Identifying Prokineticin2 as a Novel Immunomodulatory Factor in Diagnosis and Treatment of Sepsis*
CONCLUSIONS: This study elucidated a previously unrecognized role of prokineticin2 in clinical diagnosis and treatment of sepsis. The proof-of-concept study determined a central role of prokineticin2 in alleviating sepsis-induced death by regulation of macrophage function, which presents a new strategy for sepsis immunotherapy. (Source: Critical Care Medicine)
Source: Critical Care Medicine - April 1, 2022 Category: Emergency Medicine Tags: Laboratory Investigation Source Type: research

Concise Definitive Review for Reinitiation of Antidepressants, Antipsychotics, and Gabapentinoids in ICU Patients
CONCLUSIONS: Additional larger studies are needed to evaluate the safety and efficacy of reinitiation of select prior-to-admission NPM to prevent agitation and delirium in ICU patients. Multiple factors for NPM reinitiation should be considered, such as reason for admission, organ dysfunction, available route of administration to provide prior-to-admission NPM, concomitant additional medications for agitation and delirium, and safety of these medications for patients in the ICU. (Source: Critical Care Medicine)
Source: Critical Care Medicine - April 1, 2022 Category: Emergency Medicine Tags: Concise Definitive Review Source Type: research

Use of Extracorporeal Membrane Oxygenation in Acutely Poisoned Pediatric Patients in United States: A Retrospective Analysis of the Extracorporeal Life Support Registry From 2003 to 2019
OBJECTIVES: To describe the use of extracorporeal membrane oxygenation (ECMO) in the management of pediatric poisoning in the United States and to identify predictors of mortality. DESIGN: Retrospective cohort study. SETTING: Data reported to the Extracorporeal Life Support Organization by 76 U.S. ECMO centers from 2003 to 2019. PATIENTS: Pediatric patients (0–18 yr) receiving ECMO for poisoning. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: During our study period, 86 cases of acute poisoning were identified and included in the analysis. The median age was 12.0 year and 52.9%...
Source: Critical Care Medicine - April 1, 2022 Category: Emergency Medicine Tags: Pediatric Critical Care Source Type: research

Association Between Vasopressin Rebranding and Utilization in Patients With Septic Shock*
CONCLUSIONS: After vasopressin rebranding, utilization continued to increase quarterly despite a significant increase in vasopressin cost. Vasopressin appeared to have price inelastic demand in septic shock. (Source: Critical Care Medicine)
Source: Critical Care Medicine - April 1, 2022 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Prone Position in COVID-19 and -COVID-19 Acute Respiratory Distress Syndrome: An International Multicenter Observational Comparative Study*
The objective of this study was to quantify the response to prone position, describe the differences between coronavirus disease 2019 acute respiratory distress syndrome and acute respiratory distress syndrome, and explore variables associated with survival. DESIGN: Retrospective, observational, multicenter, international cohort study. SETTING: Seven ICUs in Italy, United Kingdom, and France. PATIENTS: Three hundred seventy-six adults (220 coronavirus disease 2019 acute respiratory distress syndrome and 156 acute respiratory distress syndrome). INTERVENTION: None. MEASUREMENTS AND MAIN RESULT...
Source: Critical Care Medicine - April 1, 2022 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Vascular Thrombosis in Severe COVID-19 Requiring Extracorporeal Membrane Oxygenation: A Multicenter Study
CONCLUSIONS: In patients who received extracorporeal membrane oxygenation, coronavirus disease 2019 is associated with a higher prevalence of vascular thrombosis compared with noncoronavirus disease viral pneumonias. The pattern of pulmonary vascular changes suggests concurrent embolic disease and small vessel disease. Despite this, vascular thrombosis was not linked to poorer short-term prognosis in those with coronavirus disease 2019. (Source: Critical Care Medicine)
Source: Critical Care Medicine - April 1, 2022 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Association of Catecholamine Dose, Lactate, and Shock Duration at Vasopressin Initiation With Mortality in Patients With Septic Shock*
CONCLUSIONS: Higher norepinephrine-equivalent dose at vasopressin initiation and higher lactate concentration at vasopressin initiation were each associated higher in-hospital mortality in patients with septic shock who received vasopressin. (Source: Critical Care Medicine)
Source: Critical Care Medicine - April 1, 2022 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

The Influence of Hypercapnia and Atmospheric Pressure on the Pao2/Fio2 Ratio—Pathophysiologic Considerations, a Case Series, and Introduction of a Clinical Tool*
CONCLUSIONS: Correcting the Pao2/Fio2 ratio for the alveolar gas equation predominantly affects patients with high ratios between Pao2 and Fio2 and Paco2 and at low atmospheric pressure. Using the corrected Pao2/Fio2 ratio for acute respiratory distress syndrome classification results in improved correlation with the 7-day ICU mortality and increases generalization among acute respiratory distress syndrome studies. The authors provide a free, web-based tool. (Source: Critical Care Medicine)
Source: Critical Care Medicine - April 1, 2022 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Differences and Similarities Among COVID-19 Patients Treated in Seven ICUs in Three Countries Within One Region: An Observational Cohort Study*
OBJECTIVES: To investigate healthcare system–driven variation in general characteristics, interventions, and outcomes in coronavirus disease 2019 (COVID-19) patients admitted to the ICU within one Western European region across three countries. DESIGN: Multicenter observational cohort study. SETTING: Seven ICUs in the Euregio Meuse-Rhine, one region across Belgium, The Netherlands, and Germany. PATIENTS: Consecutive COVID-19 patients supported in the ICU during the first pandemic wave. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Baseline demographic and clinical characterist...
Source: Critical Care Medicine - April 1, 2022 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Use of Airway Pressure Release Ventilation in Patients With Acute Respiratory Failure Due to COVID-19: Results of a Single-Center Randomized Controlled Trial*
OBJECTIVES: Airway pressure release ventilation is a ventilatory mode characterized by a mandatory inverse inspiratory:expiratory ratio with a very short expiratory phase, aimed to avoid derecruitment and allow spontaneous breathing. Recent basic and clinical evidence suggests that this mode could be associated with improved outcomes in patients with acute respiratory distress syndrome. The aim of this study was to compare the outcomes between airway pressure release ventilation and traditional ventilation targeting low tidal volume, in patients with severe coronavirus disease 2019. DESIGN: Single-center randomi...
Source: Critical Care Medicine - April 1, 2022 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

The Association Between the Decision to Withdraw Life-Sustaining Therapy and Patient Mortality in U.K. ICUs*
CONCLUSIONS: Decision to withdraw or withhold life-sustaining treatment in critically ill adults in the United Kingdom was associated with increased 180-day mortality in the marginal patients. The increased mortality from a decision to withdraw or withhold life-sustaining treatment in the marginal patient may be informative when establishing patients’ preferences and evaluating the cost-effectiveness of intensive treatments. (Source: Critical Care Medicine)
Source: Critical Care Medicine - April 1, 2022 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Immune Profiling Demonstrates a Common Immune Signature of Delayed Acquired Immunodeficiency in Patients With Various Etiologies of Severe Injury*
CONCLUSIONS: Using REAnimation Low Immune Status Marker immunomonitoring panel, we detected delayed injury-acquired immunodeficiency in a subgroup of severely injured patients independently of primary disease. Critically ill patients’ immune status could be captured through the combined monitoring of a common panel of complementary markers of pro-/anti-inflammatory, innate, and adaptive immune responses. Such immune monitoring needs to be incorporated in larger study cohorts with more extensive immune surveillance to develop specific hypothesis allowing for identification of biological systems affecting altered immun...
Source: Critical Care Medicine - April 1, 2022 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Risk of Dementia and Structural Brain Changes Following Nonneurological Infections During 9-Year Follow-Up*
CONCLUSIONS: In this 9-year observational follow-up study, sepsis episodes were associated with subsequent development of dementia. Nonneurologic infections had no effect on the trajectory of structural cerebral changes. (Source: Critical Care Medicine)
Source: Critical Care Medicine - April 1, 2022 Category: Emergency Medicine Tags: Feature Articles Source Type: research

Benchmarking Inpatient Mortality Using Electronic Medical Record Data: A Retrospective, Multicenter Analytical Observational Study*
CONCLUSIONS: Variables considered by traditional ICU prognostic models accurately benchmark patient mortality for patients receiving care in multiple hospital locations, not only the ICU. Unlike Acute Physiology and Chronic Health Evaluation, this model relies on electronic medical record data alone and does not require personnel to collect the independent predictor variables. Assessing the model’s utility for benchmarking hospital performance will require prospective testing in a larger representative sample of hospitals. (Source: Critical Care Medicine)
Source: Critical Care Medicine - April 1, 2022 Category: Emergency Medicine Tags: Feature Articles Source Type: research

Diversity of Authors of Publications From the Canadian Critical Care Trials Group*
CONCLUSIONS: Authors of Canadian Critical Care Trials Group publications are diverse with regard to demographic and professional characteristics. (Source: Critical Care Medicine)
Source: Critical Care Medicine - April 1, 2022 Category: Emergency Medicine Tags: Feature Articles Source Type: research