Use of glucocorticoids in patients with acute respiratory distress syndrome: a meta-analysis and trial sequential analysis
AbstractBackgroundAcute respiratory distress syndrome (ARDS) is a common and disabling disease with high rates of mortality and morbidity. The role of steroids in treating ARDS remains controversial. We aim to examine the evidence behind using glucocorticoids in the management of ARDS from the available studies.MethodsWe performed a literature review of major electronic databases for randomized controlled trials (RCTs) comparing glucocorticoids versus placebo in treating patients with ARDS. Our primary outcome was hospital mortality. Other outcomes included ICU mortality, number of ventilator-free days at day 28, incidence...
Source: Journal of Intensive Care - June 30, 2020 Category: Intensive Care Source Type: research

Epidemiology of sepsis and septic shock in intensive care units between sepsis-2 and sepsis-3 populations: sepsis prognostication in intensive care unit and emergency room (SPICE-ICU)
ConclusionsMost patients with infection admitted to ICU meet sepsis-2 and sepsis-3 criteria. However, in-hospital mortality did not occur if patients did not meet any criteria. Better criteria might be developed by better selection and combination of elements in both definitions.Trial registrationUMIN000027452 (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - June 30, 2020 Category: Intensive Care Source Type: research

Early prediction of high flow nasal cannula therapy outcomes using a modified ROX index incorporating heart rate
ConclusionWhile validation studies are required, the ROX-HR index appears to be a promising tool for early identification of treatment failure in patients initiated on HFNC for acute hypoxemic respiratory failure or as a preventative treatment after a planned extubation. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - June 22, 2020 Category: Intensive Care Source Type: research

Association between low pH and unfavorable neurological outcome among out-of-hospital cardiac arrest patients treated by extracorporeal CPR: do not dismiss confounders!
AbstractRecently, Okada et al. reported an association between low pH value before the implementation of extracorporeal cardiopulmonary resuscitation (ECPR) and 1-month unfavorable neurological outcome among out-of-hospital cardiac arrest (OHCA) patients treated with ECPR.Nevertheless, we believe that some methodological flaws deserve their conclusions.The time duration between OHCA occurrence and blood gas analysis (BGA), a major confounder for misinterpretation, was not taken into account. It is not reported whether the result of BGA analysis was considered and/or treated, and if ECPR implementation decision had been inf...
Source: Journal of Intensive Care - June 22, 2020 Category: Intensive Care Source Type: research

Save the ICU and save lives during the COVID-19 pandemic
AbstractAppropriate critical care delivery for Coronavirus disease 2019 (COVID-19) is a cornerstone in saving lives. Earlier publications worldwide demonstrate higher mortality among patients receiving mechanical ventilation in intensive care units during “surges” in the number of cases. In contrast, lower mortality outcomes are evident in Japan using CRISIS [CRoss Icu Searchable Information System] data by the national registry, Japan ECMOnet for COVID-19. This highlights the need for scientific analysis of the medical factors contributing to hi gh survival rates and social factors associated with low case &ld...
Source: Journal of Intensive Care - June 15, 2020 Category: Intensive Care Source Type: research

Shortening of low-flow duration over time was associated with improved outcomes of extracorporeal cardiopulmonary resuscitation in in-hospital cardiac arrest
In this study, we hypothesized that quality improvement in efforts to shorten the duration of initiating ECPR had decreased LFD over the last 15  years of experience at an academic tertiary care hospital, which in turn improved the outcomes of in-hospital CA (IHCA).MethodsThis was a single-center retrospective observational study of ECPR patients between January 2003 and December 2017. A rapid response system (RRS) and an extracorporeal membrane oxygenation (ECMO) program were initiated in 2011 and 2013. First, the association of LFD per minute with the 90-day mortality and neurological outcome was analyzed using mu...
Source: Journal of Intensive Care - June 15, 2020 Category: Intensive Care Source Type: research

Correction to: Nationwide system to centralize decisions around ECMO use for severe COVID-19 pneumonia in Japan (Special Correspondence)
An amendment to this paper has been published and can be accessed via the original article. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - May 25, 2020 Category: Intensive Care Source Type: research

Neuromuscular blockade management in the critically Ill patient
AbstractNeuromuscular blocking agents (NMBAs) can be an effective modality to address challenges that arise daily in the intensive care unit (ICU). These medications are often used to optimize mechanical ventilation, facilitate endotracheal intubation, stop overt shivering during therapeutic hypothermia following cardiac arrest, and may have a role in the management of life-threatening conditions such as elevated intracranial pressure and status asthmaticus (when deep sedation fails or is not tolerated). However, current NMBA use has decreased during the last decade due to concerns of potential adverse effects such as veno...
Source: Journal of Intensive Care - May 24, 2020 Category: Intensive Care Source Type: research

Lymphopenia in severe coronavirus disease-2019 (COVID-19): systematic review and meta-analysis
AbstractObjectiveClinical and laboratory biomarkers to predict the severity of coronavirus disease 2019 (COVID-19) are essential in this pandemic situation of which resource allocation must be urgently prepared especially in the context of respiratory support readiness. Lymphocyte count has been a marker of interest since the first COVID-19 publication. We conducted a systematic review and meta-analysis in order to investigate the association of lymphocyte count on admission and the severity of COVID-19. We would also like to analyze whether patient characteristics such as age and comorbidities affect the relationship betw...
Source: Journal of Intensive Care - May 24, 2020 Category: Intensive Care Source Type: research

The advent of medical artificial intelligence: lessons from the Japanese approach
AbstractArtificial intelligence or AI has been heralded as the most transformative technology in healthcare, including critical care medicine. Globally, healthcare specialists and health ministries are being pressured to create and implement a roadmap to incorporate applications of AI into care delivery. To date, the majority of Japan ’s approach to AI has been anchored in industry, and the challenges that have occurred therein offer important lessons for nations developing new AI strategies. Notably, the demand for an AI-literate workforce has outpaced training programs and knowledge. This is particularly observable...
Source: Journal of Intensive Care - May 18, 2020 Category: Intensive Care Source Type: research

Association between low pH and unfavorable neurological outcome among out-of-hospital cardiac arrest patients treated by extracorporeal CPR: a prospective observational cohort study in Japan
AbstractBackgroundWe aimed to identify the association of pH value in blood gas assessment with neurological outcome among out-of-hospital cardiac arrest (OHCA) patients treated by extracorporeal cardiopulmonary resuscitation (ECPR).MethodsWe retrospectively analyzed the database of a multicenter prospective observational study on OHCA patients in Osaka prefecture, Japan (CRITICAL study), from July 1, 2012 to December 31, 2016. We included adult OHCA patients treated by ECPR. Patients with OHCA from external causes such as trauma were excluded. We conducted logistic regression analysis to identify the odds ratio (OR) and 9...
Source: Journal of Intensive Care - May 11, 2020 Category: Intensive Care Source Type: research

Monocyte distribution width enhances early sepsis detection in the emergency department beyond SIRS and qSOFA
ConclusionsMDW improves the early detection of sepsis during the initial ED encounter and is complementary to SIRS and qSOFA parameters that are currently used for this purpose. This study supports the incorporation of MDW with other readily available clinical parameters during the initial ED encounter for the early detection of sepsis.Trial registrationClinicalTrials.gov,NCT03145428. First posted May 9, 2017. The first subjects were enrolled June 19, 2017, and the study completion date was January 26, 2018. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - May 5, 2020 Category: Intensive Care Source Type: research

Low-chloride- versus high-chloride-containing hypertonic solution for the treatment of subarachnoid hemorrhage –related complications: The ACETatE (A low ChloriE hyperTonic solution for brain Edema) randomized trial
We report a trial comparing the effect of two hypertonic solutions with different chloride contents on the resultant serum chloride concentrations in SAH patients, with a primary outcome aimed at limiting chloride elevation.MethodsA low ChloridE hyperTonic solution for brain Edema (ACETatE) trial is a single-center, double-blinded, double-dummy, randomized pilot trial comparing bolus infusions of 23.4% NaCl and 16.4% NaCl/Na-acetate for the treatment of cerebral edema in patients with SAH. Randomization occurred when patients developed hyperchloremia (serum Cl−≥ 109 mmol/L) and required hyperosmolar treatment.Resu...
Source: Journal of Intensive Care - May 4, 2020 Category: Intensive Care Source Type: research

Leptospirosis as an important differential of pulmonary haemorrhage on the intensive care unit: a case managed with VV-ECMO
ConclusionsLeptospirosis is a rare but important differential to be considered in diffuse alveolar haemorrhage presenting to the ICU, especially in young males. A thorough history for occupational or recreational risk factors may offer the diagnostic clue. Most patients recover fully with antibiotics. However, resulting acute severe respiratory failure can ensue. In this situation, early consideration for respiratory ECMO support offers time for clearance of endobronchial clot, parenchymal recovery, and prevention of ventilator-induced lung injury. Steroids have no clear evidence but may be used to avoid delay in treating ...
Source: Journal of Intensive Care - April 26, 2020 Category: Intensive Care Source Type: research

Impact of host- and early treatment-related factors on mortality in ICU patients with candidemia: a bicentric retrospective observational study
ConclusionsCandidemia in intensive care unit patients is still associated with high 30-day crude mortality rates. The only predictor of death was Acute Physiology and Chronic Health Evaluation II score ≤ 24 h following candidemia onset. Early empiric antifungal therapy and/or early CVC removal conferred no significant clinical benefit on survival in this patient population. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - April 26, 2020 Category: Intensive Care Source Type: research

Nationwide system to centralize decisions around ECMO use for severe COVID-19 pneumonia in Japan (Special Correspondence)
AbstractThe novel coronavirus disease 2019 (COVID-19) is spreading in Japan. We have collected a total of 26 patients with COVID-19 who required extracorporeal membranous oxygenation (ECMO). The available data from the first 14 cases demonstrated that the median age of patients was 71 and the median PaO2/FIO2 ratio, positive end-expiratory pressure, mean airway pressure, and lung compliance were 70, 15 cmH2O, 21 cmH2O, and 28  mL/cmH2O, respectively. Median serum KL-6 level was 333  U/mL. Consequently, 16 (62%) out of the 26 have been weaned off and 6 (26%) have been extubated and on rehabilitation, while the...
Source: Journal of Intensive Care - April 24, 2020 Category: Intensive Care Source Type: research

Antimicrobials administration time in patients with suspected sepsis: is faster better? An analysis by propensity score
ConclusionsDespite the obvious constraints given for sample size and residual confounding, our results suggest that we need a more comprehensive approach to sepsis and its treatment, considering early detection, multiple interventions, and goals beyond the simple time-to-antimicrobials. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - April 22, 2020 Category: Intensive Care Source Type: research

Spinal cord autoregulation using near-infrared spectroscopy under normal, hypovolemic, and post-fluid resuscitation conditions in a swine model: a comparison with cerebral autoregulation
AbstractBackgroundFew studies have investigated spinal cord autoregulation using near-infrared spectroscopy (NIRS). Here, we assessed spinal cord autoregulation under normal, hypovolemic, and post-fluid resuscitation conditions compared with cerebral autoregulation.MethodsTen pigs (36.1 ± 1.1 kg) were anesthetized with 2.5% isoflurane, before phenylephrine administration at 0.5, 1, 2, and 5 μg kg−1 min−1 in a stepwise fashion at 10-min intervals (baseline), followed by similar administration of sodium nitroprusside (SNP). Hypovolemia was induced by a 600-ml bleed (25% estim...
Source: Journal of Intensive Care - April 15, 2020 Category: Intensive Care Source Type: research

Clinical outcomes of empirical high-dose meropenem in critically ill patients with sepsis and septic shock: a randomized controlled trial
ConclusionsEmpirical therapy with the high-dose meropenem presented comparable clinical outcomes to the standard-dose meropenem in sepsis and septic shock patients. Besides, subgroup analysis manifested superior microbiological cure rate in sepsis or septic shock patients admitted from ED.Trial registrationClinicalTrials.gov,NCT03344627, registered on November 17, 2017 (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - April 15, 2020 Category: Intensive Care Source Type: research

Serial change of neutrophil extracellular traps in tracheal aspirate of patients with acute respiratory distress syndrome: report of three cases
ConclusionsIn these three cases, the formation of NETs was observed in tracheal aspirate of patients with ARDS by either direct or indirect insults to the lung. The amount of NET formation changed dynamically over the clinical course of each patient. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - April 10, 2020 Category: Intensive Care Source Type: research

Japan ECMOnet for COVID-19: telephone consultations for cases with severe respiratory failure caused by COVID-19
AbstractRecently, the novel coronavirus disease 2019 (COVID-19) started spreading in Japan. Therefore, the number of patients with severe COVID-19 requiring extracorporeal membranous oxygenation (ECMO) is expected to increase. A working group has been formed to provide telephone consultation services for cases with severe respiratory failure caused by COVID-19 in Japan. During the first 13  days of the service, there were 12 consultations. For each consultation, we advised the patient on the initiation of ECMO and arranged transportation for patients with ECMO. Based on experience from the H1N1 influenza pandemic, t...
Source: Journal of Intensive Care - April 7, 2020 Category: Intensive Care Source Type: research

Management of life-threatening hemoptysis
AbstractIt is estimated that 5 –14% of patients presenting with hemoptysis will have life-threatening hemoptysis, with a reported mortality rate between 9 and 38%. This manuscript provides a comprehensive literature review on life-threatening hemoptysis, including the etiology and mechanisms, initial stabilization, and manageme nt of patients. There is no consensus on the optimal diagnostic approach to life-threatening hemoptysis, so we present a practical approach to utilizing chest radiography, computed tomography, and bronchoscopy, alone or in combination, to localize the bleeding site depending on patient stabili...
Source: Journal of Intensive Care - April 5, 2020 Category: Intensive Care Source Type: research

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Source: Journal of Intensive Care - March 13, 2020 Category: Intensive Care Source Type: research

Comment on Early versus delayed mobilization for in-hospital mortality and health-related quality of life among critically ill patients: a systematic review and meta-analysis (Okada et al., Journal of Intensive Care 2019)
AbstractCritical comment on the review by Okada et al. on the effect of early versus delayed mobilization because of their definition of early mobilization as mobilization within a week of ICU admission in contrast to current evidence. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - March 12, 2020 Category: Intensive Care Source Type: research

Thoracic fluid content: a novel parameter for predicting failed weaning from mechanical ventilation
ConclusionsThoracic fluid content showed moderate ability for predicting weaning outcome in surgical critically ill patients. However, in the subgroup of patients with ejection fraction less than 40%, TFC above 50 k Ω−1 has an excellent ability to predict weaning failure. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - March 5, 2020 Category: Intensive Care Source Type: research

Variables predicting weaning outcome in prolonged mechanically ventilated tracheotomized patients: a retrospective study
AbstractBackgroundSeveral studies have assessed predictors of weaning and extubation outcome in short-term mechanically ventilated patients, but there are only few studies on predictors of weaning from prolonged mechanical ventilation.MethodsRetrospective, single-center, observational study at a specialized national weaning center in Germany. Patients ’ medical records were reviewed to obtain data on demographics, comorbidities, respiratory indices, and the result of a prospectively documented, standardized spontaneous breathing trial (SBT) upon admission to the weaning center. Respiratory indices assessed were the v...
Source: Journal of Intensive Care - February 21, 2020 Category: Intensive Care Source Type: research

Should we treat sepsis-induced DIC with anticoagulants?
AbstractBackgroundDisseminated intravascular coagulation (DIC) is a common complication in sepsis because of crosstalk between the immune system and the coagulation system. Several anticoagulant agents have been tested in an attempt to improve the survival of patients with sepsis and sepsis-induced DIC. Here, we discuss the rationale against using anticoagulation therapy in septic DIC.Main body of the abstractCoagulopathy and DIC are associated with increased mortality in sepsis. Several anticoagulant agents have been tested in an attempt to improve the survival of patients with sepsis and sepsis-induced DIC, but have prov...
Source: Journal of Intensive Care - February 14, 2020 Category: Intensive Care Source Type: research

A question is “what are the optimal targets for anticoagulant therapies?”
AbstractA high mortality rate is found among septic patients with disseminated intravascular coagulation (DIC). Anticoagulants have been used for treating septic DIC especially in Japanese clinical settings; however, their effectiveness is quite controversial across studies. According to several randomized controlled trials and meta-analyses, antithrombin and recombinant thrombomodulin had no therapeutic benefit in the treatment of sepsis. However, the majority of the previous research did not discuss “septic DIC” but simply “sepsis”, and some reviews showed that anticoagulants were benefit only in ...
Source: Journal of Intensive Care - February 14, 2020 Category: Intensive Care Source Type: research

Validity of an under-mattress sensor for objective sleep measurement in critically ill patients: a prospective observational study
ConclusionsNSCAN had moderate agreement, high sensitivity, and poor specificity in intensive care settings, which is most likely due to its inability to identify immobile wakefulness often observed in critically ill patients or sleep depth. This remains a barrier to its use in the assessment of subjective sleep quality.Trial registrationThis investigation was part of an interventional trial registered with the University Hospital Medical Information Network Individual Clinical Trials Registry (UMIN000026350,http://www.umin.ac.jp/icdr/index-j.html) on March 1, 2017. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - February 11, 2020 Category: Intensive Care Source Type: research

Vitamin C may reduce the duration of mechanical ventilation in critically ill patients: a meta-regression analysis
AbstractBackgroundOur recent meta-analysis indicated that vitamin C may shorten the length of ICU stay and the duration of mechanical ventilation. Here we analyze modification of the vitamin C effect on ventilation time, by the control group ventilation time (which we used as a proxy for severity of disease in the patients of each trial).MethodsWe searched MEDLINE, Scopus, and the Cochrane Central Register of Controlled Trials and reference lists of relevant publications. We included controlled trials in which the administration of vitamin C was the only difference between the study groups. We did not limit our search to r...
Source: Journal of Intensive Care - February 7, 2020 Category: Intensive Care Source Type: research

Hemodynamic effects of intravenous paracetamol in critically ill children with septic shock on inotropic support
ConclusionsHypotensive events are not uncommon in critically ill children on inotropic support treated with intravenous paracetamol, and physicians should be alert to their occurrence and the need for intervention. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - January 29, 2020 Category: Intensive Care Source Type: research

Molecular diversity of extended-spectrum β-lactamases and carbapenemases, and antimicrobial resistance
AbstractAlong with the recent spread of multidrug-resistant bacteria, outbreaks of extended-spectrum β-lactamase (ESBL) and carbapenemase-producing bacteria present a serious challenge to clinicians. β-lactam antibiotics are the most frequently used antibacterial agents and ESBLs, and carbapenemases confer resistance not only to carbapenem antibiotics but also to penicillin and cephem antibiotics . The mechanism of β-lactam resistance involves an efflux pump, reduced permeability, altered transpeptidases, and inactivation by β-lactamases. Horizontal gene transfer is the most common mechanism associated ...
Source: Journal of Intensive Care - January 28, 2020 Category: Intensive Care Source Type: research

Neuromuscular blockade in acute respiratory distress syndrome: a systematic review and meta-analysis of randomized controlled trials
ConclusionNMBA improves oxygenation only after 48  h in moderate, severe ARDS patients and has a lower barotrauma risk without affecting ICU weakness. However, NMBA does not reduce ventilator-free days, duration of mechanical ventilation or, most importantly, the mortality risk regardless of the severity of ARDS. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - January 28, 2020 Category: Intensive Care Source Type: research

Correlation between urinary biomarker and organ failure in patients with sepsis and patients after esophagectomy: a prospective observational study
AbstractBackgroundNeutrophil gelatinase-associated lipocalin (NGAL) is a diagnostic marker for acute kidney injury (AKI). NGAL expression is highly induced not only in kidney injury but also in bacterial infection, inflammation, and cancer. The factors regulating NGAL expression are proinflammatory cytokines, and plasma NGAL levels have been increased in septic shock. However, there are no reports of urine neutrophil gelatinase-associated lipocalin (uNGAL) levels after open esophagectomy.MethodsWe prospectively enrolled critically ill patients, including patients with sepsis (n = 45) and patients who underwen...
Source: Journal of Intensive Care - January 17, 2020 Category: Intensive Care Source Type: research

Impact of the stress ulcer prophylactic protocol on reducing the unnecessary administration of stress ulcer medications and gastrointestinal bleeding: a single-center, retrospective pre-post study
ConclusionsAfter the checklist and the criteria were introduced, the administration of stress ulcer prophylaxis medications decreased without an increase in upper gastrointestinal bleeding in critically ill adults. Prospective studies are necessary to evaluate the causal relationship between the introduction of them and gastrointestinal adverse events in critically ill adults. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - January 16, 2020 Category: Intensive Care Source Type: research

Correction to: To develop a regional ICU mortality prediction model during the first 24  h of ICU admission utilizing MODS and NEMS with six other independent variables from the critical care information system (CCIS) Ontario, Canada
In the original publication of this article [1], there were several transcription errors in the logistic regression equation model as below (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - January 14, 2020 Category: Intensive Care Source Type: research

The effect of antithrombin added to recombinant human-soluble thrombomodulin for severe community-acquired pneumonia-associated disseminated intravascular coagulation: a retrospective cohort study using a nationwide inpatient database
ConclusionsCompared with rhTM alone, combination of rhTM with antithrombin for severe community-acquired pneumonia-associated disseminated intravascular coagulation may be ineffective for reducing mortality and may increase bleeding. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - January 13, 2020 Category: Intensive Care Source Type: research

Risk modifiers of acute respiratory distress syndrome in patients with non-pulmonary sepsis: a retrospective analysis of the FORECAST study
AbstractBackgroundPredisposing conditions and risk modifiers instead of causes and risk factors have recently been used as alternatives to identify patients at a risk of acute respiratory distress syndrome (ARDS). However, data regarding risk modifiers among patients with non-pulmonary sepsis is rare.MethodsWe conducted a secondary analysis of the multicenter, prospective, Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis and Trauma (FORECAST) cohort study that was conducted in 59 intensive care units (ICUs) in Japan during January 2016 –March 2017. Adult patients with severe ...
Source: Journal of Intensive Care - January 10, 2020 Category: Intensive Care Source Type: research

Patients suffering from psychological impairments following critical illness are in need of information
AbstractBackgroundBecause critical illness survivors frequently experience several long-term psychological impairments altering quality of life after ICU, there is a trend towards increasing follow-up care, mainly via ICU follow-up clinics. Despite these and other initiatives, understanding of patient ’s post-ICU needs to help them cope with their problems and subsequently improve quality of life is largely lacking. Our aim was therefore to assess the needs, expectations and wishes in ICU survivors to receive information with the purpose to help them better grasp ICU treatment. In addition, we assessed the perceived ...
Source: Journal of Intensive Care - January 9, 2020 Category: Intensive Care Source Type: research

Health economic evaluations of sepsis interventions in critically ill adult patients: a systematic review
ConclusionsThere is wide variation in the cost-effectiveness of sepsis interventions. There remain important gaps in the literature, with no economic evaluations identified for several interventions routinely used in sepsis. Given the high economic and social burden of sepsis, high-quality economic evaluations are needed to increase our understanding of the cost-effectiveness of these interventions in routine clinical practice and to inform decision makers.Trial registrationPROSPEROCRD42018095980 (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - January 8, 2020 Category: Intensive Care Source Type: research

Circadian disruption of core body temperature in trauma patients: a single-center retrospective observational study
AbstractBackgroundCircadian clock alterations were poorly reported in trauma patients, although they have a critical role in human physiology. Core body temperature is a clinical variable regulated by the circadian clock. Our objective was to identify the circadian temperature disruption in trauma patients and to determine whether these disruptions were associated with the 28-day mortality rate.MethodsA retrospective and observational single-center cohort study was conducted. All adult severe trauma patients admitted to the intensive care unit of Aix Marseille University, North Hospital, from November 2013 to February 2018...
Source: Journal of Intensive Care - January 6, 2020 Category: Intensive Care Source Type: research

Epidemiology and outcomes of sepsis among hospitalizations with systemic lupus erythematosus admitted to the ICU: a population-based cohort study
ConclusionsSepsis is a major, incremental driver of the demand for critical care services among SLE hospitalizations. Despite its relatively low mortality, sepsis was associated with most of the short-term deaths among ICU patients with SLE. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - January 6, 2020 Category: Intensive Care Source Type: research

Correction to: Predictors of intracranial hemorrhage in adult patients on extracorporeal membrane oxygenation: an observational cohort study
In the original publication of this article [1], the first author ’s name should be changed from Alexander Fletcher Sandersjöö to Alexander Fletcher-Sandersjöö. The family name of the author is Fletcher-Sandersjöö. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - January 3, 2020 Category: Intensive Care Source Type: research

Dexmedetomidine improved renal function in patients with severe sepsis: an exploratory analysis of a randomized controlled trial
ConclusionA sedation strategy with dexmedetomidine is associated with improved renal function and decrease mortality rates among patients with severe sepsis.Trial registrationThis trial was registered on ClinicalTrials.gov (NCT01760967) on January 1, 2013. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - January 2, 2020 Category: Intensive Care Source Type: research

Serum histone H3 levels and platelet counts are potential markers for coagulopathy with high risk of death in septic patients: a single-center observational study
AbstractBackgroundRecent studies have suggested that anticoagulant therapy does not confer a survival benefit overall in sepsis, but might be beneficial in sepsis-associated disseminated intravascular coagulation (DIC). In particular, those with high Sequential Organ Failure Assessment (SOFA) scores might be the optimal target for anticoagulant therapy. However, both DIC and SOFA scores require the measurement of multiple markers. The purpose of this study was to explore a minimal marker set for determining coagulopathy at high risk of death in septic patients, wherein histone H3 levels were evaluated as indicators of both...
Source: Journal of Intensive Care - December 26, 2019 Category: Intensive Care Source Type: research

Non-convulsive seizures in the encephalopathic critically ill cancer patient does not necessarily portend a poor prognosis
AbstractBackgroundNon-convulsive status epilepticus (NCSE) is present in 10 –30% of ICU patients with altered mental status (AMS) and is associated to poor outcomes. To our knowledge, there is no data describing the prevalence and outcomes of critically ill cancer patients with AMS associated to non-convulsive seizures (NCS) or NCSE. We aim to describe the outcomes and ri sk factors of critically ill cancer patients with encephalopathy associated with non-convulsive seizures (NCS).MethodsThis is a 3-year prospective observational study in a mixed oncological ICU at MD Anderson Cancer Center. Data of ICU patients with...
Source: Journal of Intensive Care - December 16, 2019 Category: Intensive Care Source Type: research

Parental opinions regarding consent for observational research of no or minimal risk in the pediatric intensive care unit
ConclusionUnderstanding of risk, practical difficulties, consent bias, and Research Ethics Board safeguards was poor. Future study is needed to confirm our finding that most agreed with alternative methods of consent for observational research. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - December 16, 2019 Category: Intensive Care Source Type: research

Monitoring of muscle mass in critically ill patients: comparison of ultrasound and two bioelectrical impedance analysis devices
This study was conducted to compare ultrasound and BIA for the monitoring of muscle mass in critically ill patients.MethodsWe recruited adult patients who were expected to undergo mechanical ventilation for>  48 h and to remain in the intensive care unit (ICU) for>  5 days. On days 1, 3, 5, 7, and 10, muscle mass was evaluated using an ultrasound and two BIA devices (Bioscan: Malton International, England; Physion: Nippon Shooter, Japan). The influence of fluid balance was also evaluated between each measurement day.ResultsWe analyzed 93 images in 21 patients. The age of the patients was 6...
Source: Journal of Intensive Care - December 16, 2019 Category: Intensive Care Source Type: research

Neuromuscular electrical stimulation in critically ill traumatic brain injury patients attenuates muscle atrophy, neurophysiological disorders, and weakness: a randomized controlled trial
This study primarily aimed to assess the time needed and effects of an NMES protocol on muscle architecture, neuromuscular electrophysiological disorder (NED), and muscle strength, and secondarily, to evaluate the effects on plasma systemic inflammation, catabolic responses, and clinical outcomes.MethodsWe performed a randomized clinical trial in critically ill TBI patients. The control group received only conventional physiotherapy, while the NMES group additionally underwent daily NMES for 14  days in the lower limb muscles. Participants were assessed at baseline and on days 3, 7, and 14 of their stay in the intensi...
Source: Journal of Intensive Care - December 12, 2019 Category: Intensive Care Source Type: research

Role of serial lactate measurement to predict 28-day mortality in patients undergoing emergency laparotomy for perforation peritonitis: prospective observational study
ConclusionPreoperative, immediate postoperative and 24-h postoperative lactate value independently predict 28-day mortality in perforation peritonitis patients undergoing emergency laparotomy. Combination of MPI and 24-h lactate value is the most accurate predictor of mortality.Trial registrationClinical Trial Registry of India -CTRI/2018/01/011103 (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - December 11, 2019 Category: Intensive Care Source Type: research