Association of Metformin Use During Hospitalization and Mortality in Critically Ill Adults With Type 2 Diabetes Mellitus and Sepsis*
CONCLUSIONS: Metformin exposure during hospitalization is associated with a decrease in 90-day mortality in patients with type 2 diabetes mellitus and sepsis. (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 27, 2022 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Therapeutic Hyperthermia Is Associated With Improved Survival in Afebrile Critically Ill Patients With Sepsis: A Pilot Randomized Trial
CONCLUSIONS: Participants randomized to external forced-air warming did not have a difference in HLA-DR expression or IFN-γ production. In this pilot study, however, 28-day mortality was lower in the intervention group. Future research should seek to better elucidate the impact of temperature modulation on immune and nonimmune organ failure pathways in sepsis. (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 27, 2022 Category: Emergency Medicine Tags: Feature Articles Source Type: research

Sex Differences in Treatment of Adult Intensive Care Patients: A Systematic Review and Meta-Analysis
CONCLUSIONS: Women were less likely than men to receive mechanical ventilation or renal replacement therapy and had shorter ICU length of stay than men. There is substantial heterogeneity and risk of bias in the literature; however, these findings persisted in sensitivity analyses. (Source: Critical Care Medicine)
Source: Critical Care Medicine - May 27, 2022 Category: Emergency Medicine Tags: Feature Articles Source Type: research

Educational Outcomes of Childhood Survivors of Critical Illness—A Population-Based Linkage Study*
OBJECTIVES: Major postintensive care sequelae affect up to one in three adult survivors of critical illness. Large cohorts on educational outcomes after pediatric intensive care are lacking. We assessed primary school educational outcomes in a statewide cohort of children who survived PICU during childhood. DESIGN: Multicenter population-based study on children less than 5 years admitted to PICU. Using the National Assessment Program—Literacy and Numeracy database, the primary outcome was educational achievement below the National Minimum Standard (NMS) in year 3 of primary school. Cases were compared with con...
Source: Critical Care Medicine - May 27, 2022 Category: Emergency Medicine Tags: Feature Articles Source Type: research

The authors reply
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - April 21, 2022 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Key Role of Gut Microbiota in Neuroinflammation of Septic Patients
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - April 21, 2022 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

The author replies
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - April 21, 2022 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Refractory Anaphylaxis Needing Emergency Intubation Supported by Expert Opinion and Published Guidelines: Could We Use Off-Label Drugs to Avoid It?
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - April 21, 2022 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Impact of the Coronavirus Disease 2019 Pandemic on Moral Distress Among Nurses and Physicians in Spanish ICUs
OBJECTIVES: To assess the impact of COVID-19 pandemic on moral distress (MD) among healthcare professionals (HCPs) (physicians and nurses) in Spanish ICUs. DESIGN: Cross-sectional, prospective study. SETTING: ICUs in Spain. PARTICIPANTS: HCPs currently working in Spanish ICUs. INTERVENTIONS: Data were collected via electronic survey with the use of a 50-item questionnaire in two different periods: prepandemic (October-December 2019) and during the second wave of COVID-19 (September-November 2020). MEASUREMENTS AND MAIN RESULTS: During the prepandemic and pandemic periods, 1,065 (57.1%...
Source: Critical Care Medicine - April 21, 2022 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Monitoring Spinal Cord Tissue Oxygen in Patients With Acute, Severe Traumatic Spinal Cord Injuries
OBJECTIVES: To determine the feasibility of monitoring tissue oxygen tension from the injury site (pscto2) in patients with acute, severe traumatic spinal cord injuries. DESIGN: We inserted at the injury site a pressure probe, a microdialysis catheter, and an oxygen electrode to monitor for up to a week intraspinal pressure (ISP), spinal cord perfusion pressure (SCPP), tissue glucose, lactate/pyruvate ratio (LPR), and pscto2. We analyzed 2,213 hours of such data. Follow-up was 6–28 months postinjury. SETTING: Single-center neurosurgical and neurocritical care units. SUBJECTS: Twenty-six patients ...
Source: Critical Care Medicine - April 21, 2022 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

A Minimally Invasive and Highly Effective Extracorporeal CO2 Removal Device Combined With a Continuous Renal Replacement Therapy
CONCLUSIONS: This new extracorporeal ion-exchange resin-based multiple-organ support device proved extremely high efficiency in CO2 removal and continuous renal support in a preclinical setting. Further studies are required before clinical implementation. (Source: Critical Care Medicine)
Source: Critical Care Medicine - April 21, 2022 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Evaluating Vitamin C in Septic Shock: A Randomized Controlled Trial of Vitamin C Monotherapy*
CONCLUSIONS: Vitamin C monotherapy failed to significantly reduce mortality in septic shock patients as hypothesized. Our findings do not support its routine clinical use for this purpose. (Source: Critical Care Medicine)
Source: Critical Care Medicine - April 21, 2022 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Early Neuromuscular Blockade in Moderate-to-Severe Pediatric Acute Respiratory Distress Syndrome
OBJECTIVES: The use of neuromuscular blocking agents (NMBAs) in pediatric acute respiratory distress syndrome (PARDS) is common but unsupported by efficacy data. We sought to compare the outcomes between patients with moderate-to-severe PARDS receiving continuous NMBA during the first 48 hours of endotracheal intubation (early NMBA) and those without. DESIGN: Secondary analysis of data from the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) clinical trial, a pediatric multicenter cluster randomized trial of sedation. SETTING: Thirty-one PICUs in the United States. PATIENT...
Source: Critical Care Medicine - April 21, 2022 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Differential Effects of Gamma-Aminobutyric Acidergic Sedatives on Risk of Post-Extubation Delirium in the ICU: A Retrospective Cohort Study From a New England Health Care Network
OBJECTIVES: To evaluate whether different gamma-aminobutyric acidergic (GABAergic) sedatives such as propofol and benzodiazepines carry differential risks of post-extubation delirium in the ICU. DESIGN: Retrospective cohort study. SETTING: Seven ICUs in an academic hospital network, Beth Israel Deaconess Medical Center (Boston, MA). PATIENTS: Ten thousand five hundred and one adult patients mechanically ventilated for over 24 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We tested the hypothesis that benzodiazepine versus propofol-based sedation is associated with fewer d...
Source: Critical Care Medicine - April 21, 2022 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Outcome of Temporary Circulatory Support As a Bridge-to-Left Ventricular Assist Device Strategy in Cardiogenic Shock Patients
CONCLUSIONS: BTL strategy is not associated with a lower survival among cardiogenic shock patients with LVAD implantation. Predictors of mortality are combined surgery with LVAD, higher BMI, and HF duration. (Source: Critical Care Medicine)
Source: Critical Care Medicine - April 21, 2022 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research