Late Awakening Is Common in Settings Without Withdrawal of Life-Sustaining Therapy in Out-of-Hospital Cardiac Arrest Survivors Who Undergo Targeted Temperature Management*
OBJECTIVES: We investigated awakening time and characteristics of awakening compared nonawakening and factors contributing to poor neurologic outcomes in out-of-hospital cardiac arrest survivors in no withdrawal of life-sustaining therapy settings. DESIGN: Retrospective analysis of the Korean Hypothermia Network Pro registry. SETTING: Multicenter ICU. PATIENTS: Adult (≥ 18 yr) comatose out-of-hospital cardiac arrest survivors who underwent targeted temperature management at 33–36°C between October 2015 and December 2018. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We meas...
Source: Critical Care Medicine - February 1, 2022 Category: Emergency Medicine Tags: Feature Articles Source Type: research

RBC Transfusion in Venovenous Extracorporeal Membrane Oxygenation: A Multicenter Cohort Study
CONCLUSIONS: Transfusion of RBC has a high occurrence rate in patients on venovenous extracorporeal membrane oxygenation, even in nonbleeding patients. There is a need for future studies to find optimal transfusion thresholds and triggers in patients on extracorporeal membrane oxygenation. (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 1, 2022 Category: Emergency Medicine Tags: Feature Articles Source Type: research

Coronavirus Disease 2019 Temperature Trajectories Correlate With Hyperinflammatory and Hypercoagulable Subphenotypes
OBJECTIVES: Body temperature trajectories of infected patients are associated with specific immune profiles and survival. We determined the association between temperature trajectories and distinct manifestations of coronavirus disease 2019. DESIGN: Retrospective observational study. SETTING: Four hospitals within an academic healthcare system from March 2020 to February 2021. PATIENTS: All adult patients hospitalized with coronavirus disease 2019. INTERVENTIONS: Using a validated group-based trajectory model, we classified patients into four previously defined temperature trajectory subphen...
Source: Critical Care Medicine - February 1, 2022 Category: Emergency Medicine Tags: Feature Articles Source Type: research

Disparities in Hypoxemia Detection by Pulse Oximetry Across Self-Identified Racial Groups and Associations With Clinical Outcomes*
OBJECTIVES: To assess disparities in hypoxemia detection by pulse oximetry across self-identified racial groups and associations with clinical outcomes. DESIGN: Observational cohort study from May 5, 2018, to December 31, 2020. SETTING: Three academic medical centers in the United States. PATIENTS: Adults greater than or equal to 18 years who self-identified as White, Black, Asian, or American Indian admitted to the ICU or undergoing surgery during inpatient hospitalization with simultaneous measurements of pulse oximetry-estimated oxygen saturation and arterial blood gas-derived oxygen saturation....
Source: Critical Care Medicine - February 1, 2022 Category: Emergency Medicine Tags: Feature Articles Source Type: research

Lung- and Diaphragm-Protective Ventilation by Titrating Inspiratory Support to Diaphragm Effort: A Randomized Clinical Trial
OBJECTIVES: Lung- and diaphragm-protective ventilation is a novel concept that aims to limit the detrimental effects of mechanical ventilation on the diaphragm while remaining within limits of lung-protective ventilation. The premise is that low breathing effort under mechanical ventilation causes diaphragm atrophy, whereas excessive breathing effort induces diaphragm and lung injury. In a proof-of-concept study, we aimed to assess whether titration of inspiratory support based on diaphragm effort increases the time that patients have effort in a predefined “diaphragm-protective” range, without compromising lung-pr...
Source: Critical Care Medicine - February 1, 2022 Category: Emergency Medicine Tags: Feature Articles Source Type: research

Optimal Cerebral Perfusion Pressure During Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage
OBJECTIVES: The recommendation of induced hypertension for delayed cerebral ischemia treatment after aneurysmal subarachnoid hemorrhage has been challenged recently and ideal pressure targets are missing. A new concept advocates an individual cerebral perfusion pressure where cerebral autoregulation functions best to ensure optimal global perfusion. We characterized optimal cerebral perfusion pressure at time of delayed cerebral ischemia and tested the conformity of induced hypertension with this target value. DESIGN: Retrospective analysis of prospectively collected data. SETTING: University hospital neu...
Source: Critical Care Medicine - February 1, 2022 Category: Emergency Medicine Tags: Feature Articles Source Type: research

Transfusion-Associated Delirium in Children: No Difference Between Short Storage Versus Standard Issue RBCs
This study was performed in two stages. First, we compared patients receiving either short storage or standard RBCs in a multi-institutional prospective randomized controlled trial. Then, we compared all transfused patients in the randomized controlled trial with a single-center cohort of nontransfused patients matched for confounders of delirium/coma. SETTING: Twenty academic PICUs who participated in the Age of Transfused Blood in Critically Ill Children trial. PATIENTS: Children 3 days to 16 years old who were transfused RBCs within the first 7 days of admission. INTERVENTIONS: Subjects were randomi...
Source: Critical Care Medicine - February 1, 2022 Category: Emergency Medicine Tags: Feature Articles Source Type: research

Ake Grenvik, MD, PhD, MCCM
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - February 1, 2022 Category: Emergency Medicine Tags: In Memoriam Source Type: research

Insights on Blood Product Transfusions on ICU-Acquired Infections in Septic Shock
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - December 20, 2021 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Bayesian Models for Therapeutic Monitoring of Vancomycin in the Critically Ill: What Should They Predict?
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - December 20, 2021 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Hyperoxia on Venoarterial Extracorporeal Membrane Oxygenation: A Modifiable Risk?
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - December 20, 2021 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Possible Underestimation of Cerebral Hyperoxia in Patients With Left Ventricular Output Encountering With Extracorporeal Membrane Oxygenation Flow at the Aortic Arch
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - December 20, 2021 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Potential Confounders in Evaluating the Impact of Hyperoxia on Neurological Outcomes in Patients Receiving Extracorporeal Membrane Oxygenation
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - December 20, 2021 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Coronavirus Disease-Induced Blurred Judgment
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - December 20, 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 - December 20, 2021 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research