Mechanical circulatory support in cardiogenic shock
AbstractCardiogenic shock is a complex and diverse pathological condition characterized by reduced myocardial contractility. The goal of treatment of cardiogenic shock is to improve abnormal hemodynamics and maintain adequate tissue perfusion in organs. If hypotension and insufficient tissue perfusion persist despite initial therapy, temporary mechanical circulatory support (t-MCS) should be initiated. This decade sees the beginning of a new era of cardiogenic shock management using t-MCS through the accumulated experience with use of intra-aortic balloon pump (IABP) and venoarterial extracorporeal membrane oxygenation (VA...
Source: Journal of Intensive Care - December 19, 2023 Category: Intensive Care Source Type: research
Higher levels of circulating desphospho-uncarboxylated matrix Gla protein over time are associated with worse survival: the prospective Maastricht Intensive Care COVID cohort
ConclusionICU mortality in COVID-19 patients was associated with higher dp-ucMGP levels over 4 weeks, independent of age, gender, and APACHE II score, and not explained by inflammation, renal function, history of coumarin use, and CAC score. No association with PE was observed. At ETI, higher levels of dp-ucMGP were associated with higher OR for both ICU and six month mortality in crude and adjusted modes, although not statistically significantly. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - December 18, 2023 Category: Intensive Care Source Type: research
Functional intervention following cardiac surgery to prevent postoperative delirium in older patients (FEEL WELL study)
ConclusionsResults of the study imply that a multisensory stimulation done on the first 3 days after planned cardiac surgery can reduce the incidence and duration of postoperative delirium in older patients. Influence of the treatment on the incidence of delirium in other patient groups, the length of stay in the intensive care unit, and patients ´ postoperative pain should be confirmed in further clinical studies.Trial registration: DRKS, DRKS00026909. Registered 28 October 2021, Retrospectively registered,https://drks.de/search/de/trial/DRKS00026909. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - December 13, 2023 Category: Intensive Care Source Type: research
Light and dark sides of evidence-based and supportive ICU care for patients undergoing extracorporeal membrane oxygenation
(Source: Journal of Intensive Care)
Source: Journal of Intensive Care - December 7, 2023 Category: Intensive Care Source Type: research
Intensive care unit mortality and cost-effectiveness associated with intensivist staffing: a Japanese nationwide observational study
ConclusionsICU1/2 is associated with lower ICU patient mortality than ICU3/4. Treatments under ICU1/2 are more cost-effective than those under ICU3/4, with an ICER of < 5 million JPY/QALY. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - December 4, 2023 Category: Intensive Care Source Type: research
Prognostic value of oxygen saturation index trajectory phenotypes on ICU mortality in mechanically ventilated patients: a multi-database retrospective cohort study
ConclusionsDynamic OSI-trajectory phenotypes were closely related to the mortality of ICU patients requiring IMV treatment and might be a useful prognostic indicator in critically ill patients. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - November 29, 2023 Category: Intensive Care Source Type: research
Visualizing the dynamic mechanical power and time burden of mechanical ventilation patients: an analysis of the MIMIC-IV database
ConclusionsCumulative exposure to higher intensities and/or longer duration of mechanical ventilation is associated with worse outcomes. Considering both the intensity and duration of mechanical ventilation may help evaluate patient outcomes and guide adjustments in mechanical ventilation to minimize harmful exposure. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - November 29, 2023 Category: Intensive Care Source Type: research
Optimized ventilation power to avoid VILI
AbstractThe effort to minimize VILI risk must be multi-pronged. The need to adequately ventilate, a key determinant of hazardous power, is reduced by judicious permissive hypercapnia, reduction of innate oxygen demand, and by prone body positioning that promotes both efficient pulmonary gas exchange and homogenous distributions of local stress. Modifiable ventilator-related determinants of lung protection include reductions of tidal volume, plateau pressure, driving pressure, PEEP, inspiratory flow amplitude and profile (using longer inspiration to expiration ratios), and ventilation frequency. Underappreciated conditional...
Source: Journal of Intensive Care - November 20, 2023 Category: Intensive Care Source Type: research
The optimal dose of mobilisation therapy in the ICU: a prospective cohort study
ConclusionsA mobilisation duration of more than 40 min positively impacts functional outcomes at ICU discharge. However, the maximum level achieved during ICU stay was the most crucial factor regarding adequate dosage, as higher duration did not show an additional benefit in patients with already high mobilisation levels.Trial registration: Prospective Registry of Mobilization-, Routine- and Outcome Data of Intensive Care Patients (MOBDB), NCT03666286. Registered 11 September 2018 —retrospectively registered,https://classic.clinicaltrials.gov/ct2/show/NCT03666286. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - November 20, 2023 Category: Intensive Care Source Type: research
Prolonged use of neuromuscular blocking agents is associated with increased long-term mortality in mechanically ventilated medical ICU patients: a retrospective cohort study
ConclusionsOur study demonstrated that prolonged use of NMBAs was associated with an increased risk of long-term mortality in critically ill patients requiring mechanical ventilation. Further studies are needed to validate our findings. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - November 17, 2023 Category: Intensive Care Source Type: research
Variation in coagulation factor activity levels cause discrepancies between activated partial thromboplastin time and anti-Xa activity for heparin monitoring: a retrospective observational study
ConclusionsDiscrepancies between APTT and anti-Xa activity were frequently observed, influenced by changes in coagulation factors activity levels. The lower and upper groups were classified as pseudo-heparin-resistant and coagulopathy types, respectively. Accurate monitoring of heparin in critically ill patients is crucial, especially in cases of pseudo-heparin resistance, where APTT values may wrongly indicate inadequate heparin dosing despite sufficient anti-Xa activity. Understanding these discrepancies is important for managing heparin therapy in critically ill patients.Trial registration: Not applicable. (Source: Jour...
Source: Journal of Intensive Care - November 16, 2023 Category: Intensive Care Source Type: research
Translation of patients ’ advance directives in intensive care units: are we there yet?
ConclusionsAlthough ADs may improve intensive- and end-of-life care, insufficient knowledge, lack of awareness, poor communication between healthcare providers and patients or surrogates, lack of standardization of directives, as well as ethical and legal concerns challenge their implementation. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - November 15, 2023 Category: Intensive Care Source Type: research
Efficacy, safety, and pharmacokinetics of MR13A11A, a generic of remifentanil, for pain management of Japanese patients in the intensive care unit: a double-blinded, fentanyl-controlled, randomized, non-inferiority phase 3 study
ConclusionsRemifentanil can be used safely for pain management in mechanically ventilated Japanese patients in the ICU.Trial registration: Japan Registry of Clinical Trials, jRCT2080224954. Registered 20 November 2019,https://jrct.niph.go.jp/latest-detail/jRCT2080224954. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - November 13, 2023 Category: Intensive Care Source Type: research
Concerns with the revised Japanese recommendation for administering vitamin C to septic patients
(Source: Journal of Intensive Care)
Source: Journal of Intensive Care - November 13, 2023 Category: Intensive Care Source Type: research
Lacosamide dosing in patients receiving continuous renal replacement therapy
ConclusionsVolume of distribution, total clearance, CRRT clearance and body weight were significantly contributed to lacosamide dosing. Clinical validation of the finding is strongly indicated. (Source: Journal of Intensive Care)
Source: Journal of Intensive Care - November 9, 2023 Category: Intensive Care Source Type: research
