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 “surges,...
Source: Journal of Intensive Care - June 14, 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
ConclusionA shorter LFD was associated with increased 90-day survival and favorable neurological outcomes of IHCA patients who received ECPR. The quality improvement in administering ECPR over time, including the RRS program and the ECMO program, appeared to ameliorate clinical outcomes. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - June 14, 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 24, 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 23, 2020 Category: Intensive Care Source Type: research
Lymphopenia in severe coronavirus disease-2019 (COVID-19): systematic review and meta-analysis
ConclusionThis meta-analysis showed that lymphopenia on admission was associated with poor outcome in patients with COVID-19. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - May 23, 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 wit...
Source: Journal of Intensive Care - May 17, 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
ConclusionsThis multi-institutional observational study showed that low pH value (< 7.03) before the implementation of ECPR was associated with 1 month unfavorable neurological outcome among OHCA patients treated with ECPR. It may be helpful to consider the candidate for ECPR. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - May 10, 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 4, 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
ConclusionsOur pilot trial showed the feasibility and safety of replacing 23.4% NaCl infusions with 16.4% NaCl/Na-acetate infusions to treat cerebral edema in patients with SAH. The degree of hyperchloremia was similar in the two groups. 16.4% NaCl/Na-acetate infusions led to lower Cl− load and AKI rates than 23.4% NaCl infusions. Further multi-center studies are needed to corroborate these results.Trial registrationclinicaltrials.gov #NCT03204955, registered on 6/28/2017 (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - May 3, 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 25, 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 25, 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 other 10 ...
Source: Journal of Intensive Care - April 23, 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 21, 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
ConclusionsSpinal cord autoregulation is less robust than cerebral autoregulation and more pressure-dependent. Similar to cerebral oxygenation, spinal cord oxygenation is volume-tolerant but is more sensitive to hypotension. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - April 14, 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 14, 2020 Category: Intensive Care Source Type: research
