
CONCLUSIONS: This study shows that overburdening of ICU professionals during an extended period of time leads to symptoms of burnout. Working long hours and under conditions of scarcity of staff, time, and resources comes at the price of ICU professionals’ mental health. (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 25, 2021 Category: Emergency Medicine Tags: Late Breaker Articles Source Type: research

ICU-Based Renal Replacement Therapy
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 25, 2021 Category: Emergency Medicine Tags: 50th Anniversary Articles Source Type: research

The Society of Critical Care Medicine at 50 Years: ICU Organization and Management
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 25, 2021 Category: Emergency Medicine Tags: 50th Anniversary Articles Source Type: research

Venoarterial Extracorporeal Membranous Oxygenation Should Be Considered as an Appropriate Rescue Therapy for Sepsis-Induced Refractory Cardiogenic Shock
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - January 16, 2021 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 - January 16, 2021 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Is the Recruited Lung Volume Underestimated in Presence of Overdistension?
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - January 16, 2021 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 - January 16, 2021 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Fluid Resuscitation in Septic Patients With Comorbid Heart Failure
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - January 16, 2021 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research