Midodrine administration during critical illness: fixed-dose or titrate to response?
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - November 25, 2020 Category: Intensive Care Source Type: research

Ten reasons for focusing on the care we provide for family members of critically ill patients with COVID-19
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - November 24, 2020 Category: Intensive Care Source Type: research

Migrants in the intensive care unit: time to show we care
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - November 24, 2020 Category: Intensive Care Source Type: research

Christmas-colored urine in vasoplegic shock
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - November 24, 2020 Category: Intensive Care Source Type: research

Phenotypes and personalized medicine in the acute respiratory distress syndrome
AbstractAlthough the acute respiratory distress syndrome (ARDS) is well defined by the development of acute hypoxemia, bilateral infiltrates and non-cardiogenic pulmonary edema, ARDS is heterogeneous in terms of clinical risk factors, physiology of lung injury, microbiology, and biology, potentially explaining why pharmacologic therapies have been mostly unsuccessful in treating ARDS. Identifying phenotypes of ARDS and integrating this information into patient selection for clinical trials may increase the chance for efficacy with new treatments. In this review, we focus on classifying ARDS by the associated clinical disor...
Source: Intensive Care Medicine - November 18, 2020 Category: Intensive Care Source Type: research

The role for high flow nasal cannula as a respiratory support strategy in adults: a clinical practice guideline
ConclusionsThis clinical practice guideline synthesizes current best-evidence into four recommendations for HFNC use in patients with hypoxemic respiratory failure, following extubation, in the peri-intubation period, and postoperatively for bedside clinicians. (Source: Intensive Care Medicine)
Source: Intensive Care Medicine - November 17, 2020 Category: Intensive Care Source Type: research

Discriminating between CPAP success and failure in COVID-19 patients with severe respiratory failure
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - November 16, 2020 Category: Intensive Care Source Type: research

Intensive care for COVID-19 in low- and middle-income countries: research opportunities and challenges
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - November 13, 2020 Category: Intensive Care Source Type: research

Physical restraint of patients in Australia and New Zealand intensive care units
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - November 12, 2020 Category: Intensive Care Source Type: research

Transfusion in the mechanically ventilated patient
AbstractRed blood cell transfusions are a frequent intervention in critically ill patients, including  in those who are receiving mechanical ventilation. Both these interventions can impact negatively on lung function with risks of transfusion-related acute lung injury (TRALI) and other forms of acute respiratory distress syndrome (ARDS). The interactions between transfusion, mechanical ventilation , TRALI and ARDS are complex and other patient-related (e.g., presence of sepsis or shock, disease severity, and hypervolemia) or blood product-related (e.g., presence of antibodies or biologically active mediators) factors...
Source: Intensive Care Medicine - November 12, 2020 Category: Intensive Care Source Type: research

What ’s new in ECMO for COVID-19?
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - November 12, 2020 Category: Intensive Care Source Type: research

Mechanical ventilation in patients with acute brain injury: recommendations of the European Society of Intensive Care Medicine consensus
AbstractPurposeTo provide clinical practice recommendations and generate a research agenda on mechanical ventilation and respiratory support in patients with acute brain injury (ABI).MethodsAn international consensus panel was convened including 29 clinician-scientists in intensive care medicine with expertise in acute respiratory failure, neurointensive care, or both, and two non-voting methodologists. The panel was divided into seven subgroups, each addressing a predefined clinical practice domain relevant to patients admitted to the intensive care unit (ICU) with ABI, defined as acute traumatic brain or cerebrovascular ...
Source: Intensive Care Medicine - November 11, 2020 Category: Intensive Care Source Type: research

Pulmonary infections complicating ARDS
AbstractPulmonary infection is one of the main complications occurring in patients suffering from acute respiratory distress syndrome (ARDS). Besides traditional risk factors, dysregulation of lung immune defenses and microbiota may play an important role in ARDS patients. Prone positioning does not seem to be associated with a higher risk of pulmonary infection. Although bacteria associated with ventilator-associated pneumonia (VAP) in ARDS patients are similar to those in patients without ARDS, atypical pathogens (Aspergillus, herpes simplex virus and cytomegalovirus) may also be responsible for infection in ARDS patient...
Source: Intensive Care Medicine - November 11, 2020 Category: Intensive Care Source Type: research

Prone position in ARDS patients: why, when, how and for whom
AbstractIn ARDS patients, the change from supine to prone position generates a more even distribution of the gas –tissue ratios along the dependent–nondependent axis and a more homogeneous distribution of lung stress and strain. The change to prone position is generally accompanied by a marked improvement in arterial blood gases, which is mainly due to a better overall ventilation/perfusion matching. Impro vement in oxygenation and reduction in mortality are the main reasons to implement prone position in patients with ARDS. The main reason explaining a decreased mortality is less overdistension in non-dependen...
Source: Intensive Care Medicine - November 10, 2020 Category: Intensive Care Source Type: research

Analgesia and sedation in patients with ARDS
AbstractAcute Respiratory Distress Syndrome (ARDS) is one of the most demanding conditions in an Intensive Care Unit (ICU). Management of analgesia and sedation in ARDS is particularly challenging. An expert panel was convened to produce a “state-of-the-art” article to support clinicians in the optimal management of analgesia/sedation in mechanically ventilated adults with ARDS, including those with COVID-19. Current ICU analgesia/sedation guidelines promote analgesia first and minimization of sedation, wakefulness, delirium preve ntion and early rehabilitation to facilitate ventilator and ICU liberation. Howev...
Source: Intensive Care Medicine - November 10, 2020 Category: Intensive Care Source Type: research

Airborne spread of SARS-CoV-2 while using high-flow nasal cannula oxygen therapy: myth or reality?
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - November 10, 2020 Category: Intensive Care Source Type: research

Fluid administration and monitoring in ARDS: which management?
AbstractModalities of fluid management in patients sustaining the acute respiratory distress syndrome (ARDS) are challenging and controversial. Optimal fluid management should provide adequate oxygen delivery to the body, while avoiding inadvertent increase in lung edema which further impairs gas exchange. In ARDS patients, positive fluid balance has been associated with prolonged mechanical ventilation, longer ICU and hospital stay, and higher mortality. Accordingly, a restrictive strategy has been compared to a more liberal approach in randomized controlled trials conducted in various clinical settings. Restrictive strat...
Source: Intensive Care Medicine - November 9, 2020 Category: Intensive Care Source Type: research

How to ventilate obstructive and asthmatic patients
AbstractExacerbations are part of the natural history of chronic obstructive pulmonary disease and asthma. Severe exacerbations can cause acute respiratory failure, which may ultimately require mechanical ventilation. This review summarizes practical ventilator strategies for the management of patients with obstructive airway disease. Such strategies include non-invasive mechanical ventilation to prevent intubation, invasive mechanical ventilation, from the time of intubation to weaning, and strategies intended to prevent post-extubation acute respiratory failure. The role of tracheostomy, the long-term prognosis, and pote...
Source: Intensive Care Medicine - November 9, 2020 Category: Intensive Care Source Type: research

Neurofilament to predict post-anoxic neurological outcome: are we ready for the prime time?
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - November 9, 2020 Category: Intensive Care Source Type: research

Long term outcomes of critically ill COVID-19 pneumonia patients: early learning
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - November 9, 2020 Category: Intensive Care Source Type: research

From the inside out: personal journeys in intensive care
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - November 8, 2020 Category: Intensive Care Source Type: research

Myorelaxants in ARDS patients
AbstractNeuromuscular blocking agents (NMBAs) inhibit patient-initiated active breath and the risk of high tidal volumes and consequent high transpulmonary pressure swings, and minimize patient/ ventilator asynchrony in acute respiratory distress syndrome (ARDS). Minimization of volutrauma and ventilator-induced lung injury (VILI) results in a lower incidence of barotrauma, improved oxygenation and a decrease in circulating proinflammatory markers. Recent randomized clinical trials did not reveal harmful muscular effects during a short course of NMBAs. The use of NMBAs should be considered during the early phase of severe ...
Source: Intensive Care Medicine - November 7, 2020 Category: Intensive Care Source Type: research

Current and evolving standards of care for patients with ARDS
AbstractCare for patients with acute respiratory distress syndrome (ARDS) has changed considerably over the 50 years since its original description. Indeed, standards of care continue to evolve as does how this clinical entity is defined and how patients are grouped and treated in clinical practice. In this narrative review we discuss current standards – treatments that have a solid evidence base and are well established as targets for usual care – and also evolving standards – treatments that have promise and may become widely adopted in the future. We focus on three broad domains of ventilatory manageme...
Source: Intensive Care Medicine - November 6, 2020 Category: Intensive Care Source Type: research

Impact of late administration of corticosteroids in COVID-19 ARDS
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - November 6, 2020 Category: Intensive Care Source Type: research

Pharmacological principles guiding prolonged glucocorticoid treatment in ARDS
AbstractCurrent literature addressing the pharmacological principles guiding glucocorticoid (GC) administration in ARDS is scant. This paucity of information may have led to the heterogeneity of treatment protocols and misinterpretation of available findings. GCs are agonist compounds that bind to the GC receptor (GR) producing a pharmacological response. Clinical efficacy depends on the magnitude and duration of exposure to GR. We updated the meta-analysis of randomized trials investigating GC treatment in ARDS, focusing on treatment protocols and response. We synthesized the current literature on the role of the GR in GC...
Source: Intensive Care Medicine - November 4, 2020 Category: Intensive Care Source Type: research

COVID-19: what the clinician should know about post-mortem findings
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - November 3, 2020 Category: Intensive Care Source Type: research

Clinical strategies for implementing lung and diaphragm-protective ventilation: avoiding insufficient and excessive effort
AbstractMechanical ventilation may have adverse effects on both the lung and the diaphragm. Injury to the lung is mediated by excessive mechanical stress and strain, whereas the diaphragm develops atrophy as a consequence of low respiratory effort and injury in case of excessive effort. The lung and diaphragm-protective mechanical ventilation approach aims to protect both organs simultaneously whenever possible. This review summarizes practical strategies for achieving lung and diaphragm-protective targets at the bedside, focusing on inspiratory and expiratory ventilator settings, monitoring of inspiratory effort or respir...
Source: Intensive Care Medicine - November 2, 2020 Category: Intensive Care Source Type: research

Extracorporeal life support for adults with acute respiratory distress syndrome
AbstractExtracorporeal life support (ECLS) can support gas exchange in patients with the acute respiratory distress syndrome (ARDS). During ECLS, venous blood is drained from a central vein via a cannula, pumped through a semipermeable membrane that permits diffusion of oxygen and carbon dioxide, and returned via a cannula to a central vein. Two related forms of ECLS are used. Venovenous extracorporeal membrane oxygenation (ECMO), which uses high blood flow rates to both oxygenate the blood and remove carbon dioxide, may be considered in patients with severe ARDS whose oxygenation or ventilation cannot be maintained adequa...
Source: Intensive Care Medicine - November 2, 2020 Category: Intensive Care Source Type: research

Designing an ARDS trial for 2020 and beyond: focus on enrichment strategies
AbstractWith the exception of a few successes in trials of supportive care, the majority of interventional clinical trials for acute respiratory distress syndrome (ARDS) have not led to new therapies. To improve the likelihood of benefit from clinical trial interventions in ARDS, clinical trial design must be improved. To optimize trial design, many factors need to be considered including the type of therapy to be tested, the type of trial (phase 2 or 3), how patients will be selected, primary and secondary end-points, and strategy for conduct of the trial, including potential newer trial designs such as platform or adapti...
Source: Intensive Care Medicine - November 2, 2020 Category: Intensive Care Source Type: research

Physiological dead space ventilation, disease severity and outcome in ventilated patients with hypoxaemic respiratory failure due to coronavirus disease 2019
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - November 1, 2020 Category: Intensive Care Source Type: research

Monitoring of high-flow nasal cannula for SARS-CoV-2 severe pneumonia: less is more, better look at respiratory rate
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - November 1, 2020 Category: Intensive Care Source Type: research

Tranexamic acid in traumatic brain injury: systematic review and meta-analysis trumps a large clinical trial?
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - October 31, 2020 Category: Intensive Care Source Type: research

Clinical validation of precision medicine protocols: the last mile is the longest
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - October 29, 2020 Category: Intensive Care Source Type: research

Acute respiratory failure and mechanical ventilation in the context of the COVID-19 pandemic: why a special issue in ICM?
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - October 29, 2020 Category: Intensive Care Source Type: research

A pandemic of cognitive bias
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - October 27, 2020 Category: Intensive Care Source Type: research

Neuromuscular blockade in patients with ARDS: a rapid practice guideline
AbstractThe aim of this Intensive Care Medicine Rapid Practice Guideline (ICM-RPG) is to formulate an evidence-based guidance for the use of neuromuscular blocking agents (NMBA) in adults with acute respiratory distress syndrome (ARDS). The panel comprised 20 international clinical experts from 12 countries, and 2 patient representatives. We adhered to the methodology for trustworthy clinical practice guidelines and followed a strict conflict of interest policy. We convened panelists through teleconferences and web-based discussions. Guideline experts from the guidelines in intensive care, development, and evaluation Group...
Source: Intensive Care Medicine - October 26, 2020 Category: Intensive Care Source Type: research

Ten tips to optimize weaning and extubation success in the critically ill
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - October 26, 2020 Category: Intensive Care Source Type: research

How to ventilate obese patients in the ICU
AbstractObesity is an important risk factor for major complications, morbidity and mortality related to intubation procedures and ventilation in the intensive care unit (ICU). The fall in functional residual capacity promotes airway closure and atelectasis formation. This narrative review presents the impact of obesity on the respiratory system and the key points to optimize airway management, noninvasive and invasive mechanical ventilation in ICU patients with obesity. Non-invasive strategies should first optimize body position with reverse Trendelenburg position or sitting position. Noninvasive ventilation (NIV) is consi...
Source: Intensive Care Medicine - October 23, 2020 Category: Intensive Care Source Type: research

Physiological and quantitative CT-scan characterization of COVID-19 and typical ARDS: a matched cohort study
AbstractPurposeTo investigate whether COVID-19-ARDS differs from all-cause ARDS.MethodsThirty-two consecutive, mechanically ventilated COVID-19-ARDS patients were compared to two historical ARDS sub-populations 1:1 matched for PaO2/FiO2 or for compliance of the respiratory system. Gas exchange, hemodynamics and respiratory mechanics were recorded at 5 and 15 cmH2O PEEP. CT scan variables were measured at 5 cmH2O PEEP.ResultsAnthropometric characteristics were similar in COVID-19-ARDS, PaO2/FiO2-matched-ARDS and Compliance-matched-ARDS. The PaO2/FiO2-matched-ARDS and COVID-19-ARDS populations (both with PaO2/FiO2 106 &thins...
Source: Intensive Care Medicine - October 21, 2020 Category: Intensive Care Source Type: research

Efficacy and safety of tranexamic acid in acute traumatic brain injury: a systematic review and meta-analysis of randomized-controlled trials
ConclusionsIn patients with acute TBI, TXA probably has no effect on mortality or disability. TXA may decrease hematoma expansion on subsequent imaging; however, this outcome is likely of less importance to patients. The use of TXA probably does not increase the risk of adverse events. (Source: Intensive Care Medicine)
Source: Intensive Care Medicine - October 20, 2020 Category: Intensive Care Source Type: research

Five things every clinician should know about AI ethics in intensive care
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - October 19, 2020 Category: Intensive Care Source Type: research

Comparison of mechanical power estimations in mechanically ventilated patients with ARDS: a secondary data analysis from the EPVent study
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - October 19, 2020 Category: Intensive Care Source Type: research

Differences in clinical deterioration among three sub-phenotypes of COVID-19 patients at the time of first positive test: results from a clustering analysis
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - October 19, 2020 Category: Intensive Care Source Type: research

Antimicrobial stewardship in ICUs during the COVID-19 pandemic: back to the 90s?
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - October 17, 2020 Category: Intensive Care Source Type: research

Antiseptic mouthwash, the nitrate –nitrite–nitric oxide pathway, and hospital mortality: a hypothesis generating review
AbstractMeta-analyses and several large cohort studies have demonstrated that antiseptic mouthwashes are associated with mortality in hospitalized patients. A clear pathogenic mechanism is lacking, leading to controversy and a reluctance to abandon or limit the use of antiseptic mouthwashes. Here, we generate the hypothesis that a disturbance in nitric oxide homeostasis by antiseptic mouthwashes may be responsible for the observed increase in mortality risk. Nitric oxide is essential in multiple physiological processes, and a reduction in nitric oxide bioavailability is associated with the occurrence or worsening of pathol...
Source: Intensive Care Medicine - October 16, 2020 Category: Intensive Care Source Type: research

Biomarkers in the ICU: less is more? No
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - October 15, 2020 Category: Intensive Care Source Type: research

Paediatric Inflammatory Multisystem Syndrome Temporally-Associated with SARS-CoV-2 Infection: An Overview
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - October 14, 2020 Category: Intensive Care Source Type: research

Intensive care accessibility and outcomes in pandemics
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - October 14, 2020 Category: Intensive Care Source Type: research

Propofol-infusion syndrome in traumatic brain injury: consider the ECMO option
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - October 14, 2020 Category: Intensive Care Source Type: research

Correction to: Hypoalbuminemia and acute kidney injury: a meta-analysis of observational clinical studies
The article Hypoalbuminemia and acute kidney injury: a meta-analysis of observational clinical studies, written by Christian J. Wiedermann. (Source: Intensive Care Medicine)
Source: Intensive Care Medicine - October 14, 2020 Category: Intensive Care Source Type: research