Respiratory drive: a journey from health to disease
AbstractRespiratory drive is defined as the intensity of respiratory centers output during the breath and is primarily affected by cortical and chemical feedback mechanisms. During the involuntary act of breathing, chemical feedback, primarily mediated through CO2, is the main determinant of respiratory drive. Respiratory drive travels through neural pathways to respiratory muscles, which execute the breathing process and generate inspiratory flow (inspiratory flow-generation pathway). In a healthy state, inspiratory flow-generation pathway is intact, and thus respiratory drive is satisfied by the rate of volume increase, ...
Source: Journal of Intensive Care - April 22, 2024 Category: Intensive Care Source Type: research
The optimal glycemic target in critically ill patients: an updated network meta-analysis
AbstractAcute glycemic control significantly affects the clinical outcomes of critically ill patients. This updated network meta-analysis examines the benefits and harms of four target blood glucose levels (< 110, 110–144, 144–180, and> 180 mg/dL). Analyzing data of 27,541 patients from 37 trials, the surface under the cumulative ranking curve for mortality and hypoglycemia was highest at a target blood glucose level of 144–180 mg/dL, while for infection and acute kidney injury at 110–144 mg/dL. Further evidence is needed to determine whether 110–144 or 144–180 mg/dL is superior as an optimal glu...
Source: Journal of Intensive Care - April 14, 2024 Category: Intensive Care Source Type: research
Predictors and outcomes of withholding and withdrawal of life-sustaining treatments in intensive care units in Singapore: a multicentre observational study
ConclusionsDifferences in the independent predictors of withholding and withdrawal of LST exist. Even after accounting for baseline characteristics, both withholding and withdrawal of LST independently predict hospital mortality. Later mortality in patients who had LST withdrawn compared to withholding suggests that the decision to withdraw may be at the point when medical futility is recognised. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - March 26, 2024 Category: Intensive Care Source Type: research
Risk factors for arterial catheter failure and complications during critical care hospitalisation: a secondary analysis of a multisite, randomised trial
ConclusionsAC failure is common with ultrasound-guided insertion associated with lower failure rates.Trial registration Australian New Zealand Clinical Trial Registry (ACTRN 12610000505000); date registered: 18 June 2010. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - March 8, 2024 Category: Intensive Care Source Type: research
From bedside to recovery: exercise therapy for prevention of post-intensive care syndrome
ConclusionPICS is a growing global healthcare concern. This review aims to guide clinicians, researchers, policymakers, and healthcare providers in utilising ET as a therapeutic and preventive measure for patients during and after an ICU admission to address this problem. An improved understanding of the effectiveness of ET and the clinical and research gaps that needs to be urgently addressed will greatly assist clinicians in their efforts to rehabilitate ICU survivors, improving patients ’ quality of survival and helping them return to their normal lives after hospital discharge. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - February 29, 2024 Category: Intensive Care Source Type: research
Unit-to-unit transfer due to shortage of intensive care beds in Sweden 2015 –2019 was associated with a lower risk of death but a longer intensive care stay compared to no transfer: a registry study
ConclusionsIntensive care unit-to-unit transfer due to shortage of bed capacity as compared to no transfer during a 5-year period preceding the COVID-19 pandemic in Sweden was associated with lower risk of death within 90 days but with longer stay in intensive care. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - February 27, 2024 Category: Intensive Care Source Type: research
Exploring the therapeutic role of early heparin administration in ARDS management: a MIMIC-IV database analysis
ConclusionThis research highlights that early prophylactic administration of heparin may substantially lower mortality in ARDS patients. These findings underscore the potential of heparin as a key component in the management of ARDS, offering a new perspective and novel strategies for clinical treatment. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - February 26, 2024 Category: Intensive Care Source Type: research
Development and validation of a nomogram to predict the risk of sepsis-associated encephalopathy for septic patients in PICU: a multicenter retrospective cohort study
ConclusionsThe novel nomogram and online calculator showed performance in predicting the morbidity of SAE in patients with sepsis admitted to the PICU, thereby potentially assisting clinicians in the early detection and intervention of SAE. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - February 20, 2024 Category: Intensive Care Source Type: research
External validation of the HACOR score and ROX index for predicting treatment failure in patients with coronavirus disease 2019 pneumonia managed on high-flow nasal cannula therapy: a multicenter retrospective observational study in Japan
ConclusionsIn COVID-19 patients receiving HFNC therapy in Japan, the predictive performance of the HACOR score and ROX index at the 2-h time-point may be inadequate. Furthermore, clinicians should be mindful of time-point scores owing to the variation of the models ’ predictive performance with the time-point.Trial registration UMIN (registration number: UMIN000050024, January 13, 2023) (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - February 15, 2024 Category: Intensive Care Source Type: research
Association between regional critical care capacity and the incidence of invasive mechanical ventilation for coronavirus disease 2019: a population-based cohort study
ConclusionsThe results of prefecture-level analyses demonstrate that increased numbers of ICU beds, resource-rich ICU beds, and intensivists are associated with the incidence of invasive mechanical ventilation among patients recently diagnosed with COVID-19 during the pandemic. These findings have important implications for healthcare policymakers, aiding in efficiently allocating critical care resources during crises, particularly in regions with limited ICU bed capacities.Registry and the registration no. of the study/trial The approval date of the registry was August 20, 2020, and the registration no. of the study was l...
Source: Journal of Intensive Care - January 30, 2024 Category: Intensive Care Source Type: research
Chest CT findings in severe acute respiratory distress syndrome requiring V-V ECMO: J-CARVE registry
ConclusionsTraction bronchiectasis and subcutaneous emphysema increased the risk of 90-day in-hospital mortality in patients with severe ARDS who required V-V ECMO. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - January 26, 2024 Category: Intensive Care Source Type: research
Efficacy of permissive underfeeding for critically ill patients: an updated systematic review and trial sequential meta-analysis
ConclusionsPermissive underfeeding may reduce ICU mortality in critically ill patients and help to shorten mechanical ventilation duration, but the overall mortality is not improved. Owing to the sample size and patient heterogeneity, the conclusions still need to be verified by well-designed, large-scale RCTs.Trial Registration The protocol for our meta-analysis and systematic review was registered and recorded in PROSPERO (registration no. CRD42023451308). Registered 14 August 2023 (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - January 23, 2024 Category: Intensive Care Source Type: research
Limitation of life sustaining measures in neurocritical care: sex, timing, and advance directive
ConclusionsIn patients receiving LLST, the presence of an AD was associated with an increase of early LLST, but not with an increased in-hospital mortality. This supports the notion that the presence of an AD is primarily an expression of the patients ’ will but does not per se predestine the patient for an unfavorable outcome. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - January 16, 2024 Category: Intensive Care Source Type: research
Post-intensive care syndrome follow-up system after hospital discharge: a narrative review
ConclusionsThis narrative review aimed to summarize the PICS follow-up system after hospital discharge and provide a comprehensive approach for the prevention and treatment of PICS. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - January 12, 2024 Category: Intensive Care Source Type: research
Development of quality indicators for palliative care in intensive care units and pilot testing them via electronic medical record review
ConclusionsThe QI set, developed using the modified Delphi method and tested using EMR data, provided a tool for assessing the quality of palliative care in ICUs. In the two ICUs considered in this study, aspects of the palliative care process with a low performance frequency were identified, and further national surveys were recommended. It is necessary to conduct ongoing surveys at more facilities to improve the quality of palliative care in ICUs. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - January 9, 2024 Category: Intensive Care Source Type: research
