The authors reply
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Reviewing the Impact of Invasive Procedures on Post Intensive Care Syndrome
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 16, 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 - February 16, 2019 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Is Combined Biomarkers a Future Tool for Early Prediction of Mortality Among Septic Patients?
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 16, 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 - February 16, 2019 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Vasopressor Use in Hemorrhagic Shock—What Can Propensity Matching Actually Tell Us?
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 16, 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 - February 16, 2019 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Organ Failure Modifies the Relationship Between Calorie Exposure and ICU Outcome in Acute Respiratory Distress Syndrome Patients: Further Analysis Is Required
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 16, 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 - February 16, 2019 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Blood Pressure Covariance Not Accounted for in Angiotensin II for the Treatment of High-Output Shock 3 Subgroup Analysis
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 16, 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 - February 16, 2019 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

The Role of Early Brain Imaging in Patients on Extracorporeal Membrane Oxygenation
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 16, 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 - February 16, 2019 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Assumption Versus Knowledge
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 16, 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 - February 16, 2019 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Sepsis in Non-ICU Patients: A Call for Guideline Reassessment
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Extracorporeal Life Support for Severe Acute Chest Syndrome in Adult Sickle Cell Disease: A Preliminary Report
Conclusions: Our study shows that outcome is impaired in sickle cell disease patients receiving extracorporeal life support while in severe multiple organ failure. Further studies are needed to evaluate selection criteria in this setting. (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Online Brief Report Source Type: research

Critical Care Ultrasound: A Systematic Review of International Training Competencies and Program
Conclusions: Despite widespread and increasing use of ultrasound in ICUs, the majority of countries lacked a formal training program and clearly defined competencies. Even among the countries where these are available, there remains variability. There is a need to better define the competencies required in core critical care ultrasonography and standardize the assessment process. (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Online Review Article Source Type: research

Cardioprotection by Humoral Factors Released After Remote Ischemic Preconditioning Depends on Anesthetic Regimen
Objectives: Remote ischemic preconditioning (RIPC) is a practicable and noninvasive method to protect the heart against ischemia reperfusion injury. Unfortunately results from clinical studies are not convincing. Propofol is suggested to be an inhibiting factor of cardioprotection by RIPC, but the underlying mechanism is still unknown. We investigated whether after RIPC the release of humoral factors and/or the direct cardioprotective effect at the myocardium is inhibited by propofol. Design: Randomized, prospective, blinded laboratory investigation. Setting: Experimental laboratory. Patients/Subjects: Male Wist...
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Online Laboratory Investigations Source Type: research

Hemodynamic-Directed Cardiopulmonary Resuscitation Improves Neurologic Outcomes and Mitochondrial Function in the Heart and Brain
Objectives: Less than half of the thousands of children who suffer in-hospital cardiac arrests annually survive, and neurologic injury is common among survivors. Hemodynamic-directed cardiopulmonary resuscitation improves short-term survival, but its impact on longer term survival and mitochondrial respiration—a potential neurotherapeutic target—remains unknown. The primary objectives of this study were to compare rates of 24-hour survival with favorable neurologic outcome after cardiac arrest treated with hemodynamic-directed cardiopulmonary resuscitation versus standard depth-guided cardiopulmonary resuscit...
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Online Laboratory Investigations Source Type: research

Detecting Early Markers of Ventilator-Associated Pneumonia by Analysis of Exhaled Gas
Conclusions: This is the first in vivo study that shows the potential of gas chromatography-ion mobility spectrometry for early detection of ventilator-associated pneumonia specific volatile organic compounds and species differentiation by noninvasive analyses of exhaled gas. (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Online Laboratory Investigations Source Type: research

Dysglycemia and Neurologic Outcome in Mechanically Ventilated Patients With Guillain-Barré Syndrome
Conclusions: In the present study, we found that neurologic disability at ICU discharge correlated with dysglycemia in mechanically ventilated Guillain-Barré syndrome patients. These finding indicates that dysglycemia may delay motor recovery and impact the functional outcome of Guillain-Barré syndrome. Blood glucose control might be an adjuvant therapy for improving Guillain-Barré syndrome recovery. (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Six Hours of Manual Ventilation With a Bag-Valve-Mask Device Is Feasible and Clinically Consistent
Conclusions: Manual ventilation of intubated patients can be performed continuously for 6 hours without excessive physical effort on the part of the operator. The quality of delivered ventilation was clinically adequate for all of them. There was a mild but significant trend toward hyperventilation, albeit within safe clinical levels, which was due to an increasing ventilatory rate rather than an increase in tidal volume. (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Extracorporeal Membrane Oxygenation Use in Cardiogenic Shock: Impact of Age on In-Hospital Mortality, Length of Stay, and Costs
Objectives: Increasing age is a well-recognized risk factor for in-hospital mortality in patients receiving extracorporeal membrane oxygenation for cardiogenic shock, but the shape of this relationship is unknown. In addition, the impact of age on hospital length of stay, patterns of patient disposition, and costs has been incompletely characterized. Design: Retrospective analysis of the National Inpatient Sample. Setting: U.S. nonfederal hospitals, years 2004–2016. Patients: Adults with cardiogenic shock treated with extracorporeal membrane oxygenation (3,094; weighted national estimate: 15,415). Interve...
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

A Pilot Study Identifying Brain-Targeting Adaptive Immunity in Pediatric Extracorporeal Membrane Oxygenation Patients With Acquired Brain Injury
Objectives: Extracorporeal membrane oxygenation provides short-term cardiopulmonary life support, but is associated with peripheral innate inflammation, disruptions in cerebral autoregulation, and acquired brain injury. We tested the hypothesis that extracorporeal membrane oxygenation also induces CNS-directed adaptive immune responses which may exacerbate extracorporeal membrane oxygenation-associated brain injury. Design: A single center prospective observational study. Setting: Pediatric and cardiac ICUs at a single tertiary care, academic center. Patients: Twenty pediatric extracorporeal membrane oxygenation...
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

The Cost-Effectiveness of Interventions to Increase Utilization of Prone Positioning for Severe Acute Respiratory Distress Syndrome
Conclusions: Interventions that increase utilization of proning would be cost-effective from both societal and hospital perspectives under many plausible cost and benefit assumptions. (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Clinician Perspectives Regarding In-Hospital Cardiac Arrest Resuscitation: A Multicenter Survey
Objectives: Evaluate clinicians’ sentiments about participating in cardiac arrest resuscitations and identify factors associated with confidence in resuscitation of cardiac arrest. Design: Electronic survey. Setting: Twenty-one hospitals in Utah and Idaho. Subjects: All attending physicians, residents, and nurses in a multilevel healthcare system likely to participate in an in-hospital cardiac arrest resuscitation at least once every 2 years. Interventions: None. Measurements and Methods: A survey instrument evaluating clinician perceptions of in-hospital cardiac arrest resuscitation participation wa...
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Efficacy and Safety of Bronchial Artery Embolization on Hemoptysis in Chronic Thromboembolic Pulmonary Hypertension: A Pilot Prospective Cohort Study
Conclusions: Bronchial artery embolization procedure demonstrated effectiveness and safety to treat hemoptysis in chronic thromboembolic pulmonary hypertension patients at our center, but further controlled studies are needed before it can be considered as an effective therapy for these patients. (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Therapeutic Plasma Exchange in Children With Thrombocytopenia-Associated Multiple Organ Failure: The Thrombocytopenia-Associated Multiple Organ Failure Network Prospective Experience
Conclusions: Therapeutic plasma exchange use in thrombocytopenia-associated multiple organ failure was associated with a decrease in organ dysfunction. After accounting for several risk factors, 28-day all-cause mortality was lower in children treated with therapeutic plasma exchange compared with those receiving no therapeutic plasma exchange. A multicenter randomized clinical trial is necessary to determine a causal relationship. (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Online Editorial Board Acknowledgment
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Editorial Board Acknowledgment Source Type: research

Proprotein Convertase Subtilisin/Kexin Type 9 Inhibition and Survival in Sepsis: Causal Inference Through Human Genetics*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Editorials Source Type: research

Fragility, Spin, and Interpretation of Randomized Clinical Trials*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Editorials Source Type: research

Predicting the Unpredictable—How to Score the Risk of Delirium in Critically Ill Patients*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Editorials Source Type: research

Finding the Hidden (Statistical) Platform*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Editorials Source Type: research

Disrupting Deficiencies in Data Delivery and Decision-Making During Daily ICU Rounds*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Editorials Source Type: research

Resuscitating Hearts and Minds: 1-Year Outcomes Following Extracorporeal Membrane Oxygenation for Cardiac Arrest*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Editorials Source Type: research

Heparin-Induced Thrombocytopenia: Finding the Needle in the Haystack*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Editorials Source Type: research

Nosocomial Pneumonia in the ICU: Still More Questions Than Answers*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Editorials Source Type: research

Risky Decisions for Patients: Reducing the Chances of Getting Autonomy Wrong*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Editorials Source Type: research

Widespread Adoption of Guidelines Will Require Automated Clinician Decison Support*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Editorials Source Type: research

Surveillance for Adult Sepsis Events: An Idea Whose Time Has Come*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Editorials Source Type: research

Low Low-Density Lipoprotein Levels Are Associated With, But Do Not Causally Contribute to, Increased Mortality in Sepsis*
Conclusions: Both 3-Hydroxy-3-Methylglutaryl-CoA Reductase and Proprotein Convertase Subtilisin/Kexin type 9 genetic scores should have been associated with increased mortality if low low-density lipoprotein levels contributed causally to sepsis mortality. But this was not the case, and the opposite was observed for the Proprotein Convertase Subtilisin/Kexin type 9 genetic score. This suggests that low-density lipoprotein levels, per se, do not contribute causally to adverse sepsis outcomes. The Proprotein Convertase Subtilisin/Kexin type 9 genetic score finding raises the possibility that increased low-density lipoprote...
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Brief Report Source Type: research

The Fragility and Reliability of Conclusions of Anesthesia and Critical Care Randomized Trials With Statistically Significant Findings: A Systematic Review*
Objectives: The Fragility Index, which represents the number of patients responsible for a statistically significant finding, has been suggested as an aid for interpreting the robustness of results from clinical trials. A small Fragility Index indicates that the statistical significance of a trial depends on only a few events. Our objectives were to calculate the Fragility Index of statistically significant results from randomized controlled trials of anesthesia and critical care interventions and to determine the frequency of distorted presentation of results or “spin”. Data Sources: We systematically sea...
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Review Article Source Type: research

Confirming the Clinical Safety and Feasibility of a Bundled Methodology to Improve Cardiopulmonary Resuscitation Involving a Head-Up/Torso-Up Chest Compression Technique
The objective here was to confirm clinical safety/feasibility of this bundled approach including use of mechanical cardiopulmonary resuscitation provided at a head-up angle. Design: Quarterly tracking of the frequency of successful resuscitation before, during, and after the clinical introduction of a bundled head-up/torso-up cardiopulmonary resuscitation strategy. Setting: 9-1-1 response system for a culturally diverse, geographically expansive, populous jurisdiction. Patients: All 2,322 consecutive out-of-hospital cardiac arrest cases (all presenting cardiac rhythms) were followed over 3.5 years (January 1, 2014...
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Plenary Article Source Type: research

Heterogeneity and Variability in Pressure Autoregulation of Organ Blood Flow: Lessons Learned Over 100+ Years
Conclusions: The organs with robust autoregulation are the brain, spinal cord, heart, and kidney. Skeletal muscle has moderate autoregulation. Nearly all splanchnic organs including the stomach, small intestine, colon, liver, and pancreas possess weak autoregulation. Autoregulation can be readily affected by a variety of clinically relevant factors. Organs with weak or weakened autoregulation are at a greater risk of suboptimal perfusion when blood pressure fluctuates. Cerebral autoregulation and outcomes are closely related. These lessons learned over 100+ years are instructive in clinical care. (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Concise Definitive Review Source Type: research

Prediction of ICU Delirium: Validation of Current Delirium Predictive Models in Routine Clinical Practice*
Objectives: To investigate the ability of available delirium risk assessment tools to identify patients at risk of delirium in an Australian tertiary ICU. Design: Prospective observational study. Setting: An Australian tertiary ICU. Patients: All patients admitted to the study ICU between May 8, 2017, and December 31, 2017, were assessed bid for delirium throughout their ICU stay using the Confusion Assessment Method for ICU. Patients were included in this study if they remained in ICU for over 24 hours and were excluded if they were delirious on ICU admission, or if they were unable to be assessed using the Con...
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Neurologic Critical Care Source Type: research

Improved Guideline Adherence and Reduced Brain Dysfunction After a Multicenter Multifaceted Implementation of ICU Delirium Guidelines in 3,930 Patients
Objectives: Implementation of delirium guidelines at ICUs is suboptimal. The aim was to evaluate the impact of a tailored multifaceted implementation program of ICU delirium guidelines on processes of care and clinical outcomes and draw lessons regarding guideline implementation. Design: A prospective multicenter, pre-post, intervention study. Setting: ICUs in one university hospital and five community hospitals. Patients: Consecutive medical and surgical critically ill patients were enrolled between April 1, 2012, and February 1, 2015. Interventions: Multifaceted, three-phase (baseline, delirium screening, a...
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Neurologic Critical Care Source Type: research

Ferroptosis Contributes to Neuronal Death and Functional Outcome After Traumatic Brain Injury*
Conclusions: Biomarkers of ferroptotic death were increased after traumatic brain injury. Baicalein decreased ferroptotic phosphatidylethanolamine oxidation and improved outcome after controlled cortical impact, suggesting that 15-lipoxygenase pathway might be a valuable therapeutic target after traumatic brain injury. (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Neurologic Critical Care Source Type: research

Data Omission by Physician Trainees on ICU Rounds*
Conclusions: In an academic rounding model reliant on trainees to preview and select data for presentation during ICU rounds, verbal appraisal of patient data was highly incomplete. Additional trainee oversight and education, improved electronic health record tools, and novel academic rounding paradigms are needed to address this potential source of medical error. (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Quality and Safety Source Type: research

Extracorporeal Cardiopulmonary Resuscitation: One-Year Survival and Neurobehavioral Outcome Among Infants and Children With In-Hospital Cardiac Arrest*
Conclusions: About one third of children survived with good neurobehavioral outcome 1 year after receiving extracorporeal cardiopulmonary resuscitation for in-hospital arrest. Open-chest cardiac massage and minimum postarrest lactate were associated with survival with good neurobehavioral outcome at 1 year. (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Pediatric Critical Care Source Type: research