Effect of prone positioning on survival in adult patients receiving venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis
AbstractPurposePrevious studies support the potential efficacy of venovenous extracorporeal membrane oxygenation (vvECMO) for improving survival in severe acute respiratory distress syndrome (ARDS) cases. Prone positioning (PP) has been shown to improve the outcomes of moderate-to-severe ARDS patients. Few studies and no randomized controlled trials have evaluated the effect of PP performed in ECMO patients.MethodsWe performed a systematic review and meta-analysis examining the effect of prone positioning for ARDS patients receiving vvECMO on survival. All authors were contacted to obtain complementary information not ment...
Source: Intensive Care Medicine - January 17, 2022 Category: Intensive Care Source Type: research

De-adoption of chlorhexidine oral care and ICU mortality
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - January 17, 2022 Category: Intensive Care Source Type: research

Do not forget the blood cultures!
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - January 17, 2022 Category: Intensive Care Source Type: research

When the harms of intensive care treatment outweigh the benefits, the default use of time-limited trials is not ethically justifiable
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - January 15, 2022 Category: Intensive Care Source Type: research

The next big epidemic? Device shutdowns
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - January 14, 2022 Category: Intensive Care Source Type: research

Choice of priors: how much scepticism is appropriate?
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - January 13, 2022 Category: Intensive Care Source Type: research

Towards evidence-based staffing: the promise and pitfalls of patient-to-intensivist ratios
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - January 13, 2022 Category: Intensive Care Source Type: research

Education to save lives: C19SPACE, the COVID19 Skills PrepAration CoursE
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - January 10, 2022 Category: Intensive Care Source Type: research

We are proud of you Jamie
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - January 3, 2022 Category: Intensive Care Source Type: research

Mechanisms of oxygenation responses to proning and recruitment in COVID-19 pneumonia
This study aimed at investigating the mechanisms underlying the oxygenation response to proning and recruitment maneuvers in coronavirus disease 2019 (COVID-19) pneumonia.MethodsTwenty-five patients with COVID-19 pneumonia, at variable times  since admission (from 1 to 3 weeks), underwent computed tomography (CT) lung scans, gas-exchange and lung-mechanics measurement in supine and prone positions at 5 cmH2O and during recruiting maneuver (supine, 35 cmH2O). Within the non-aerated tissue, we differentiated the atelectatic and consolidated tissue (recruitable and non-recruitable at 35 cmH2O of airway pressure). Po...
Source: Intensive Care Medicine - January 1, 2022 Category: Intensive Care Source Type: research

Understanding purpura fulminans in adult patients
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - January 1, 2022 Category: Intensive Care Source Type: research

Unraveling the secret of re-balancing homeostasis in sepsis: a critical view on extracorporeal blood purification modalities
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - January 1, 2022 Category: Intensive Care Source Type: research

C-reactive protein in immunometabolism: spared from ‘paying the piper’
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - January 1, 2022 Category: Intensive Care Source Type: research

Change in perception of the quality of death in the intensive care unit by healthcare workers associated with the implementation of the “well-dying law”
ConclusionOur study is the first to show that implementing the well-dying law is associated with quality of death in the ICU, although the quality of death in South Korea remains relatively low and should be further improved. (Source: Intensive Care Medicine)
Source: Intensive Care Medicine - January 1, 2022 Category: Intensive Care Source Type: research

Inhaled amphotericin B lipid complex for prophylaxis against COVID-19-associated invasive pulmonary aspergillosis
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - December 23, 2021 Category: Intensive Care Source Type: research

Correction to: Palliative care interventions in intensive care unit patients
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - December 21, 2021 Category: Intensive Care Source Type: research

Bleeding and thrombotic events in adults supported with venovenous extracorporeal membrane oxygenation: an ELSO registry analysis
This study aimed at analyzing the prevalence, mortality association, and risk factors for bleeding and thrombosis events (BTEs) among adults supported with venovenous extracorporeal membrane oxygenation (VV-ECMO).MethodsWe queried the Extracorporeal Life Support Organization registry for adults supported with VV-ECMO from 2010 to 2017. Multivariable logistic regression modeling was used to assess the association between BTEs and in-hospital mortality and the predictors of BTEs.ResultsAmong 7579 VV-ECMO patients meeting criteria, 40.2% experienced  ≥ 1 BTE. Thrombotic events comprised 54.9% of all BTEs and ...
Source: Intensive Care Medicine - December 18, 2021 Category: Intensive Care Source Type: research

The AKI care bundle: all bundle components are created equal —are they?
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - December 18, 2021 Category: Intensive Care Source Type: research

Bleeding and thrombotic events in adults supported with venovenous extracorporeal membrane oxygenation: an ELSO registry analysis
This study aimed at analyzing the prevalence, mortality association, and risk factors for bleeding and thrombosis events (BTEs) among adults supported with venovenous extracorporeal membrane oxygenation (VV-ECMO).MethodsWe queried the Extracorporeal Life Support Organization registry for adults supported with VV-ECMO from 2010 to 2017. Multivariable logistic regression modeling was used to assess the association between BTEs and in-hospital mortality and the predictors of BTEs.ResultsAmong 7579 VV-ECMO patients meeting criteria, 40.2% experienced  ≥ 1 BTE. Thrombotic events comprised 54.9% of all BTEs and ...
Source: Intensive Care Medicine - December 18, 2021 Category: Intensive Care Source Type: research

The AKI care bundle: all bundle components are created equal —are they?
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - December 18, 2021 Category: Intensive Care Source Type: research

Pick your prior: scepticism about sceptical prior beliefs
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - December 17, 2021 Category: Intensive Care Source Type: research

Feasibility of conservative fluid administration and deresuscitation compared with usual care in critical illness: the Role of Active Deresuscitation After Resuscitation-2 (RADAR-2) randomised clinical trial
This study investigated the feasibility of a randomised trial comparing conservative fluid administration and deresuscitation (active removal of accumulated fluid using diuretics or ultrafiltration) with usual care in critical illness.MethodsOpen-label, parallel-group, allocation-concealed randomised clinical feasibility trial. Mechanically ventilated adult patients expected to require critical care beyond the next calendar day were enrolled between 24 and 48  h following admission to the intensive care unit (ICU). Patients were randomised to either a 2-stage fluid strategy comprising conservative fluid administration...
Source: Intensive Care Medicine - December 16, 2021 Category: Intensive Care Source Type: research

Can serum markers of brain injury predict good neurological outcome after out ‑of‑hospital cardiac arrest?
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - December 16, 2021 Category: Intensive Care Source Type: research

Sometimes, less is just less …
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - December 16, 2021 Category: Intensive Care Source Type: research

Can serum markers of brain injury predict neurological outcome after out-of-hospital cardiac arrest? Author ’s reply
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - December 16, 2021 Category: Intensive Care Source Type: research

Meningeal inflammation and cerebral vasculitis during acute COVID-19 with spontaneous regression
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - December 16, 2021 Category: Intensive Care Source Type: research

Feasibility of conservative fluid administration and deresuscitation compared with usual care in critical illness: the Role of Active Deresuscitation After Resuscitation-2 (RADAR-2) randomised clinical trial
This study investigated the feasibility of a randomised trial comparing conservative fluid administration and deresuscitation (active removal of accumulated fluid using diuretics or ultrafiltration) with usual care in critical illness.MethodsOpen-label, parallel-group, allocation-concealed randomised clinical feasibility trial. Mechanically ventilated adult patients expected to require critical care beyond the next calendar day were enrolled between 24 and 48  h following admission to the intensive care unit (ICU). Patients were randomised to either a 2-stage fluid strategy comprising conservative fluid administration...
Source: Intensive Care Medicine - December 16, 2021 Category: Intensive Care Source Type: research

Can serum markers of brain injury predict good neurological outcome after out ‑of‑hospital cardiac arrest?
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - December 16, 2021 Category: Intensive Care Source Type: research

Sometimes, less is just less …
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - December 16, 2021 Category: Intensive Care Source Type: research

Can serum markers of brain injury predict neurological outcome after out-of-hospital cardiac arrest? Author ’s reply
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - December 16, 2021 Category: Intensive Care Source Type: research

Meningeal inflammation and cerebral vasculitis during acute COVID-19 with spontaneous regression
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - December 16, 2021 Category: Intensive Care Source Type: research

Current practice and evolving concepts in septic shock resuscitation
AbstractClinical and pathophysiological understanding of septic shock has progressed exponentially in the previous decades, translating into a steady decrease in septic shock-related morbidity and mortality. Even though large randomized, controlled trials have addressed fundamental aspects of septic shock resuscitation, many questions still exist. In this review, we will describe the current standards of septic shock resuscitation, but the emphasis will be placed on evolving concepts in different domains such as clinical resuscitation targets, adequate use of fluids and vasoactive drugs, refractory shock, and the use of ex...
Source: Intensive Care Medicine - December 15, 2021 Category: Intensive Care Source Type: research

Prognostic value of global deep white matter DTI metrics for 1-year outcome prediction in ICU traumatic brain injury patients: an MRI-COMA and CENTER-TBI combined study
ConclusionThe model successfully identified, with a specificity compatible with a personalized decision-making process in ICU, one in two patients who had an unfavorable outcome at 1  year after the injury, and two-thirds of the patients who experienced a favorable outcome. (Source: Intensive Care Medicine)
Source: Intensive Care Medicine - December 14, 2021 Category: Intensive Care Source Type: research

Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial
ConclusionWhile the primary outcome of Day 7 survival was greater in patients randomized to ketamine, there was no significant difference in survival by Day 28. (Source: Intensive Care Medicine)
Source: Intensive Care Medicine - December 14, 2021 Category: Intensive Care Source Type: research

Correction to: Role of total lung stress on the progression of early COVID ‑19 pneumonia
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - December 14, 2021 Category: Intensive Care Source Type: research

Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial
ConclusionWhile the primary outcome of Day 7 survival was greater in patients randomized to ketamine, there was no significant difference in survival by Day 28. (Source: Intensive Care Medicine)
Source: Intensive Care Medicine - December 14, 2021 Category: Intensive Care Source Type: research

Correction to: Role of total lung stress on the progression of early COVID ‑19 pneumonia
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - December 14, 2021 Category: Intensive Care Source Type: research

Source-specific host response and outcomes in critically ill patients with sepsis: a prospective cohort study
AbstractPurposeThere is limited knowledge on how the source of infection impacts the host response to sepsis. We aimed to compare the host response in sepsis patients with a single, known source at admission (
Source: Intensive Care Medicine - December 13, 2021 Category: Intensive Care Source Type: research

Correction to: Ensuring editorial continuity and quality of science during the COVID-19 storm: the ICM experience
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - December 3, 2021 Category: Intensive Care Source Type: research

Association of patient-to-intensivist ratio with hospital mortality in Australia and New Zealand
ConclusionWe found no association of PIR with hospital mortality across ANZ ICUs. The low cohort predicted mortality may limit external validity. (Source: Intensive Care Medicine)
Source: Intensive Care Medicine - December 2, 2021 Category: Intensive Care Source Type: research

Randomised clinical trials in critical care: past, present and future
AbstractRandomised clinical trials (RCTs) are the gold standard for providing unbiased evidence of intervention effects. Here, we provide an overview of the history of RCTs and discuss the major challenges and limitations of current critical care RCTs, including overly optimistic effect sizes; unnuanced conclusions based on dichotomization of results; limited focus on patient-centred outcomes other than mortality; lack of flexibility and ability to adapt, increasing the risk of inconclusive results and limiting knowledge gains before trial completion; and inefficiency due to lack of re-use of trial infrastructure. We discu...
Source: Intensive Care Medicine - December 2, 2021 Category: Intensive Care Source Type: research

Association of patient-to-intensivist ratio with hospital mortality in Australia and New Zealand
ConclusionWe found no association of PIR with hospital mortality across ANZ ICUs. The low cohort predicted mortality may limit external validity. (Source: Intensive Care Medicine)
Source: Intensive Care Medicine - December 2, 2021 Category: Intensive Care Source Type: research

Randomised clinical trials in critical care: past, present and future
AbstractRandomised clinical trials (RCTs) are the gold standard for providing unbiased evidence of intervention effects. Here, we provide an overview of the history of RCTs and discuss the major challenges and limitations of current critical care RCTs, including overly optimistic effect sizes; unnuanced conclusions based on dichotomization of results; limited focus on patient-centred outcomes other than mortality; lack of flexibility and ability to adapt, increasing the risk of inconclusive results and limiting knowledge gains before trial completion; and inefficiency due to lack of re-use of trial infrastructure. We discu...
Source: Intensive Care Medicine - December 2, 2021 Category: Intensive Care Source Type: research

Raising awareness for time-limited trial discussion upon ICU triage and admission
(Source: Intensive Care Medicine)
Source: Intensive Care Medicine - December 1, 2021 Category: Intensive Care Source Type: research

Brain injury after cardiac arrest: pathophysiology, treatment, and prognosis
AbstractPost-cardiac arrest brain injury (PCABI) is caused by initial ischaemia and subsequent reperfusion of the brain following resuscitation. In those who are admitted to intensive care unit after cardiac arrest, PCABI manifests as coma, and is the main cause of mortality and long-term disability. This review describes the mechanisms of PCABI, its treatment options, its outcomes, and the suggested strategies for outcome prediction. (Source: Intensive Care Medicine)
Source: Intensive Care Medicine - November 27, 2021 Category: Intensive Care Source Type: research

External validation of prognostic scores for COVID-19: a multicenter cohort study of patients hospitalized in Greater Paris University Hospitals
ConclusionSeven prognostic scores were fairly accurate to predict death in hospitalized COVID-19 patients. The 4C Mortality Score and the ABCS stand out because they performed as well in our cohort and their initial validation cohort, during the first epidemic wave and subsequent waves, and in younger and older patients. (Source: Intensive Care Medicine)
Source: Intensive Care Medicine - November 27, 2021 Category: Intensive Care Source Type: research