What Socioeconomic Disadvantage Means for Critical Illness Recovery, Clinical Care, and Research*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - April 21, 2022 Category: Emergency Medicine Tags: Editorials Source Type: research

Prone Position and COVID-19: Mechanisms and Effects*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - April 21, 2022 Category: Emergency Medicine Tags: Editorials Source Type: research

Consensus-Based Guidelines for the Recognition, Diagnosis, and Management of Hemophagocytic Lymphohistiocytosis in Critically Ill Children and Adults
CONCLUSIONS: Further studies are needed to determine optimal treatment for patients with hemophagocytic lymphohistiocytosis in ICUs, including the use of novel and adjunct therapies. (Source: Critical Care Medicine)
Source: Critical Care Medicine - April 21, 2022 Category: Emergency Medicine Tags: Review Article Source Type: research

The Child With Severe Chronic Illness in the ICU: A Concise Review
CONCLUSIONS: The future of pediatric critical care medicine is intertwined with that of children with serious chronic illness. More concerted efforts are needed to address their distinctive needs and study the effectiveness of strategies to do so. (Source: Critical Care Medicine)
Source: Critical Care Medicine - April 21, 2022 Category: Emergency Medicine Tags: Concise Definitive Review Source Type: research

Beyond the Alveolar Epithelium: Plasma Soluble Receptor for Advanced Glycation End Products Is Associated With Oxygenation Impairment, Mortality, and Extrapulmonary Organ Failure in Children With Acute Respiratory Distress Syndrome
OBJECTIVES: Soluble receptor for advanced glycation end products is a known plasma marker of alveolar epithelial injury. However, RAGE is also expressed on cell types beyond the lung, and its activation leads to up-regulation of pro-inflammatory mediators. We sought to examine the relationship between plasma soluble receptor for advanced glycation end products and primary pulmonary dysfunction, extrapulmonary organ dysfunction, and mortality in pediatric acute respiratory distress syndrome patients at two early time points following acute respiratory distress syndrome diagnosis and compare these results to plasma surfa...
Source: Critical Care Medicine - April 21, 2022 Category: Emergency Medicine Tags: Pediatric Critical Care Source Type: research

Ventilator-Associated Lower Respiratory Tract Bacterial Infections in COVID-19 Compared With Non-COVID-19 Patients*
OBJECTIVES: Ventilator-associated lower respiratory tract infections (VA-LRTIs) are associated with prolonged length of stay and increased mortality. We aimed to investigate the occurrence of bacterial VA-LRTI among mechanically ventilated COVID-19 patients and compare these findings to non-COVID-19 cohorts throughout the first and second wave of the pandemic. DESIGN: Retrospective cohort study. SETTING: Karolinska University Hospital, Stockholm, Sweden. PATIENTS: All patients greater than or equal to 18 years treated with mechanical ventilation between January 1, 2011, and December 31, 2020. IN...
Source: Critical Care Medicine - April 21, 2022 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

A Retrospective Observational Study Exploring 30- and 90-Day Outcomes for Patients With COVID-19 After Percutaneous Tracheostomy and Gastrostomy Placement*
CONCLUSIONS: More than nine-in-10 patients in our population of COVID-19 patients who underwent tracheostomy and PEG were alive 90 days later and most were living at home. This study provides new information regarding the outcomes of this patient population that may serve as a step in guiding clinicians, patients, and families when making decisions regarding these devices. (Source: Critical Care Medicine)
Source: Critical Care Medicine - April 21, 2022 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

A Multicenter Cohort Study of Falls Among Patients Admitted to the ICU*
CONCLUSIONS: We observed that among ICU patients, falls occur frequently, vary substantially between ICUs, and are associated with modifiable risk factors, longer ICU and hospital stays, and lower risk of death. Our study suggests that fall prevention strategies should be considered for critically ill patients admitted to ICU. (Source: Critical Care Medicine)
Source: Critical Care Medicine - April 21, 2022 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Patient Heterogeneity and the J-Curve Relationship Between Time-to-Antibiotics and the Outcomes of Patients Admitted With Bacterial Infection*
CONCLUSIONS: Antibiotic timing is a function of patient factors regardless of sepsis criteria. Similarly, we show that early administration of antibiotics is associated with improved outcomes in all patients with severe bacterial illness. Our findings suggest identifying infection is a rate-limiting and actionable step that can improve outcomes in septic and nonseptic patients. (Source: Critical Care Medicine)
Source: Critical Care Medicine - April 21, 2022 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Coronavirus Disease 2019 and Out-of-Hospital Cardiac Arrest: No Survivors*
OBJECTIVES: To describe and compare survival among patients with out-of-hospital cardiac arrest as a function of their status for coronavirus disease 2019. DESIGN: We performed an observational study of out-of-hospital cardiac arrest patients between March 2020 and December 2020. Coronavirus disease 2019 status (confirmed, suspected, or negative) was defined according to the World Health Organization’s criteria. SETTING: Information on the patients and their care was extracted from the French national out-of-hospital cardiac arrest registry. The French prehospital emergency medical system has two tiers:...
Source: Critical Care Medicine - April 21, 2022 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Preexisting Clinical Frailty Is Associated With Worse Clinical Outcomes in Patients With Sepsis*
OBJECTIVES: Frailty is a multidimensional syndrome or state of increased vulnerability to poor resolution of homoeostasis following a stressor event. Frailty is common in patients with sepsis. Sepsis and frailty are both associated with older age and chronic medical conditions. However, there is limited evidence about the direct association between frailty and sepsis. The aim of this study is to determine the association between preexisting clinical frailty and clinical outcomes in patients with sepsis. DESIGN: A nationwide propensity score–matched cohort study analyzing data prospectively collected between Se...
Source: Critical Care Medicine - April 21, 2022 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Hyperdynamic Left Ventricular Ejection Fraction in ICU Patients With Sepsis
OBJECTIVES: To evaluate the cause and prognosis of hyperdynamic left ventricular ejection fraction in critically ill patients with sepsis. DESIGN: Retrospective, single-center cohort study. SETTING: University Hospital ICU, Birmingham, United Kingdom. PATIENTS: ICU patients who received a transthoracic echocardiogram within 7 days of sepsis between April 2016 and December 2019. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: The 90-day mortality rates of normal (55–70%), depressed ( 70%) were compared. Multivariate logistic regression analysis was performed to determine the assoc...
Source: Critical Care Medicine - April 21, 2022 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Clinical Benefit of Extubation in Patients on Venoarterial Extracorporeal Membrane Oxygenation
OBJECTIVES: Although patients on venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock are usually supported with mechanical ventilation, it is not clear whether sedation cessation and extubation might improve outcomes. DESIGN: Retrospective cohort study with propensity score overlap weighting analysis. SETTING: Three ICUs in a 1,500-bed tertiary university hospital. PATIENTS: From an overall cohort of 641 patients with venoarterial-extracorporeal membrane oxygenation support, the primary analysis was performed in 344 patients who had been successfully decannulated in or...
Source: Critical Care Medicine - April 21, 2022 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Extended Lung Ultrasound to Differentiate Between Pneumonia and Atelectasis in Critically Ill Patients: A Diagnostic Accuracy Study
CONCLUSIONS: In critically ill patients with pulmonary consolidation on chest radiograph, an extended lung ultrasound protocol is an accurate and directly bedside available tool to differentiate pneumonia from atelectasis. It outperforms standard lung ultrasound and clinical scores. (Source: Critical Care Medicine)
Source: Critical Care Medicine - April 21, 2022 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Hastening Death in Canadian ICUs: End-of-Life Care in the Era of Medical Assistance in Dying*
CONCLUSIONS: Most Canadian intensivists surveyed do not think that medical assistance in dying has changed their approach to end of life in the ICU. A significant minority are ethically conflicted about the current approach to assisted dying/euthanasia in Canada. Almost half believe it is ethical to intentionally hasten death during withdrawal of life-sustaining therapies if death is expected. (Source: Critical Care Medicine)
Source: Critical Care Medicine - April 21, 2022 Category: Emergency Medicine Tags: Feature Articles Source Type: research