The authors reply
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

ICU Utilization for Patients With Acute Exacerbations of Chronic Obstructive Pulmonary Disease Receiving Noninvasive Ventilation. Seeking Answers to the Questions of Utilization: Does Perception Reflect Reality?
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 13, 2019 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 13, 2019 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

It Is Time to Treat the Patient and Not Just the Ventilator
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 13, 2019 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 13, 2019 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Use of Dexmedetomidine for Deep Sedation and Reduction of Vasopressor Requirement?
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 13, 2019 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 13, 2019 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Food and Drink and the Mitochondrion: Is Less Really More?
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 13, 2019 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 13, 2019 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

The Role of Pharmacist in Scientific Antimicrobial Management Strategy in the ICU
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 13, 2019 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 13, 2019 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Severe Sepsis and Septic Shock Early Management Bundle Risks Aiding Vasopressor Misuse
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Impact of Structured Pathways for Postcardiac Arrest Care: A Systematic Review and Meta-Analysis
Conclusions: Following cardiac arrest, patients treated in a structured care pathway may have a substantially higher likelihood of favorable functional outcome than those who receive standard care. These findings suggest benefit of a highly organized approach to postcardiac arrest care, in which a cluster of evidence-based interventions are delivered by a specialized interdisciplinary team. Given the overall low certainty of evidence, definitive recommendations will need confirmation in additional high-quality studies. (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Online Review Article Source Type: research

Myeloid-Derived Suppressor Cells Mediate Immunosuppression After Cardiopulmonary Bypass
Conclusions: Cardiopulmonary bypass strongly impairs the adaptive immune system by triggering the accumulation of myeloid-derived suppressor cells. These myeloid-derived suppressor cells induce an immunosuppressive T cell phenotype by increasing serum arginine breakdown. Supplementation with L-arginine may be an effective measure to counteract the onset of immunoparalysis in the setting of cardiopulmonary bypass. (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Online Laboratory Investigations Source Type: research

Argon Inhalation for 24 Hours After Onset of Permanent Focal Cerebral Ischemia in Rats Provides Neuroprotection and Improves Neurologic Outcome
Conclusions: Neurologic outcome (neuroscore), overall recovery (body weight), and infarct volumes were significantly improved after 24-hour inhalation of 70% argon administered immediately after severe permanent stroke induction. Neurologic outcome and overall recovery were also significantly improved even when argon treatment was delayed for 2 hours or until after reperfusion. (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Online Laboratory Investigations Source Type: research

Neurologic Complications of Infective Endocarditis: A Joint Model for a Septic Thromboembolism and Inflammatory Small Vessel Disease
Conclusions: This original model of infective endocarditis recapitulates the neurologic lesion spectrum observed in humans and suggests synergistic mechanisms involved, including thromboembolism and cerebral vasculitis, promoted by a systemic bacteremia-mediated inflammation. (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Online Laboratory Investigations Source Type: research

Circulating Histones Are Major Mediators of Multiple Organ Dysfunction Syndrome in Acute Critical Illnesses
Conclusions: High levels of circulating histones are major mediators of multiple organ dysfunction syndrome. Our results indicate that monitoring upon ICU admission could inform on disease severity and developing antihistone therapy holds great potential of reducing multiple organ dysfunction syndrome and improving survival of critically ill patients. (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Frailty and Associated Outcomes and Resource Utilization Among Older ICU Patients With Suspected Infection
Conclusions: The presence of frailty among older ICU patients with suspected infection is associated with increased mortality, discharge to long-term care, hospital readmission, resource utilization, and costs. This work highlights the importance of clinical frailty in risk stratification of older ICU patients with suspected infection. (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Adjusting for Disease Severity Across ICUs in Multicenter Studies
Conclusions: When different disease severity measures are available across centers, the performance of various methods to control for confounding by disease severity may show important differences. When planning multicenter studies, researchers should make contingency plans to limit the use of or properly incorporate different disease measures across centers in the statistical analysis. (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Assessing Competence in Central Venous Catheter Placement by Pediatric Critical Care Fellows: A National Survey Study*
Conclusions: Despite national mandates for skill competence by many accrediting bodies, no standardized system currently exists across programs for assessing central venous catheter placement. Most pediatric critical care medicine programs use a global assessment and decisions around the ability of a fellow to place a central venous catheter under indirect supervision are largely based upon subjective assessment of performance. Further investigation is needed to determine if this finding is consistent in other specialties/subspecialties, if utilization of standardized assessment methods can improve program directors&rsqu...
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Continuation of Newly Initiated Midodrine Therapy After Intensive Care and Hospital Discharge: A Single-Center Retrospective Study
Objectives: Midodrine is an α1-agonist approved for orthostatic hypotension. Recently, it has received attention as an oral vasopressor to facilitate ICU discharge. The purpose of this study was to identify the incidence of continuation of newly initiated midodrine upon ICU and hospital discharge and identify risk factors associated with its occurrence. Design: Single-center retrospective study. Setting: ICU patients from January 2011 to October 2016 at Mayo Clinic, Rochester. Patients: Adult patients admitted to any ICU who received new midodrine for hypotension and survived to discharge. Interventions: ...
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Intra-Abdominal Hypertension Is Responsible for False Negatives to the Passive Leg Raising Test
Objectives: To compare the passive leg raising test ability to predict fluid responsiveness in patients with and without intra-abdominal hypertension. Design: Observational study. Setting: Medical ICU. Patients: Mechanically ventilated patients monitored with a PiCCO2 device (Pulsion Medical Systems, Feldkirchen, Germany) in whom fluid expansion was planned, with (intra-abdominal hypertension+) and without (intra-abdominal hypertension–) intra-abdominal hypertension, defined by an intra-abdominal pressure greater than or equal to 12 mm Hg (bladder pressure). Interventions: We measured the changes...
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Trends and Outcomes in Sepsis Hospitalizations With and Without Atrial Fibrillation: A Nationwide Inpatient Analysis
Objectives: Atrial fibrillation is frequently seen in sepsis-related hospitalizations. However, large-scale contemporary data from the United States comparing outcomes among sepsis-related hospitalizations with versus without atrial fibrillation are limited. The aim of our study was to assess the frequency of atrial fibrillation and its impact on outcomes of sepsis-related hospitalizations. Design: Retrospective cohort study. Setting: The National Inpatient Sample databases (2010–2014). Patients: Primary discharge diagnosis of sepsis with and without atrial fibrillation were identified using prior validate...
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Glomerular Hyper- and Hypofiltration During Acute Circulatory Failure: Iohexol-Based Gold-Standard Descriptive Study
Conclusions: We demonstrated the feasibility of iohexol clearance measurement in unstable critically ill patients. Normal kidney function is exceptional during the early phase of acute circulatory failure. Glomerular filtration rate estimation by urinary creatinine clearance frequently fails to detect renal impairment. Hyperfiltration is very infrequent. (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Biphasic Release of the Alarmin High Mobility Group Box 1 Protein Early After Trauma Predicts Poor Clinical Outcome
Conclusions: High mobility group box 1 protein was released in two consecutive phases. Only the second high mobility group box 1 protein wave was a significant predictor of outcome. Patients with a high high mobility group box 1 protein concentration between 3 and 6 hours after trauma might hypothetically benefit from high mobility group box 1 protein-specific antagonist therapy. (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Training for Competence in Central Venous Catheter Placement in Pediatric Patients—What Are We Missing?*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Editorials Source Type: research

Understanding Cognitive Outcome Trajectories After Critical Illness*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Editorials Source Type: research

Inflammasomes Assemble: Cytoplasmic Guardians or Fallen Heroes?*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Editorials Source Type: research

Risk Stratification Tools in Sepsis: From Acute Physiology and Chronic Health Evaluation to Quick Sequential Organ Failure Assessment*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Editorials Source Type: research

To Feed or Not to Feed: What to Do for Patients Receiving Sustained Neuromuscular Blockade?*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Editorials Source Type: research

Changing the Position: Iterative Improvements in the Chain of Lung Transplantation*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Editorials Source Type: research

Sepsis: From Little Findings Big Ideas Grow*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Editorials Source Type: research

Nudges in the Care of the Critically Ill*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Editorials Source Type: research

Should Patients With Acute Respiratory Distress Syndrome on Venovenous Extracorporeal Membrane Oxygenation Have Ventilatory Support Reduced to the Lowest Tolerable Settings? No
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Viewpoints Source Type: research

Should Patients With Acute Respiratory Distress Syndrome on Venovenous Extracorporeal Membrane Oxygenation Have Ventilatory Support Reduced to the Lowest Tolerable Settings? Yes
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Viewpoints Source Type: research

Growth and Changing Characteristics of Pediatric Intensive Care 2001–2016
Objectives: We assessed the growth, distribution, and characteristics of pediatric intensive care in 2016. Design: Hospitals with PICUs were identified from prior surveys, databases, online searching, and clinician networking. A structured web-based survey was distributed in 2016 and compared with responses in a 2001 survey. Setting: PICUs were defined as a separate unit, specifically for the treatment of children with life-threatening conditions. PICU hospitals contained greater than or equal to 1 PICU. Subjects: Physician medical directors and nurse managers. Interventions: None. Measurements and Main Resu...
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Pediatric Critical Care Source Type: research

Intracranial Hypertension and Cerebral Perfusion Pressure Insults in Adult Hypertensive Intraventricular Hemorrhage: Occurrence and Associations With Outcome
Conclusions: Elevated intracranial pressure and inadequate cerebral perfusion pressure are not infrequent during extraventricular drainage for severe intraventricular hemorrhage, and level and duration predict higher short-term mortality and long-term mortality. Burden of low cerebral perfusion pressure was also associated with poor short- and long-term outcomes and may be more significant than intracranial pressure. Adverse consequences of intracranial pressure-time burden and cerebral perfusion pressure-time burden should be tested prospectively as potential thresholds for therapeutic intervention. (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Neurologic Critical Care Source Type: research

Association Between Critical Care Admissions and Cognitive Trajectories in Older Adults*
Objectives: Patients requiring admission to an ICU may subsequently experience cognitive decline. Our objective was to investigate longitudinal cognitive trajectories in older adults hospitalized in ICUs. We hypothesized that individuals hospitalized for critical illness develop greater cognitive decline compared with those who do not require ICU admission. Design: A retrospective cohort study using prospectively collected cognitive scores of participants enrolled in the Mayo Clinic Study of Aging and ICU admissions retrospectively ascertained from electronic medical records. A covariate-adjusted linear mixed effects ...
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Neurologic Critical Care Source Type: research

Calorie Intake During Status Epilepticus and Outcome: A 5-Year Cohort Study
Conclusions: Our results indicate that increased calorie intake during status epilepticus is independently associated with unfavorable outcome. These findings require further validation and investigations into potential mediators, such as induction of ketogenesis, immunomodulating effects, and/or reduction of ICU-associated complications, such as infections. (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Neurologic Critical Care Source Type: research

Extracorporeal Membrane Oxygenation for Septic Shock
Conclusions: The current results add not only to the growing evidence of the benefit of venoarterial extracorporeal membrane oxygenation for septic cardiomyopathy but also indicate improved hospital survival in distributive septic shock. (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Association of Elevated Plasma Interleukin-18 Level With Increased Mortality in a Clinical Trial of Statin Treatment for Acute Respiratory Distress Syndrome*
Conclusions: Elevated baseline plasma interleukin-18 was associated with higher mortality in sepsis-induced acute respiratory distress syndrome. A rise in plasma interleukin-18 was also associated with increased mortality and was more common in subjects randomized to statin therapy in this clinical trial. (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Predictive Accuracy of Quick Sequential Organ Failure Assessment for Hospital Mortality Decreases With Increasing Comorbidity Burden Among Patients Admitted for Suspected Infection*
Conclusions: The accuracy of quick Sequential Organ Failure Assessment to predict hospital mortality diminishes with increasing comorbidity burden. Patients with comorbidities may have baseline abnormalities in quick Sequential Organ Failure Assessment variables that reduce predictive accuracy. Additional research is needed to better understand quick Sequential Organ Failure Assessment performance across different comorbid conditions with modification that incorporates the context of changes to baseline variables. (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Early Enteral Nutrition in Patients Undergoing Sustained Neuromuscular Blockade: A Propensity-Matched Analysis Using a Nationwide Inpatient Database*
Conclusions: According to this retrospective database study, early enteral nutrition may be associated with lower in-hospital mortality with no increase in-hospital pneumonia in patients undergoing sustained treatment with neuromuscular blocking agents. (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Mitochondrial DNA Haplogroups and Delirium During Sepsis
Conclusions: Variations in mitochondrial DNA are associated with development of and protection from delirium in Caucasians and African Americans during sepsis. Future studies are now required to determine whether mitochondrial DNA and mitochondrial dysfunction contribute to the pathogenesis of delirium during sepsis so that targeted treatments can be developed. (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

A 360° Rotational Positioning Protocol of Organ Donors May Increase Lungs Available for Transplantation*
Objectives: To evaluate the improvement in lung donation and immediate lung function after the implementation of a 360° rotational positioning protocol within an organ procurement organization in the Midwest. Design: Retrospective observational study. Setting: The Midwest Transplant Network from 2005 to 2017. Rotational positioning of donors began in 2008. Subjects: Potential deceased lung donors. Interventions: A 360° rotational protocol. Presence of immediate lung function in recipients, change in Pao2:Fio2 ratio during donor management, initial and final Pao2:Fio2 ratio, and proportion of lungs don...
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Recommendation of New Medical Alarms Based on Audibility, Identifiability, and Detectability in a Randomized, Simulation-Based Study
The objective was to identify the best performing icons based on audibility and performance in a simulated clinical environment. Design: Three sets of icon alarms were designed using empirical methods. Subjects participated in a series of clinical simulation experiments that examined the audibility, identification accuracy, and response time of each of these icon alarms. A statistical model that combined the outcomes was used to rank the alarms in overall efficacy. We constructed the “best” and “worst” performing sets based on this ranking and prospectively validated these sets in a subsequent ex...
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

At-Risk Drinking Is Independently Associated With Acute Kidney Injury in Critically Ill Patients
Objectives: Unhealthy use of alcohol and acute kidney injury are major public health problems, but little is known about the impact of excessive alcohol consumption on kidney function in critically ill patients. We aimed to determine whether at-risk drinking is independently associated with acute kidney injury in the ICU and at ICU discharge. Design: Prospective observational cohort study. Setting: A 21-bed polyvalent ICU in a university hospital. Patients: A total of 1,107 adult patients admitted over a 30-month period who had an ICU stay of greater than or equal to 3 days and in whom alcohol consumption could ...
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Effect of Increasing Blood Pressure With Noradrenaline on the Microcirculation of Patients With Septic Shock and Previous Arterial Hypertension
Objectives: To assess whether an increase in mean arterial pressure in patients with septic shock and previous systemic arterial hypertension changes microcirculatory and systemic hemodynamic variables compared with patients without arterial hypertension (control). Design: Prospective, nonblinded, interventional study. Setting: Three ICUs in two teaching hospitals. Patients: After informed consent, we included patients older than 18 years with septic shock for at least 6 hours, sedated, and under mechanical ventilation. We paired patients with and without arterial hypertension by age. Interventions: After obt...
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

National Performance on the Medicare SEP-1 Sepsis Quality Measure
We examined the hospital factors associated with reporting SEP-1 data, the hospital factors associated with performance on the SEP-1 measure, and the relationship between SEP-1 performance and performance on other quality measures related to time-sensitive medical conditions. A total of 3,283 hospitals were eligible for the analysis, of which 2,851 (86.8%) reported SEP-1 performance data. SEP-1 reporting was more common in larger, nonprofit hospitals. The most common reason for nonreporting was an inadequate case volume. Among hospitals reporting SEP-1 performance data, overall bundle compliance was generally low, but it v...
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Monocyte Distribution Width: A Novel Indicator of Sepsis-2 and Sepsis-3 in High-Risk Emergency Department Patients*
Conclusions: An monocyte distribution width value of greater than 20.0 U is effective for sepsis detection, based on either Sepsis-2 criteria or Sepsis-3 criteria, during the initial emergency department encounter. In tandem with WBC, monocyte distribution width is further predicted to enhance medical decision making during early sepsis management in the emergency department. (Source: Critical Care Medicine)
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Feature Articles Source Type: research