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Ingen søgeord valgt.
49 emner vises.
Lam, Jennifer O.; Lee, Catherine; Gilsanz, Paola; Hou, Craig E.; Leyden, Wendy A.; Satre, Derek D.; Flamm, Jason A.; Towner, William J.; Horberg, Michael A.; Silverberg, Michael J.
AIDS, 24.11.2021
Tilføjet 30.11.2021
Objective:
To compare dementia incidence and prevalence after age 50 by HIV status.
Design:
Observational cohort, 2000 to 2016.
Methods:
People with HIV (PWH) on antiretroviral therapy (ART) and demographically-similar people without HIV (PWoH), all aged 50 years and older, were identified from Kaiser Permanente healthcare systems in Northern California, Southern California, and Mid-Atlantic States (Maryland, Virginia, Washington D.C.). Dementia diagnoses were obtained from electronic health records. Incidence and prevalence of dementia, overall and by time period (i.e., 2000–2002, 2003–2004, …, 2015–2016), were calculated using Poisson regression. Trends were examined using Joinpoint regression. Rate ratios were used to compare dementia by HIV status with adjustment for sociodemographics, substance use, and clinical factors.
Results:
The study included 13,296 PWH and 155,354 PWoH (at baseline: for both, mean age = 54 years, 89% male; for PWH, 80% with HIV RNA
Læs mere Tjek på PubMedKawthar Mohamed, Piotr Rzymski, Md Shahidul Islam, Rangarirai Makuku, Ayesha Mushtaq, Amjad Khan, Mariya Ivanovska, Sara A. Makka, Fareeda Hashem, Leander Marquez, Orsolya Cseprekal, Essouma Mickael, Irene Ling, Amanuel Godana Arero, Sarah Cuschieri, Kseniia Minakova, Eduardo Rodríguez‐Román, Sunny O. Abarikwu, Attig‐Bahar Faten, Giulia Grancini, Nima Rezaei
Journal of Medical Virology, 30.11.2021
Tilføjet 30.11.2021
Mette Bøegh Levring, Dorte Kinggaard Holm, Anna Christine Nilsson, Joschka Martin Bauer, Iben Skov Jensen, Jesper Rømhild Davidsen, Line Dahlerup Rasmussen, Ulrik Sprogøe, Søren Thue Lillevang
Journal of Medical Virology, 30.11.2021
Tilføjet 30.11.2021
Shahab Falahi, Azra Kenarkoohi
Journal of Medical Virology, 30.11.2021
Tilføjet 30.11.2021
Miguel Angel Duarte Millán, Nieves Mesa Plaza, Marta Guerrero Santillán, Alejandro Morales Ortega, David Bernal Bello, Ana Isabel Farfán Sedano, Vanessa García de Viedma García, Laura Velázquez Rios, Begoña Frutos Pérez, Cristina Lucía De Ancos Aracil, Guillermo Soria Fernández‐Llamazares, María Toledano Macías, Rafael Cristóbal Bilbao, Nuria Luquin Ciuro, Jorge Marrero Francés, Sara Isabel Piedrabuena García, José Angel Satue Bartolomé, Sonia Gonzalo Pascua, Marta Rivilla Jiménez, Lorena Carpintero García, Ibone Ayala Larrañaga, Virginia García Bermúdez, Celia Lara Montes, Álvaro Ricardo Llerena Riofrío, Luis Rivas Prado, Stefan Walter, Almudena Escribá Barcena, Juan Víctor San Martín López, José Manuel Ruíz Giardín
Journal of Medical Virology, 30.11.2021
Tilføjet 30.11.2021
Sribal Selvarajan, Sudhabharathi Reju, Krithika Gopalakrishnan, Ramachandran Padmanabhan, Padma Srikanth
Journal of Medical Virology, 29.11.2021
Tilføjet 30.11.2021
Liang Feng Yunyan Qiu Qing-Hui Guo Zhijie Chen James S. W. Seale Kun He Huang Wu Yuanning Feng Omar K. Farha R. Dean Astumian J. Fraser Stoddart
Science, 21.10.2021
Tilføjet 30.11.2021
Xiao Mi, Pedram Roushan, Chris Quintana, Salvatore Mandrà,, Jeffrey Marshall,, Charles Neill, Frank Arute, Kunal Arya, Juan Atalaya, Ryan Babbush, Joseph C. Bardin,, Rami Barends, Joao Basso, Andreas Bengtsson, Sergio Boixo, Alexandre Bourassa,, Michael Broughton, Bob B. Buckley, David A. Buell, Brian Burkett, Nicholas Bushnell, Zijun Chen, Benjamin Chiaro, Roberto Collins, William Courtney, Sean Demura, Alan R. Derk, Andrew Dunsworth, Daniel Eppens, Catherine Erickson, Edward Farhi, Austin G. Fowler, Brooks Foxen, Craig Gidney, Marissa Giustina, Jonathan A. Gross, Matthew P. Harrigan, Sean D. Harrington, Jeremy Hilton, Alan Ho, Sabrina Hong, Trent Huang, William J. Huggins, L. B. Ioffe, Sergei V. Isakov, Evan Jeffrey, Zhang Jiang, Cody Jones, Dvir Kafri, Julian Kelly, Seon Kim, Alexei Kitaev,, Paul V. Klimov, Alexander N. Korotkov,, Fedor Kostritsa, David Landhuis, Pavel Laptev, Erik Lucero, Orion Martin, Jarrod R. McClean, Trevor McCourt, Matt McEwen,, Anthony Megrant, Kevin C. Miao, Masoud Mohseni, Shirin Montazeri, Wojciech Mruczkiewicz, Josh Mutus, Ofer Naaman, Matthew Neeley, Michael Newman, Murphy Yuezhen Niu, Thomas E. O'Brien, Alex Opremcak, Eric Ostby, Balint Pato, Andre Petukhov, Nicholas Redd, Nicholas C. Rubin, Daniel Sank, Kevin J. Satzinger, Vladimir Shvarts, Doug Strain, Marco Szalay, Matthew D. Trevithick, Benjamin Villalonga, Theodore White, Z. Jamie Yao, Ping Yeh, Adam Zalcman, Hartmut Neven, Igor Aleiner, Kostyantyn Kechedzhi, Vadim Smelyanskiy, Yu Chen
Science, 28.10.2021
Tilføjet 30.11.2021
Zhen Zhu, Michał Papaj, Xiao-Ang Nie, Hao-Ke Xu, Yi-Sheng Gu, Xu Yang, Dandan Guan, Shiyong Wang, Yaoyi Li, Canhua Liu, Jianlin Luo, Zhu-An Xu, Hao Zheng, Liang Fu, Jin-Feng Jia
Science, 28.10.2021
Tilføjet 30.11.2021
J. Randall,, C. E. Bradley,, F. V. van der Gronden,, A. Galicia,, M. H. Abobeih,, M. Markham, D. J. Twitchen, F. Machado,, N. Y. Yao,, T. H. Taminiau,
Science, 4.11.2021
Tilføjet 30.11.2021
Sulei Hu and Wei-Xue Li
Science, 4.11.2021
Tilføjet 30.11.2021
Henry Brinkerhoff, Albert S. W. Kang, Jingqian Liu, Aleksei Aksimentiev, Cees Dekker
Science, 4.11.2021
Tilføjet 30.11.2021
Christian E. Zimmerli,,, Matteo Allegretti,, Vasileios Rantos,, Sara K. Goetz,, Agnieszka Obarska-Kosinska,, Ievgeniia Zagoriy, Aliaksandr Halavatyi, Gerhard Hummer,, Julia Mahamid, Jan Kosinski,,, Martin Beck,
Science, 11.11.2021
Tilføjet 30.11.2021
Zhen Wang, Liang Hu, Nikita Chekshin, Zhe Zhuang, Shaoqun Qian, Jennifer X. Qiao, Jin-Quan Yu
Science, 11.11.2021
Tilføjet 30.11.2021
Ian R. Humphreys,, Jimin Pei,, Minkyung Baek,, Aditya Krishnakumar,, Ivan Anishchenko,, Sergey Ovchinnikov,, Jing Zhang,, Travis J. Ness, Sudeep Banjade, Saket R. Bagde, Viktoriya G. Stancheva, Xiao-Han Li, Kaixian Liu, Zhi Zheng,, Daniel J. Barrero, Upasana Roy, Jochen Kuper, Israel S. Fernández, Barnabas Szakal, Dana Branzei,, Josep Rizo,,, Caroline Kisker, Eric C. Greene, Sue Biggins, Scott Keeney,,, Elizabeth A. Miller, J. Christopher Fromme, Tamara L. Hendrickson, Qian Cong,, David Baker,,
Science, 11.11.2021
Tilføjet 30.11.2021
Victor Hugo Cornejo, Netanel Ofer, Rafael Yuste
Science, 11.11.2021
Tilføjet 30.11.2021
Wei Liu, Marissa N. Lavagnino, Colin A. Gould, Jesús Alcázar, David W. C. MacMillan
Science, 11.11.2021
Tilføjet 30.11.2021
Dipak N. Patil, Shikha Singh, Thibaut Laboute, Timothy S. Strutzenberg, Xingyu Qiu,, Di Wu,, Scott J. Novick, Carol V. Robinson,, Patrick R. Griffin, John F. Hunt, Tina Izard, Appu K. Singh,, Kirill A. Martemyanov
Science, 18.11.2021
Tilføjet 30.11.2021
Fei Zhang, So Yeon Park, Canglang Yao, Haipeng Lu, Sean P. Dunfield,,, Chuanxiao Xiao, Soňa Uličná, Xiaoming Zhao, Linze Du Hill, Xihan Chen, Xiaoming Wang, Laura E. Mundt, Kevin H. Stone, Laura T. Schelhas,, Glenn Teeter, Sean Parkin, Erin L. Ratcliff,,, Yueh-Lin Loo, Joseph J. Berry,,, Matthew C. Beard, Yanfa Yan, Bryon W. Larson, Kai Zhu
Science, 25.11.2021
Tilføjet 30.11.2021
Jonas Tholen,, Michal Razew, Felix Weis, Wojciech P. Galej
Science, 25.11.2021
Tilføjet 30.11.2021
David R. Martinez , Alexandra Schäfer, Sophie Gobeil , Dapeng Li , Gabriela De la Cruz , Robert Parks , Xiaozhi Lu , Maggie Barr , Victoria Stalls , Katarzyna Janowska , Esther Beaudoin , Kartik Manne , Katayoun Mansouri , Robert J. Edwards , Kenneth Cronin , Boyd Yount , Kara Anasti , Stephanie A. Montgomery , Juanjie Tang , Hana Golding , Shaunna Shen , Tongqing Zhou , Peter D. Kwong , Barney S. Graham , John R. Mascola , David. C. Montefiori , S. Munir Alam , Gregory D. Sempowski , Surender Khurana , Kevin Wiehe , Kevin O. Saunders ,, Priyamvada Acharya ,, Barton F. Haynes , Ralph S. Baric
Science, 2.11.2021
Tilføjet 30.11.2021
Farhat, Abdelaziz; Li, Xilong; Huet, Beverley; Tweed, Jefferson; Morriss, Michael C.; Raman, Lakshmi
Critical Care Medicine, 19.11.2021
Tilføjet 30.11.2021
Objectives:
This project aims to describe brain injuries on routine neuroimaging in a large single-center neonatal and pediatric cohort supported by extracorporeal membrane oxygenation. The study also aims to examine the association of these injuries with neurocognitive outcomes in survivors and identify laboratory findings associated with neurologic injury.
Design:
Retrospective observational single-center cohort study.
Setting:
Tertiary care PICU.
Patients:
Pediatric patients with noncardiac indications for extracorporeal membrane oxygenation supported by venoarterial or venovenous extracorporeal membrane oxygenation, with on-extracorporeal membrane oxygenation brain CT or postextracorporeal membrane oxygenation brain CT/MRI.
Interventions:
Extracorporeal membrane oxygenation support.
MEASUREMENTS AND MAIN RESULTS:
Occurrence of brain injury on CT and MRI was reviewed; injuries were scored. Clinical and laboratory results associated with injury were identified. Survivor neurocognitive outcomes were obtained using the Pediatric Overall Performance Category scale and Pediatric Cerebral Performance Category scale. Of 132 imaged patients, 98 (74%) had radiological evidence of brain injury. Mean injury score was 6.5 (± 3.8). Head ultrasounds and clinician suspicion performed poorly in suspecting the presence of injury. Of 104 respondents to neurodevelopmental assessments, 61 (59%) had normal scores; 12.5%, 17%, and 11.5% had mild, moderate, or severe disability. A neuroimaging score greater than 10 was associated with an unfavorable outcome on the Pediatric Cerebral Performance Category (odds ratio, 3.4; p < 0.01) and Pediatric Overall Performance Category (odds ratio, 1.7; p < 0.05). Ischemic injury correlated with worse neurodevelopmental outcome. Preextracorporeal membrane oxygenation lactate, Vasoactive-Inotropic Scores, transaminitis, elevated bilirubin and creatinine levels, and thrombocytopenia were associated with injury occurrence.
Conclusions:
Brain injury is frequent in extracorporeal membrane oxygenation patients, although the majority of survivors have favorable neurocognitive outcomes. More research is needed in order to understand the etiology of such injuries. Head ultrasound and clinician suspicion are not sensitive in detecting extracorporeal membrane oxygenation–related brain injuries. Protocolizing postextracorporeal membrane oxygenation imaging with brain MRI allows the identification of injuries and provision of timely neurocognitive intervention.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).
Supported, in part, by Children’s Health. Also supported, in part, by the National Center for Advancing Translational Sciences of the National Institutes of Health under the Center for Translational Medicine’s award number UL1TR001105.
The content is solely the responsibility of the authors and does not necessarily represent the official views of Children’s Health or the National Institutes of Health.
Dr. Farhat received funding from Children’s Health through the Children’s Clinical Research Advisory Council Fellow Award and the National Center for Advancing Translational Sciences (UL1TR001105); he received support for article research from the National Institutes of Health. Dr. Li disclosed work for hire. The remaining authors have disclosed that they do not have any potential conflicts of interest.
For information regarding this article, E-mail: Lakshmi.Raman@UTsouthwestern.edu
Copyright © by 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Læs mere Tjek på PubMedPatel, Jayshil J.; Ortiz-Reyes, Alfonso; Dhaliwal, Rupinder; Clarke, John; Hill, Aileen; Stoppe, Christian; Lee, Zheng-Yii; Heyland, Daren K.
Critical Care Medicine, 19.11.2021
Tilføjet 30.11.2021
Objectives:
To conduct a systematic review and meta-analysis to evaluate the impact of IV vitamin C on outcomes in critically ill patients.
Data Sources:
Systematic search of MEDLINE, EMBASE, CINAHL, and the Cochrane Register of Controlled Trials.
Study Selection:
Randomized controlled trials testing IV vitamin C in critically ill patients.
Data Abstraction:
Two independent reviewers abstracted patient characteristics, treatment details, and clinical outcomes.
Data Synthesis:
Fifteen studies involving 2,490 patients were identified. Compared with placebo, IV vitamin C administration is associated with a trend toward reduced overall mortality (relative risk, 0.87; 95% CI, 0.75–1.00; p = 0.06; test for heterogeneity I2 = 6%). High-dose IV vitamin C was associated with a significant reduction in overall mortality (relative risk, 0.70; 95% CI, 0.52–0.96; p = 0.03), whereas low-dose IV vitamin C had no effect (relative risk, 0.94; 95% CI, 0.79–1.07; p = 0.46; test for subgroup differences, p = 0.14). IV vitamin C monotherapy was associated with a significant reduction in overall mortality (relative risk, 0.64; 95% CI, 0.49–0.83; p = 0.006), whereas there was no effect with IV vitamin C combined therapy. No trial reported an increase in adverse events related to IV vitamin C.
Conclusions:
IV vitamin C administration appears safe and may be associated with a trend toward reduction in overall mortality. High-dose IV vitamin C monotherapy may be associated with improved overall mortality, and further randomized controlled trials are warranted.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).
The study was registered in the International Prospective Register of Systematic Reviews (CRD42021244074).
Dr. Hill disclosed relations with Woerwag Pharma supplying the investigational product for a study regarding vitamin C in cardiac surgery patients. The remaining authors have disclosed that they do not have any potential conflicts of interest.
For information regarding this article, E-mail: jpatel2@mcw.edu
Copyright © by 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Læs mere Tjek på PubMedLee, Dong Hun; Cho, Yong Soo; Lee, Byung Kook; Lee, Hyoung Youn; Jeung, Kyung Woon; Jung, Yong Hun; Park, Kyu Nam; Kim, Youn-Jung; Chae, Minjung Kathy; Seo, Dong-Woo; on behalf of the KORHN Investigators
Critical Care Medicine, 19.11.2021
Tilføjet 30.11.2021
Objectives:
We investigated awakening time and characteristics of awakening compared nonawakening and factors contributing to poor neurologic outcomes in out-of-hospital cardiac arrest survivors in no withdrawal of life-sustaining therapy settings.
Design:
Retrospective analysis of the Korean Hypothermia Network Pro registry.
Setting:
Multicenter ICU.
Patients:
Adult (≥ 18 yr) comatose out-of-hospital cardiac arrest survivors who underwent targeted temperature management at 33–36°C between October 2015 and December 2018.
Interventions:
None.
Measurements and Main Results:
We measured the time from the end of rewarming to awakening, defined as a total Glasgow Coma Scale score greater than or equal to 9 or Glasgow Coma Scale motor score equals to 6. The primary outcome was awakening time. The secondary outcome was 6-month neurologic outcomes (poor outcome: Cerebral Performance Category 3–5). Among 1,145 out-of-hospital cardiac arrest survivors, 477 patients (41.7%) regained consciousness 30 hours (6–71 hr) later, and 116 patients (24.3%) awakened late (72 hr after the end of rewarming). Young age, witnessed arrest, shockable rhythm, cardiac etiology, shorter time to return of spontaneous circulation, lower serum lactate level, absence of seizures, and multisedative requirement were associated with awakening. Of the 477 who woke up, 74 (15.5%) had poor neurologic outcomes. Older age, liver cirrhosis, nonshockable rhythm, noncardiac etiology, a higher Sequential Organ Failure Assessment score, and higher serum lactate levels were associated with poor neurologic outcomes. Late awakeners were more common in the poor than in the good neurologic outcome group (38/74 [51.4%] vs 78/403 [19.4%]; p < 0.001). The awakening time (odds ratio, 1.005; 95% CIs, 1.003–1.008) and late awakening (odds ratio, 3.194; 95% CIs, 1.776–5.746) were independently associated with poor neurologic outcomes.
Conclusions:
Late awakening after out-of-hospital cardiac arrest was common in no withdrawal of life-sustaining therapy settings and the probability of awakening decreased over time.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).
Drs. Lee and Cho contributed equally.
Supported, in part, by a grant (HCRI 20048) Chonnam National University Hwasun Hospital Institute for Biomedical Science.
The authors have disclosed that they do not have any potential conflicts of interest.
For information regarding this article, E-mail: bbukkuk@hanmail.net
Copyright © by 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Læs mere Tjek på PubMedKachmar, Alicia G.; Watson, R. Scott; Wypij, David; Perry, Mallory A.; Curley, Martha A. Q.; For the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) Investigative Team
Critical Care Medicine, 19.11.2021
Tilføjet 30.11.2021
Objectives:
Socioeconomic factors may impact healthcare resource use and health-related quality of life, but their association with postcritical illness outcomes is unknown. This study examines the associations between socioeconomic status, resource use, and health-related quality of life in a cohort of children recovering from acute respiratory failure.
Design:
Secondary analysis of data from the Randomized Evaluation of Sedation Titration for Respiratory Failure clinical trial.
Setting:
Thirty-one PICUs.
Patients:
Children with acute respiratory failure enrolled whose parent/guardians consented for follow-up.
Measurements and Main Results:
Resource use included in-home care, number of healthcare providers, prescribed medications, home medical equipment, emergency department visits, and hospital readmission. Socioeconomic status was estimated by matching residential address to census tract–based median income. Health-related quality of life was measured using age-based parent-report instruments. Resource use interviews with matched census tract data (n = 958) and health-related quality of life questionnaires (n = 750/958) were assessed. Compared with high-income children, low-income children received care from fewer types of healthcare providers (β = –0.4; p = 0.004), used less newly prescribed medical equipment (odds ratio = 0.4; p < 0.001), and had more emergency department visits (43% vs 33%; p = 0.04). In the youngest cohort (< 2 yr old), low-income children had lower quality of life scores from physical ability (–8.6 points; p = 0.01) and bodily pain/discomfort (+8.2 points; p < 0.05). In addition, health-related quality of life was lower in those who had more healthcare providers and prescribed medications. In older children, health-related quality of life was lower if they had prescribed medications, emergency department visits, or hospital readmission.
Conclusions:
Children recovering from acute respiratory failure have ongoing healthcare resource use. Yet, lower income children use less in-home and outpatient services and use more hospital resources. Continued follow-up care, especially in lower income children, may help identify those in need of ongoing healthcare resources and those at-risk for decreased health-related quality of life.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).
Supported, in part, by grants from the National Heart, Lung, and Blood Institute and the National Institute of Nursing Research, National Institutes of Health (U01HL086622 to Dr. Curley and U01 HL086649 to Dr. Wypij).
Dr. Kachmar received funding from the Rita and Alex Hillman Foundation. Drs. Watson, Wypij, and Curley received support for article research from the National Institutes of Health (NIH)/National Heart, Lung, and Blood Institute. Dr. Perry has disclosed that he does not have any potential conflicts of interest.
For information regarding this article, E-mail: akachmar@nursing.upenn.edu
Copyright © by 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Læs mere Tjek på PubMedChen, Chung-Ting; Lin, Jin-Wei; Wu, Cheng-Hsueh; Kuo, Raymond Nien-Chen; Shih, Chia-Hui; Hou, Peter Chuanyi; Yen, David Hung-Tsang; How, Chorng-Kuang
Critical Care Medicine, 19.11.2021
Tilføjet 30.11.2021
Objectives:
Although several risk factors for outcomes of out-of-hospital cardiac arrest patients have been identified, the cumulative risk of their combinations is not thoroughly clear, especially after targeted temperature management. Therefore, we aimed to develop a risk score to evaluate individual out-of-hospital cardiac arrest patient risk at early admission after targeted temperature management regarding poor neurologic status at discharge.
Design:
Retrospective observational cohort study.
Setting:
Two large academic medical networks in the United States.
Patients:
Out-of-hospital cardiac arrest survivors treated with targeted temperature management with age of 18 years old or older.
Interventions:
None.
Measurements and Main Results:
Based on the odds ratios, five identified variables (initial nonShockable rhythm, Leucocyte count < 4 or > 12 K/μL after targeted temperature management, total Adrenalin [epinephrine] ≥ 5 mg, lack of oNlooker cardiopulmonary resuscitation, and Time duration of resuscitation ≥ 20 min) were assigned weighted points. The sum of the points was the total risk score known as the SLANT score (range 0–21 points) for each patient. Based on our risk prediction scores, patients were divided into three risk categories as moderate-risk group (0–7), high-risk group (8–14), and very high-risk group (15–21). Both the ability of our risk score to predict the rates of poor neurologic outcomes at discharge and in-hospital mortality were significant under the Cochran-Armitage trend test (p < 0.001 and p < 0.001, respectively).
Conclusions:
The risk of poor neurologic outcomes and in-hospital mortality of out-of-hospital cardiac arrest survivors after targeted temperature management is easily assessed using a risk score model derived using the readily available information. Its clinical utility needed further investigation.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).
The authors have disclosed that they do not have any potential conflicts of interest.
This work was performed in Brigham and Women’s Hospital, Boston, MA, and Taipei Veterans General Hospital, Taipei, Taiwan.
Address requests for reprints to: Chorng-Kuang How, MD, PhD, Department of Emergency, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Rd, Taipei 112, Taiwan. E-mail: ckhow@vghtpe.gov.tw
Copyright © by 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Læs mere Tjek på PubMedKillien, Elizabeth Y.; Rivara, Frederick P.; Dervan, Leslie A.; Smith, Mallory B.; Watson, R. Scott
Critical Care Medicine, 19.11.2021
Tilføjet 30.11.2021
Objectives:
To evaluate which individual elements of health-related quality of life contribute most to decline in overall health-related quality of life status following pediatric critical care.
Design:
Retrospective cohort study.
Setting:
Seattle Children’s Hospital.
Patients:
ICU patients age 1 month to 18 years admitted between December 2011 and February 2017.
Interventions:
None.
Measurements and Main Results:
We assessed health-related quality of life decline from baseline to postdischarge (median, 6 wk) and determined the individual items of the Pediatric Quality of Life Inventory Infant Scales (< 2 yr) and Generic Core Scales (2–18 yr) with the highest prevalence of decline. We used multivariable regression to estimate the risk of decline in each of seven thematic categories by patient age, baseline health status, diagnosis, Pediatric Risk of Mortality score, and ICU length of stay. Decline from baseline health-related quality of life occurred in 22.5% of 539 patients. Items most commonly affected for infants less than 2 years were primarily emotional (cranky/crying, sleep, and self-soothing). Children 2–18 years most commonly experienced declines in physical functioning (play/exercise, lifting, and pain). Across the entire cohort, declines in categories of energy (31.5%), activity (31.0%), sleep (28.0%), and fear (24.7%) were most commonly endorsed. Risk of decline in each category varied with patient age, medical complexity, and diagnosis.
Conclusions:
Deconditioning, sleep, fear, and pain are important targets for intervention to improve health-related quality of life outcomes for critically ill children.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http:/journals.lww.com/ccmjournal).
Supported, in part, by the National Institute of Child Health and Human Development grant 5 T32 HD057822-08.
Dr. Killien’s institution received funding from the National Institute of Child Health and Human Development (NICHD). Drs. Killien and Smith received support for article research from the National Institutes of Health. Dr. Smith received funding from a NICHD T32 training grant (T32 HD057822-11). The remaining authors have disclosed that they do not have any potential conflicts of interest.
This work was performed at Seattle Children’s Hospital, Seattle, WA.
For information regarding this article, E-mail: elizabeth.killien@seattlechildrens.org
Copyright © by 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Læs mere Tjek på PubMedWang, Yi Tian; Lang, Jenna K.; Haines, Kimberley J.; Skinner, Elizabeth H.; Haines, Terry P.
Critical Care Medicine, 19.11.2021
Tilføjet 30.11.2021
Objectives:
Significant variability exists in physical rehabilitation modalities and dosage used in the ICU. Our objective was to investigate the effect of physical rehabilitation in ICU on patient outcomes, the impact of task-specific training, and the dose-response profile.
Data Sources:
A systematic search of Ovid MEDLINE, Cochrane Library, EMBASE, and CINAHL plus databases was undertaken on the May 28, 2020.
Study Selection:
Randomized controlled trials and controlled clinical trials investigating physical rehabilitation commencing in the ICU in adults were included. Outcomes included muscle strength, physical function, duration of mechanical ventilation, ICU and hospital length of stay, mortality, and health-related quality of life. Two independent reviewers assessed titles, abstracts, and full texts against eligibility criteria.
Data Extraction:
Details on intervention for all groups were extracted using the template for intervention description and replication checklist.
Data Synthesis:
Sixty trials were included, with a total of 5,352 participants. Random-effects pooled analysis showed that physical rehabilitation improved physical function at hospital discharge (standardized mean difference, 0.22; 95% CI, 0.00–0.44), reduced ICU length of stay by 0.8 days (mean difference, –0.80 d; 95% CI, –1.37 to –0.23 d), and hospital length of stay by 1.75 days (mean difference, –1.75 d; 95% CI, –3.03 to –0.48 d). Physical rehabilitation had no impact on the other outcomes. The intervention was more effective in trials where the control group received low-dose physical rehabilitation and in trials that investigated functional exercises.
Conclusions:
Physical rehabilitation in the ICU improves physical function and reduces ICU and hospital length of stay. However, it does not appear to impact other outcomes.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).
Dr. Skinner and Prof. T. P. Haines should be considered as joint senior authors.
Mr. Wang is the guarantor of this review; he conceived this review and designed the first draft of its protocol; he screened records for inclusion into the review, managed review data, performed statistical inferences, and participated in drafting the final article; and he takes full responsibility for the integrity of the data and the accuracy of the data analysis. Ms. Lang screened records for inclusion into the review, managed review data, and participated in the drafting of the final article. Dr. Skinner conceived this review and designed the first draft of its protocol; she participated in the drafting of the final article. Dr. K. J. Haines participated in the drafting of the final article. Prof. T. P. Haines conceived this review and designed the first draft of its protocol; he performed statistical inferences and participated in the drafting of the final article. All authors read and approved the final article.
Mr. Wang received funding from the Australian Postgraduate Award. Dr. Skinner’s institution (Western Health) received funding from the Australian Institute of Musculoskeletal Science. Prof. T. P. Haines received funding from K&L Gates Law Firm and Minter Ellison Law Firm. The remaining authors have disclosed that they do not have any potential conflicts of interest.
For information regarding this article, E-mail: mwang@phcn.vic.gov.au
Copyright © by 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Læs mere Tjek på PubMedMayampurath, Anoop; Hagopian, Raffi; Venable, Laura; Carey, Kyle; Edelson, Dana; Churpek, Matthew; for the American Heart Association's Get With the Guidelines-Resuscitation Investigators
Critical Care Medicine, 19.11.2021
Tilføjet 30.11.2021
Objectives:
Prognostication of neurologic status among survivors of in-hospital cardiac arrests remains a challenging task for physicians. Although models such as the Cardiac Arrest Survival Post-Resuscitation In-hospital score are useful for predicting neurologic outcomes, they were developed using traditional statistical techniques. In this study, we derive and compare the performance of several machine learning models with each other and with the Cardiac Arrest Survival Post-Resuscitation In-hospital score for predicting the likelihood of favorable neurologic outcomes among survivors of resuscitation.
Design:
Analysis of the Get With The Guidelines-Resuscitation registry.
Setting:
Seven-hundred fifty-five hospitals participating in Get With The Guidelines-Resuscitation from January 1, 2001, to January 28, 2017.
Patients:
Adult in-hospital cardiac arrest survivors.
Interventions:
None.
Measurements and Main Results:
Of 117,674 patients in our cohort, 28,409 (24%) had a favorable neurologic outcome, as defined as survival with a Cerebral Performance Category score of less than or equal to 2 at discharge. Using patient characteristics, pre-existing conditions, prearrest interventions, and periarrest variables, we constructed logistic regression, support vector machines, random forests, gradient boosted machines, and neural network machine learning models to predict favorable neurologic outcome. Events prior to October 20, 2009, were used for model derivation, and all subsequent events were used for validation. The gradient boosted machine predicted favorable neurologic status at discharge significantly better than the Cardiac Arrest Survival Post-Resuscitation In-hospital score (C-statistic: 0.81 vs 0.73; p < 0.001) and outperformed all other machine learning models in terms of discrimination, calibration, and accuracy measures. Variables that were consistently most important for prediction across all models were duration of arrest, initial cardiac arrest rhythm, admission Cerebral Performance Category score, and age.
Conclusions:
The gradient boosted machine algorithm was the most accurate for predicting favorable neurologic outcomes in in-hospital cardiac arrest survivors. Our results highlight the utility of machine learning for predicting neurologic outcomes in resuscitated patients.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).
Drs. Mayampurath and Hagopian contributed equally to the work.
Dr. Mayampurath received funding from the National Institutes of Health (NIH) and the National Heart, Lung, and Blood Institute and Litmus Health. He is supported by a career development award from the National Heart, Lung, and Blood Institute (K01HL148390). He has performed consulting services for Litmus Health (Austin, TX). Dr. Edelson received funding from the Department of Defense (E01W81XWH2110009), the University of Chicago through a patent pending (ARCD.P0535US.P2) for risk stratification algorithms for hospitalized patients, and AgileMD (San Francisco, CA) and has ownership interest in AgileMD, which licenses electronic Cardiac Arrest Risk Triage, a patient risk analytic. She received research support and honoraria from Philips Healthcare (Andover, MA) and research support from EarlySense (Tel Aviv, Israel). Dr. Churpek received funding from the NIH and Early Sense (Tel Aviv, Israel). He has a patent pending (ARCD. P0535US.P2) for risk stratification algorithms for hospitalized patients and has received research support from EarlySense, and he is supported by an R01 from the National Institute of General Medical Sciences (R01 GM123193). The remaining authors have disclosed that they do not have any potential conflicts of interest.
For information regarding this article, E-mail: mchurpek@medicine.wisc.edu
Copyright © by 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Læs mere Tjek på PubMedMaharaj, Ritesh; Harrison, David A.; Rowan, Kathryn
Critical Care Medicine, 19.11.2021
Tilføjet 30.11.2021
Objectives:
Differences in decisions to limit life-sustaining therapy are often supported by perceptions that patients receive unnecessary and expensive treatment which provide negligible survival benefit. However, the assumption behind those beliefs—that is, that life-sustaining therapy provides no significant marginal survival benefit—remains unproven. Our objective was to quantify the effects of variations in decisions to withdraw or withhold life-sustaining treatment on 180-day mortality in critically ill patients.
Design:
Retrospective observational cohort study of a national clinical database.
Setting:
Adult ICUs participating in the Intensive Care National Audit and Research Center Case Mix Program in the United Kingdom.
Patients:
Adult patients admitted to general ICUs between April 1, 2009, and March 31, 2016.
Measurements and Main Results:
During the study period, 795,721 patients were admitted to 247 ICUs across the United Kingdom. A decision to withdraw or withhold life-sustaining treatment was made for 92,327 patients (11.6%). A multilevel model approach was used to estimate ICU-level practice variation. The ICU-level practice variation was then used as an instrument to measure the effects of decision to withdraw or withhold life-sustaining treatment on 180-day mortality. The marginal population was estimated to be 5.9% of the total cohort. A decision to withdraw or withhold life-sustaining treatment was associated with a marginal increase in 180-day mortality of 25.6% (95% CI, 23.2–27.9%).
Conclusions:
Decision to withdraw or withhold life-sustaining treatment in critically ill adults in the United Kingdom was associated with increased 180-day mortality in the marginal patients. The increased mortality from a decision to withdraw or withhold life-sustaining treatment in the marginal patient may be informative when establishing patients’ preferences and evaluating the cost-effectiveness of intensive treatments.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).
Drs. Maharaj and Harrison had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs. Harrison and Rowan contributed equally to this work. All authors contributed to concept and design, and acquisition, analysis, or interpretation of data. Dr. Maharaj contributed to drafting of the article. All authors contributed to critical revision of the article for important intellectual content. Drs. Maharaj and Harrison contributed to statistical analysis.
The authors have disclosed that they do not have any potential conflicts of interest.
The views and opinions expressed therein are those of the authors and do not necessarily reflect those of Intensive Care National Audit and Research Center.
For information regarding this article, E-mail: maharajr@lse.ac.uk
Copyright © by 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Læs mere Tjek på PubMedStevic, Neven; Argaud, Laurent; Loufouat, Joseph; Kreitmann, Louis; Desmurs, Laurent; Ovize, Michel; Bidaux, Gabriel; Cour, Martin
Critical Care Medicine, 19.11.2021
Tilføjet 30.11.2021
Objectives:
To determine whether continuous IV infusion of molar sodium lactate would limit cardiac arrest–induced neurologic injury and cardiovascular failure.
Design:
Randomized blinded study (animal model).
Setting:
University animal research facility.
Subjects:
Twenty-four adult male “New Zealand White” rabbits.
Interventions:
Anesthetized rabbits underwent 12.5 minutes of asphyxial cardiac arrest and were randomized to receive either normal saline (control group, n = 12) or molar sodium lactate (molar sodium lactate group, n = 12) at a rate of 5 mL/kg/hr during the whole 120-minute reperfusion period.
Measurements and Main Results:
Pupillary reactivity (primary outcome), levels of S100β protein, in vitro brain mitochondria functions, cardiovascular function, and fluid balance were assessed. Molar sodium lactate reduced brain injury, with a higher proportion of animals exhibiting pupillary reactivity to light (83% vs 25% in the CTRL group, p = 0.01) and lower S100β protein levels (189 ± 42 vs 412 ± 63 pg/mL, p < 0.01) at the end of the protocol. Molar sodium lactate significantly prevented cardiac arrest–induced decrease in oxidative phosphorylation and mitochondrial calcium–retention capacity compared with controls. At 120 minutes of reperfusion, survival did not significantly differ between the groups (10/12, 83% in the molar sodium lactate group vs nine of 12, 75% in the control group; p > 0.99), but hemodynamics were significantly improved in the molar sodium lactate group compared with the control group (higher mean arterial pressure [49 ± 2 vs 29 ± 3 mm Hg; p < 0.05], higher cardiac output [108 ± 4 vs 58 ± 9 mL/min; p < 0.05], higher left ventricle surface shortening fraction [38% ± 3% vs 19% ± 3%; p < 0.05], and lower left ventricular end-diastolic pressure [3 ± 1 vs 8 ± 2 mm Hg; p < 0.01]). While fluid intake was similar in both groups, fluid balance was higher in control animals (11 ± 1 mL/kg) than that in molar sodium lactate-treated rabbits (1 ± 3 mL/kg; p < 0.01) due to lower diuresis.
Conclusions:
Molar sodium lactate was effective in limiting the severity of the postcardiac arrest syndrome. This preclinical study opens up new perspectives for the treatment of cardiac arrest.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).
Supported, in part, by a research grant from the “ALLP Groupe ADENE.”
The work was performed at Université de Lyon, INSERM UMR1060 (CarMeN), IRIS team, Lyon, France.
The authors have disclosed that they do not have any potential conflicts of interest.
For information regarding this article, E-mail: martin.cour@chu-lyon.fr
Copyright © by 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Læs mere Tjek på PubMedMehta, Sangeeta; Ahluwalia, Nanki; Heybati, Kiyan; Burns, Karen E. A.; Owais, Sawayra; Cook, Deborah J.; for the Canadian Critical Care Trials Group
Critical Care Medicine, 19.11.2021
Tilføjet 30.11.2021
Objectives:
Diverse perspectives improve the quality of scholarly initiatives. The demographic and professional diversity of scientists who contribute to critical care research and publications has not been described for the Canadian Critical Care Trials Group. Our objective was to describe the diversity of authors of publications from the Canadian Critical Care Trials Group.
Design:
We conducted a quantitative content analysis of peer-reviewed articles published on behalf of the Canadian Critical Care Trials Group.
Setting:
All peer-reviewed articles that were published on behalf of the Canadian Critical Care Trials Group between 1994 and October 2020.
Subjects:
For each publication, we recorded the study design, the number of authors, and national or international collaboration. For the lead author, the senior author, and each coauthor, we recorded the following facets of diversity: gender, professional role, medical discipline, geographic location, academic stage, and visible minority status.
Interventions:
None.
Measurements and Main Results:
We identified 354 eligible publications; 74% (263/354) reported observational cohort studies, randomized trials, and surveys. Of 4,246 authors, 1,205 were unique individuals. The mean (SD) number of authors per publication was 12 (7.1). Of all 4,246 authors, 37% were women, and 13.7% were members of a visible minority group. Of all lead or senior authors, 40% and 34% respectively were women; 15% of lead and 10% of senior authors were members of a visible minority group. Three-quarters (73%) of publications listed authors from more than one profession, and more than half (54%) listed authors from more than one medical discipline. Nearly half of publications (45%) listed authors who were early career faculty, 33% listed authors who were trainees, and 67% listed authors who were from visible minority groups. Authors from different provinces and from different countries were listed in 67% and 40% of publications, respectively.
Conclusions:
Authors of Canadian Critical Care Trials Group publications are diverse with regard to demographic and professional characteristics.
Dr. Burns disclosed that she holds a career award from the Physician Services Incorporated Foundation and that she is the current chair of the Women in Critical Care Interest Group of the American Thoracic Society. The remaining authors have disclosed that they do not have any potential conflicts of interest.
For information regarding this article, E-mail: Geeta.mehta@sinaihealth.ca
Copyright © by 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Læs mere Tjek på PubMedZier, Judith L.; Newman, Nicole A.
Critical Care Medicine, 19.11.2021
Tilføjet 30.11.2021
Objectives:
To describe the unassisted return of spontaneous circulation following withdrawal of life-sustaining treatment in a child.
DESIGN:
Case report based on clinical observation and medical record review.
SETTING:
Community Children’s Hospital.
PATIENT:
Two-year old child.
INTERVENTIONS:
Following hypoxic-ischemic brain injury, the child was taken to the operating room for withdrawal of life-sustaining treatment during controlled donation after circulatory determination of death.
MEASUREMENTS AND MAIN RESULTS:
In addition to direct observation by experienced pediatric critical care providers, the child was monitored with electrocardiography, pulse oximetry, and invasive blood pressure via femoral arterial catheter in addition to direct observation by experienced pediatric critical care providers. Unassisted return of spontaneous circulation occurred greater than 2 minutes following circulatory arrest and was accompanied by return of respiration.
Conclusions:
We provide the first report of unassisted return of spontaneous circulation following withdrawal of life-sustaining treatment in a child. In our case, return of spontaneous circulation occurred in the setting of controlled donation after circulatory determination of death and was accompanied by return of respiration. Return of spontaneous circulation greater than 2 minutes following circulatory arrest in our patient indicates that 2 minutes of observation is insufficient to ensure that cessation of circulation is permanent after withdrawal of life-sustaining treatment in a child.
This work was performed at Children’s Minnesota, Minneapolis, MN.
Dr. Zier received funding from Y-mAbs Therapeutics, Inc; she disclosed she is a member of the Clinical Policy Board of LifeSource. Dr. Newman has disclosed that she does not have any potential conflicts of interest.
For information regarding this article, E-mail: zier@crccs.com
Copyright © by 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Læs mere Tjek på PubMedPetitjeans, Fabrice; Leroy, Sandrine; Pichot, Cyrille; Ghignone, Marco; Quintin, Luc; Constantin, Jean-Michel
Critical Care Medicine, 19.11.2021
Tilføjet 30.11.2021
Tsai, Min-Shan; Chen, Wen-Jone; Chen, Wei-Ting; Tien, Yu-Tzu; Chang, Wei-Tien; Ong, Hooi-Nee; Huang, Chien-Hua
Critical Care Medicine, 19.11.2021
Tilføjet 30.11.2021
Objectives:
To evaluate whether the recommended observation period of 7 days for cardiac arrest survivors is sufficient for conscious recovery and to identify the variables associated with eventual neurologic recovery among patients with delayed awakening.
Design:
A retrospective cohort study.
Setting:
A single tertiary medical center.
Patients:
Five-hundred twenty-nine nontraumatic adult cardiac arrest survivors with prearrest favorable neurologic function (Cerebral Performance Category 1–2) who survived to hospital discharge during 2011–2019.
Interventions:
The enrolled patients were classified into favorable (Cerebral Performance Category 1–2) and poor (Cerebral Performance Category 3–4) neurologic recovery according to their neurologic function at hospital discharge. Among patients with favorable neurologic recovery, those who recovered within 7 days were assigned to the early recovery group or after 7 days as the late recovery group.
Measurements and Main Results:
There were 395 patients exhibiting favorable neurologic recovery (n = 357 in the early group, n = 38 in late group) and 134 patients exhibiting poor neurologic recovery (poor recovery group). Among patients who remained unconscious on day 7, delayed awakening was associated with male sex (odds ratio [OR], 3.905; 95% CI, 1.153–13.221), prehospital return of spontaneous circulation (OR, 7.628; 95% CI, 2.084–27.922), therapeutic hypothermia (OR, 4.320; 95% CI, 1.624–11.488), and extracorporeal cardiopulmonary resuscitation (OR, 4.508; 95% CI, 1.414–14.371). Being transferred from another hospital, however, was less likely to be associated with delayed awakening (OR, 0.061; 95% CI, 0.009–0.431). The median duration for patients to regain clear consciousness in the late recovery group was 12.12 days. No patient who recovered consciousness had an unfavorable electroencephalography pattern, however, in patients with poor recovery, the 7-day electroencephalography showed 45 patients with generalized suppression (33.6%), two with burst suppression (1.5%), 14 with seizure/epileptic discharge (10.5%), and one with status epilepticus (0.7%).
Conclusions:
Up to 9.6% of cardiac arrest patients with favorable outcomes recover consciousness after the recommended 7 days of observation, indicating the observation time of 7 days seems justified but longer duration may be needed. The results of the culturally and clinically isolated population may limit the application to other population.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).
This study was performed in National Taiwan University Hospital.
The authors have disclosed that they do not have any potential conflicts of interest.
The authors have disclosed that they do not have any potential conflicts of interest.
For information regarding this article, E-mail: wjchen1955@ntu.edu.tw; chhuang730@gmail.com
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
Copyright © by 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Læs mere Tjek på PubMedPetit, Matthieu; Fetita, Catalin; Gaudemer, Augustin; Treluyer, Ludovic; Lebreton, Guillaume; Franchineau, Guillaume; Hekimian, Guillaume; Chommeloux, Juliette; Pineton de Chambrun, Marc; Brechot, Nicolas; Luyt, Charles-Edouard; Combes, Alain; Schmidt, Matthieu
Critical Care Medicine, 19.11.2021
Tilføjet 30.11.2021
Objectives:
To determine the characteristics and outcomes of patients prone-positioned during extracorporeal membrane oxygenation for severe acute respiratory distress syndrome and lung CT pattern associated with improved respiratory system static compliance after that intervention.
Design:
Retrospective, single-center study over 8 years.
Settings:
Twenty-six bed ICU in a tertiary center.
Measurements and Main Results:
A propensity score–matched analysis compared patients with prone-positioning during extracorporeal membrane oxygenation and those without. An increase of the static compliance greater than or equal to 3 mL/cm H2O after 16 hours of prone-positioning defined prone-positioning responders. The primary outcome was the time to successful extracorporeal membrane oxygenation weaning within 90 days of postextracorporeal membrane oxygenation start, with death as a competing risk. Among 298 venovenous extracorporeal membrane oxygenation–treated adults with severe acute respiratory distress syndrome, 64 were prone-positioning extracorporeal membrane oxygenation. Although both propensity score–matched groups had similar extracorporeal membrane oxygenation durations, prone-positioning extracorporeal membrane oxygenation patients’ 90-day probability of being weaned-off extracorporeal membrane oxygenation and alive was higher (0.75 vs 0.54, p = 0.03; subdistribution hazard ratio [95% CI], 1.54 [1.05–2.58]) and 90-day mortality was lower (20% vs 42%, p < 0.01) than that for no prone-positioning extracorporeal membrane oxygenation patients. Extracorporeal membrane oxygenation–related complications were comparable for the two groups. Patients without improved static compliance had higher percentages of nonaerated or poorly aerated ventral and medial-ventral lung regions (p = 0.047).
Conclusions:
Prone-positioning during venovenous extracorporeal membrane oxygenation was safe and effective and was associated with a higher probability of surviving and being weaned-off extracorporeal membrane oxygenation at 90 days. Patients with greater normally aerated lung tissue in the ventral and medial-ventral regions on quantitative lung CT-scan performed before prone-positioning are more likely to improve their static compliance after that procedure during extracorporeal membrane oxygenation.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).
Dr. Combes received grants from Getinge and personal fees from Getinge, Baxter, and Xenios outside the submitted work. Dr. Schmidt received personal fees from Getinge, Drager, 3M, and Xenios, outside the submitted work. The remaining authors have disclosed that they do not have any potential conflicts of interest.
For information regarding this article, E-mail: matthieu.schmidt@aphp.fr
Copyright © by 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Læs mere Tjek på PubMedMacDonald, Andrew J.; Subramanian, Ram M.; Olson, Jody C.; Speiser, Jaime L.; Durkalski-Mauldin, Valerie L.; Abraldes, Juan G.; Bigam, David L.; Flynn, Mary M.; Rapaka, Babusai; Shropshire, Brianne M.; Vora, Ravi S.; Karvellas, Constantine J.; for the U.S. Acute Liver Failure Study Group
Critical Care Medicine, 19.11.2021
Tilføjet 30.11.2021
Objectives:
The molecular adsorbent recirculating system removes water-soluble and albumin-bound toxins and may be beneficial for acute liver failure patients. We compared the rates of 21-day transplant-free survival in acute liver failure patients receiving molecular adsorbent recirculating system therapy and patients receiving standard medical therapy.
Design:
Propensity score–matched retrospective cohort analysis.
Setting:
Tertiary North American liver transplant centers.
Patients:
Acute liver failure patients receiving molecular adsorbent recirculating system at three transplantation centers (n = 104; January 2009–2019) and controls from the U.S. Acute Liver Failure Study Group registry.
Interventions:
Molecular adsorbent recirculating system treatment versus standard medical therapy (control).
Measurements and Main Results:
One-hundred four molecular adsorbent recirculating system patients were propensity score–matched (4:1) to 416 controls. Using multivariable conditional logistic regression adjusting for acute liver failure etiology (acetaminophen: n = 248; vs nonacetaminophen: n = 272), age, vasopressor support, international normalized ratio, King’s College Criteria, and propensity score (main model), molecular adsorbent recirculating system was significantly associated with increased 21-day transplant-free survival (odds ratio, 1.90; 95% CI, 1.07–3.39; p = 0.030). This association remained significant in several sensitivity analyses, including adjustment for acute liver failure etiology and propensity score alone (“model 2”; molecular adsorbent recirculating system odds ratio, 1.86; 95% CI, 1.05–3.31; p = 0.033), and further adjustment of the “main model” for mechanical ventilation, and grade 3/4 hepatic encephalopathy (“model 3”; molecular adsorbent recirculating system odds ratio, 1.91; 95% CI, 1.07–3.41; p = 0.029). In acetaminophen-acute liver failure (n = 51), molecular adsorbent recirculating system was associated with significant improvements (post vs pre) in mean arterial pressure (92.0 vs 78.0 mm Hg), creatinine (77.0 vs 128.2 µmol/L), lactate (2.3 vs 4.3 mmol/L), and ammonia (98.0 vs 136.0 µmol/L; p ≤ 0.002 for all). In nonacetaminophen acute liver failure (n = 53), molecular adsorbent recirculating system was associated with significant improvements in bilirubin (205.2 vs 251.4 µmol/L), creatinine (83.1 vs 133.5 µmol/L), and ammonia (111.5 vs 140.0 µmol/L; p ≤ 0.022 for all).
Conclusions:
Treatment with molecular adsorbent recirculating system is associated with increased 21-day transplant-free survival in acute liver failure and improves biochemical variables and hemodynamics, particularly in acetaminophen-acute liver failure.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).
Supported, in part, by the National Institutes of Health grant U-01 58369 (from the National Institute of Diabetes and Digestive and Kidney Diseases).
Dr. Durkalski-Maudlin’s institution received funding from the National Institutes of Health (NIH) and the National Institute of Diabetes and Digestive and Kidney Diseases. Drs. Durkalski-Maudlin and Karvellas received support for article research from the NIH. The remaining authors have disclosed that they do not have any potential conflicts of interest.
For information regarding this article, E-mail: dean.karvellas@ualberta.ca
Copyright © by 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Læs mere Tjek på PubMedIsta, Erwin; Redivo, Juliana; Kananur, Paurav; Choong, Karen; Colleti, Jose Jr; Needham, Dale M.; Awojoodu, Ronke; Kudchadkar, Sapna R.; on behalf of the International PARK-PICU Investigators
Critical Care Medicine, 19.11.2021
Tilføjet 30.11.2021
Objectives:
To evaluate current international practice in PICUs regarding components of the “Assessing Pain, Both Spontaneous Awakening and Breathing Trials, Choice of Sedation, Delirium Monitoring/Management, Early Exercise/Mobility, and Family Engagement/Empowerment” (“ABCDEF”) bundle.
Design:
Online surveys conducted between 2017 and 2019.
Setting:
One-hundred sixty-one PICUs across the United States (n = 82), Canada (n = 14), Brazil (n = 27), and Europe (n = 38) participating in the Prevalence of Acute Rehabilitation for Kids in the PICU study.
Interventions:
None.
Measurements and Main Results:
Of the 161 participating PICUs, 83% were in academic teaching hospitals and 42% were in free-standing children’s hospitals. Median size was 16 beds (interquartile range, 10–24 beds). Only 15 PICUs (9%) had incorporated all six ABCDEF bundle components into routine practice. Standardized pain assessment (A) was the most common (91%), followed by family engagement (F, 88%) and routine sedation assessment (C) with validated scales (84%). Protocols for testing extubation readiness or conducting spontaneous breathing trials (B) were reported in 57%, with 34% reporting a ventilator weaning protocol. Routine delirium monitoring with a validated screening tool (D) was reported by 44% of PICUs, and 26% had a guideline, protocol, or policy for early exercise/mobility (E). Practices for spontaneous breathing trials were variable in 29% of Canadian PICUs versus greater than 50% in the other regions. Delirium monitoring was lowest in Brazilian PICUs (18%) versus greater than 40% in other regions, and family engagement was reported in 55% of European PICUs versus greater than 90% in other regions.
Conclusions:
ABCDEF bundle components have been adopted with substantial variability across regions. Additional research must rigorously evaluate the efficacy of specific elements with a focus on B, D, E, and full ABCDEF bundle implementation. Implementation science is needed to facilitate an understanding of the barriers to ABCDEF implementation and sustainability with a focus on specific cultural and regional differences.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).
Dr. Choong’s institution received funding from the Alternative Funding Plan Innovation Fund; she received funding from McMaster University. Dr. Needham received funding from Haisco-USA Pharmaceuticals, Novartis Pharma, and GlaxoSmithKline; he disclosed that he is a principal investigator on a National Institutes of Health (NIH) funded, multicentered randomized trial (R01HL132887) funded by an unrestricted research grant to the University of Vermont from Baxter Healthcare Corporation. Dr. Kudchadkar received support for article research from the NIH. Dr. Kudchadkar was supported by an Anesthesiology and Critical Care Medicine Clinical Research Core StAARter Gran from Johns Hopkins University and the Johns Hopkins Clinical and Translational Science Award Number 5KL2RR025006 from the National Center for Advancing Translational Sciences of the NIH. The remaining authors have disclosed that they do not have any potential conflicts of interest.
For information regarding this article, E-mail: w.ista@erasmusmc.nl
Copyright © by 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Læs mere Tjek på PubMedLe Moigne, Guillaume; Nazir, Souha; Pateau, Victoire; Courtois, Emmanuelle; L’Her, Erwan
Critical Care Medicine, 19.11.2021
Tilføjet 30.11.2021
Objectives:
The mechanisms of high-flow nasal cannula are still debated but may be mediated by the generation of low positive end-expiratory pressure and a washout of the airway dead space. The aims of this study were to assess the effects of high-flow nasal cannula on tidal volume using a noninvasive method using a time-of-flight camera, under various conditions.
Design:
A physiologic evaluation in healthy volunteers.
SETTING:
An university hospital ICU.
Subjects:
Ten healthy volunteers were included in a physiologic study (CamOpt study, ClinicalTrials.gov identifier: NCT04096183).
Interventions:
All volunteers were submitted to 12 different conditions (i.e., gas flow [baseline = 0; 30–60 L/min]; mouth [open/closed]; respiratory rate [baseline; baseline + 10 breaths/min]). Tidal volume measurements were performed every minute, during a 6-minute recording period. In all combinations, reference respiratory rate was measured by using chronometric evaluation, over a 30–second period (RRREF), and by using the time-of-flight camera (RRTOF).
Measurements and Main Results:
Tidal volume increased while increasing gas flow whatever the respiratory rate and mouth condition (p < 0.001). Similar results were observed whatever the experimental conditions (p < 0.01), except one (baseline respiratory rate + 10 breaths/min and mouth closed). Tidal volume increased while decreasing respiratory rate (p < 0.001) and mouth closing (p < 0.05). Proportion of tidal volume greater than 10, 15, and 20 mL/kg changed while increasing the flow. RRTOF was in agreement with RRREF (intraclass correlation coefficient, 0.96), with a low mean bias (0.55 breaths/min) and acceptable deviation.
Conclusions:
Time-of-flight enables to detect tidal volume changes under various conditions of high-flow nasal cannula application. Tidal volume increased significantly while increasing gas flow and mouth closing. Such technique might be useful to monitor the risk of patient self-inflicted lung injury or under assistance.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).
The research was funded by Brest University Hospital.
Dr. L’Her is the cofounder and shareholder of Oxynov, a biomedical R&D Canadian Company; he received support for article research from Brest University Hospital. He is also consultant for GE Healthcare, Smiths, Sedana Medical, and Vygon. Drs. Nazir and L’Her disclosed they have a patent pending for the time-of-flight monitoring system. Dr. Nazir disclosed work for hire. Ms. Pateau is part of employee for Oxynov. The remaining authors have disclosed that they do not have any potential conflicts of interest.
For information regarding this article, E-mail: erwan.lher@chu-brest.fr
Copyright © by 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Læs mere Tjek på PubMedRass, Verena; Ianosi, Bogdan-Andrei; Lindlbauer, Moritz; Lindner, Anna; Kofler, Mario; Schiefecker, Alois J.; Pfausler, Bettina; Beer, Ronny; Helbok, Raimund
Critical Care Medicine, 19.11.2021
Tilføjet 30.11.2021
Objectives:
Patients suffering from spontaneous subarachnoid hemorrhage frequently require mechanical ventilation. Here, we aimed to identify factors associated with prolonged mechanical ventilation in subarachnoid hemorrhage patients and to create a new predictive score for prolonged mechanical ventilation.
Design:
Prospective cohort study with retrospective data analysis.
Setting:
Neurocritical care unit at a tertiary academic medical center.
Patients:
Two hundred ninety-seven consecutive nontraumatic adult subarachnoid hemorrhage patients.
Methods:
In patients with mechanical ventilation, we identified factors associated with mechanical ventilation greater than 48 hours, greater than 7 days, and greater than 14 days compared with mechanical ventilation less than or equal to 48 hours, less than or equal to 7 days, or less than or equal to 14 days in multivariable generalized linear models. Ventilated patients who died before 48 hours, 7 days, or 14 days and those never ventilated were excluded from the respective analysis. We incorporated those factors into a new prognostic score (the RAISE score) to predict prolonged mechanical ventilation greater than 7 days. The calculation was based on a random dataset of 60% of subarachnoid hemorrhage patients and was internally validated.
INTERVENTIONS:
None.
MEASUREMENTS AND MAIN RESULTS:
Patients were 57 years old (interquartile range, 47–68 yr) and presented with a median Hunt and Hess grade of 3 (1–5). Two hundred forty-two patients (82%) required mechanical ventilation for 9 days (2–20 d). In multivariable analysis, a higher Acute Physiology Score was associated with mechanical ventilation greater than 48 hours, greater than 7 days, and greater than 14 days, a higher Hunt and Hess grade with greater than 7 days and greater than 14 days. Early neuroimaging findings were associated with mechanical ventilation greater than 48 hours (hydrocephalus; high-grade Subarachnoid Hemorrhage Early Brain Edema Score), greater than 7 days (high-grade Subarachnoid Hemorrhage Early Brain Edema Score, co-occurrence of intracerebral bleeding) but not with prolonged mechanical ventilation greater than 14 days. The RAISE score, including age, Acute Physiology Score, Hunt and Hess grade, Subarachnoid Hemorrhage Early Brain Edema Score, and the co-occurrence of intracerebral hemorrhage accurately stratified patients by prolonged mechanical ventilation greater than 7 days (C-statistic 0.932). A RAISE score of 12 predicted 60% likelihood of mechanical ventilation greater than 7 days.
Conclusions:
Initial disease severity and neuroimaging findings detected within 24 hours after ICU admission were associated with the need for prolonged mechanical ventilation in patients with subarachnoid hemorrhage. These results may be helpful for patient families and caregivers to better anticipate the course of therapy.
This work was performed at Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).
Dr. Beer’s institution received funding from the Austrian Science fund (FWF) (KLI 375); he received support for article research from the FWF. The remaining authors have disclosed that they do not have any potential conflicts of interest.
For information regarding this article, E-mail: Raimund.helbok@tirol-kliniken.at; raimund.helbok@i-med.ac.at
Copyright © by 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Læs mere Tjek på PubMedGutierrez, Cristina; Brown, Anne Rain T.; May, Heather P.; Beitinjaneh, Amer; Stephens, R. Scott; Rajendram, Prabalini; Nates, Joseph L.; Pastores, Stephen M.; Dharshan, Ananda; de Moraes, Alice Gallo; Hensley, Matthew K.; Feng, Lei; Brudno, Jennifer N.; Athale, Janhavi; Ghosh, Monalisa; Kochenderfer, James N.; Arias, Alejandro S.; Lin, Yi; McEvoy, Colleen; Mead, Elena; Westin, Jason; Kostelecky, Natalie; Mian, Agrima; Herr, Megan M.
Critical Care Medicine, 19.11.2021
Tilføjet 30.11.2021
Objectives:
To report the epidemiology, treatments, and outcomes of adult patients admitted to the ICU after cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome.
Design:
Retrospective cohort study
Setting:
Nine centers across the U.S. part of the chimeric antigen receptor-ICU initiative.
Patients:
Adult patients treated with chimeric antigen receptor T-cell therapy who required ICU admission between November 2017 and May 2019.
Interventions:
Demographics, toxicities, specific interventions, and outcomes were collected.
Results:
One-hundred five patients treated with axicabtagene ciloleucel required ICU admission for cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome during the study period. At the time of ICU admission, the majority of patients had grade 3–4 toxicities (66.7%); 15.2% had grade 3–4 cytokine release syndrome and 64% grade 3–4 immune effector cell-associated neurotoxicity syndrome. During ICU stay, cytokine release syndrome was observed in 77.1% patients and immune effector cell-associated neurotoxicity syndrome in 84.8% of patients; 61.9% patients experienced both toxicities. Seventy-nine percent of patients developed greater than or equal to grade 3 toxicities during ICU stay, however, need for vasopressors (18.1%), mechanical ventilation (10.5%), and dialysis (2.9%) was uncommon. Immune Effector Cell-Associated Encephalopathy score less than 3 (69.7%), seizures (20.2%), status epilepticus (5.7%), motor deficits (12.4%), and cerebral edema (7.9%) were more prevalent. ICU mortality was 8.6%, with only three deaths related to cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome. Median overall survival time was 10.4 months (95% CI, 6.64–not available mo). Toxicity grade or organ support had no impact on overall survival; higher cumulative corticosteroid doses were associated to decreased overall and progression-free survival.
Conclusions:
This is the first study to describe a multicenter cohort of patients requiring ICU admission with cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome after chimeric antigen receptor T-cell therapy. Despite severe toxicities, organ support and in-hospital mortality were low in this patient population.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).
Drs. Gutierrez and Brown contributed equally to this study and will share first co-authorship.
Drs. Gutierrez and Brown contributed equally to and had full access to the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs. Gutierrez, Brown, May, Beitinjaneh, Stephens, Rajendram, Pastores, Dharshan, de Moraes, Hensley, Brudno, Athale, Ghosh, Lin, Kostelecky, and Herr contributed to data acquisition, review of data, and addressed any inconsistencies raised by Drs. Gutierrez and Brown. Dr. Feng conducted statistical analysis, and all authors have interpreted the data. Drs. Gutierrez and Brown drafted the article, and all authors have provided critical revision for content. All authors have read and approved the final article.
This study was supported in part by the National Institutes of Health (NIH) through Cancer Center Support Grant P30CA016672 and in part by the Intramural Research Program of the NIH Clinical Center, National Cancer Institute, and National Heart, Lung, and Blood Institute, respectively.
This data was accepted to be presented as abstracts and an oral presentation at the Society of Critical Care Medicine Congress in Orlando, FL, 2020. Drs. Gutierrez, Brudno, and Athale received support for article research from the National Institutes of Health. Dr. Gutierrez disclosed the off-label product use of anakinra; she disclosed that she served, and will serve again, in the advisory board for Legend Biotech and Janssen in August 2020. Drs. Gutierrez, May, and McEvoy disclosed the off-label product use of Siltuximab. Dr. Brown received funding from La Jolla Pharmaceutical outside the submitted work. Dr. May disclosed the off-label product use of Corticosteroids. Dr. Beitinjaneh received funding from KITE pharmaceuticals on August 2018. Drs. Brudno and Kochenderfer disclosed government work. Dr. Kochenderfer’s institution received funding from KITE pharmaceuticals, Bristol Meyers Squibb, and Kyverna; he is the principal investigator of Cooperative Research and Development Agreements with Kite, a Gilead Company and Celgene. Dr. Lin as Principal Investigator Mayo Clinic receives compensation for research activities and clinical trials with Kite/Gilead, Janssen, Celgene, BlueBird Bio, Merck, Boston Scientific, Gamida, and Takeda; advisory board with Kite/Gilead, Novartis, Janssen, Legend BioTech, JUNO, Bristol-Myers-Squibb (BMS), Celgene, BlueBird Bio, and Ethos; Data and Safety Monitoring Board: Sorrento; and steering committee: Celgene, Janssen, and Legend BioTech. Dr. McEvoy received funding from United Therapeutics. Dr. Westin received funding from BMS, Novartis, Kite Gilead, Juno Celgene, Genentech, AstraZeneca, Morphosys, and ADC Therapeutics. The remaining authors have disclosed that they do not have any potential conflicts of interest.
The findings and conclusions in this study are those of the authors and do not necessarily represent the official position of the National Institutes of Health. A subset of data from one center was published as a Letter to the Editor in the American Journal of Respiratory and Critical Care Medicine. The study did not include all patients from the chimeric antigen receptor-ICU initiative, its dataset, or measure same outcomes.
The study was conducted in accordance with the amended Declaration of Helsinki, local Institutional Review Boards approved the protocol and waived informed consent. MD Anderson Cancer Center was the leading center with protocol approval PA19-0365.
Local Institutional Review Boards approved the protocol and waived informed consent.
Data use agreements were established independently with each institution and de-identified data were made available and analyzed at MD Anderson Cancer Center. Availability of data from each center will be upon approval from each Institutional Review Board.
For information regarding this article, E-mail: CGutierrez4@mdanderson.org
Copyright © by 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Læs mere Tjek på PubMedNishikimi, Mitsuaki; Yagi, Tsukasa; Shoaib, Muhammad; Takegawa, Ryosuke; Rasul, Rehana; Hayashida, Kei; Okuma, Yu; Yin, Tai; Choudhary, Rishabh C.; Becker, Lance B.; Kim, Junhwan
Critical Care Medicine, 19.11.2021
Tilføjet 30.11.2021
Objectives:
Cardiac arrest and subsequent resuscitation have been shown to deplete plasma phospholipids. This depletion of phospholipids in circulating plasma may contribute to organ damage postresuscitation. Our aim was to identify the diminishment of essential phospholipids in postresuscitation plasma and develop a novel therapeutic approach of supplementing these depleted phospholipids that are required to prevent organ dysfunction postcardiac arrest, which may lead to improved survival.
Design:
Clinical case control study followed by translational laboratory study.
Setting:
Research institution.
Patients/Subjects:
Adult cardiac arrest patients and male Sprague-Dawley rats.
Interventions:
Resuscitated rats after 10-minute asphyxial cardiac arrest were randomized to be treated with lysophosphatidylcholine specie or vehicle.
Measurements and Main Results:
We first performed a phospholipid survey on human cardiac arrest and control plasma. Using mass spectrometry analysis followed by multivariable regression analyses, we found that plasma lysophosphatidylcholine levels were an independent discriminator of cardiac arrest. We also found that decreased plasma lysophosphatidylcholine was associated with poor patient outcomes. A similar association was observed in our rat model, with significantly greater depletion of plasma lysophosphatidylcholine with increased cardiac arrest time, suggesting an association of lysophosphatidylcholine levels with injury severity. Using a 10-minute cardiac arrest rat model, we tested supplementation of depleted lysophosphatidylcholine species, lysophosphatidylcholine(18:1), and lysophosphatidylcholine(22:6), which resulted in significantly increased survival compared with control. Furthermore, the survived rats treated with these lysophosphatidylcholine species exhibited significantly improved brain function. However, supplementing lysophosphatidylcholine(18:0), which did not decrease in the plasma after 10-minute cardiac arrest, had no beneficial effect.
Conclusions:
Our data suggest that decreased plasma lysophosphatidylcholine is a major contributor to mortality and brain damage postcardiac arrest, and its supplementation may be a novel therapeutic approach.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).
Drs. Nishikimi and Yagi contributed equally.
This work was supported, in part, by Zoll Foundation.
Dr. Kim’s institution received funding from the Zoll Foundation. Dr. Becker’s institution received funding from Philips, United Therapeutics, and Nihon Kohden; he received funding from ZOLL Medical, the National Institutes of Health, PCORI, and BrainCool. The remaining authors have disclosed that they do not have any potential conflicts of interest.
For information regarding this article, E-mail: jkim46@northwell.edu
Copyright © by 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Læs mere Tjek på PubMedWisløff-Aase, Kristin; Skulstad, Helge; Beitnes, Jan Otto; Lundblad, Runar; Halvorsen, Per Steinar; Fiane, Arnt; Espinoza, Andreas
Critical Care Medicine, 19.11.2021
Tilføjet 30.11.2021
Objectives:
Targeted temperature management (32–36°C) is used for neuroprotection in cardiac arrest survivors. The isolated effects of hypothermia on myocardial function, as used in clinical practice, remain unclear. Based on experimental results, we hypothesized that hypothermia would reversibly impair diastolic function with less tolerance to increased heart rate in patients with uninsulted hearts.
Design:
Prospective clinical study, from June 2015 to May 2018.
Setting:
Cardiothoracic surgery operation room, Oslo University Hospital.
Patients:
Twenty patients with left ventricular ejection fraction greater than 55%, undergoing ascending aorta graft-replacement connected to cardiopulmonary bypass were included.
Interventions:
Left ventricular function was assessed during reduced cardiopulmonary bypass support at 36°C, 32°C prior to graft-replacement, and at 36°C postsurgery. Electrocardiogram, hemodynamic, and echocardiographic recordings were made at spontaneous heart rate and 90 beats per minute at comparable loading conditions.
Measurements and Main Results:
Hypothermia decreased spontaneous heart rate, and R-R interval was prolonged (862 ± 170 to 1,156 ± 254 ms, p < 0.001). Although systolic and diastolic fractions of R-R interval were preserved (0.43 ± 0.07 and 0.57 ± 0.07), isovolumic relaxation time increased and diastolic filling time was shortened. Filling pattern changed from early to late filling. Systolic function was preserved with unchanged myocardial strain and stroke volume index, but cardiac index was reduced with maintained mixed venous oxygen saturation. At increased heart rate, systolic fraction exceeded diastolic fraction (0.53 ± 0.05 and 0.47 ± 0.05) with diastolic impairment. Strain and stroke volume index were reduced, the latter to 65% of stroke volume index at spontaneous heart rate. Cardiac index decreased, but mixed venous oxygen saturation was maintained. After rewarming, myocardial function was restored.
Conclusions:
In patients with normal left ventricular function, hypothermia impaired diastolic function. At increased heart rate, systolic function was subsequently reduced due to impeded filling. Changes in left ventricular function were rapidly reversed after rewarming.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http:/journals.lww.com/ccmjournal).
The authors have disclosed that they do not have any potential conflicts of interest.
The work was performed at Oslo University Hospital, Rikshospitalet, Oslo, Norway.
For information regarding this article, E-mail: uxwisk@ous-hf.no
Copyright © by 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Læs mere Tjek på PubMedLeung, Sharon; Pastores, Stephen M.; Oropello, John M.; Lilly, Craig M.; Galvagno, Samuel M. Jr; Badjatia, Neeraj; Jacobi, Judith; Herr, Daniel L.; Oliveira, Jason David; for the Academic Leaders in Critical Care Medicine Task Force of the Society of Critical Care Medicine
Critical Care Medicine, 19.11.2021
Tilføjet 30.11.2021
Objectives:
The Society of Critical Care Medicine convened its Academic Leaders in Critical Care Medicine taskforce on February 22, 2016, during the 45th Critical Care Congress to develop a series of consensus papers with toolkits for advancing critical care organizations in North America. The goal of this article is to propose a framework based on the expert opinions of critical care organization leaders and their responses to a survey, for current and future critical care organizations, and their leadership in the health system to design and implement successful regionalization for critical care in their regions.
Data Sources and Study Selection:
Members of the workgroup convened monthly via teleconference with the following objectives: to 1) develop and analyze a regionalization survey tool for 23 identified critical care organizations in the United States, 2) assemble relevant medical literature accessed using Medline search, 3) use a consensus of expert opinions to propose the framework, and 4) create groups to write the subsections and assemble the final product.
Data Extraction and Synthesis:
The most prevalent challenges for regionalization in critical care organizations remain a lack of a strong central authority to regulate and manage the system as well as a lack of necessary infrastructure, as described more than a decade ago. We provide a framework and outline a nontechnical approach that the health system and their critical care medicine leadership can adopt after considering their own structure, complexity, business operations, culture, and the relationships among their individual hospitals. Transforming the current state of regionalization into a coordinated, accountable system requires a critical assessment of administrative and clinical challenges and barriers. Systems thinking, business planning and control, and essential infrastructure development are critical for assisting critical care organizations.
Conclusions:
Under the value-based paradigm, the goals are operational efficiency and patient outcomes. Health systems that can align strategy and operations to assist the referral hospitals with implementing regionalization will be better positioned to regionalize critical care effectively.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).
Dr. Galvagno’s institution received funding from the Department of Defense; he received funding from Northwest Anesthesia Seminars and from expert defense for medicolegal work. Dr. Jacobi received funding from Visante, Merck, Pfizer, American Society of Health System Pharmacists, and a Pharmacy Continuing Education group. The remaining authors have disclosed that they do not have any potential conflicts of interest.
For information regarding this article, E-mail: pastores@mskcc.org
Copyright © by 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Læs mere Tjek på PubMedPound, Gemma M.; Jones, Daryl; Eastwood, Glenn M.; Paul, Eldho; Hodgson, Carol L.; The Australia and New Zealand Cardiac Arrest Outcome and Determinants of ECMO (ANZ-CODE) Investigators
Critical Care Medicine, 19.11.2021
Tilføjet 30.11.2021
Objectives:
To evaluate the functional outcome and health-related quality of life of in-hospital cardiac arrest survivors at 6 and 12 months.
Design:
A longitudinal cohort study.
Setting:
Seven metropolitan hospitals in Australia.
Patients:
Data were collected for hospitalized adults (≥ 18 yr) who experienced in-hospital cardiac arrest, defined as “a period of unresponsiveness, with no observed respiratory effort and the commencement of external cardiac compressions.”
Interventions:
None.
Measurements and Main Results:
Prior to hospital discharge, patients were approached for consent to participate in 6-month and 12-month telephone interviews. Outcomes included the modified Rankin Scale, Barthel Index, Euro-Quality of Life 5 Dimension 5 Level, return to work and hospital readmissions. Forty-eight patients (80%) consented to follow-up interviews. The mean age of participants was 67.2 (± 15.3) years, and 33 of 48 (68.8%) were male. Good functional outcome (modified Rankin Scale score ≤ 3) was reported by 31 of 37 participants (83.8%) at 6 months and 30 of 33 (90.9%) at 12 months. The median Euro-Quality of Life-5D index value was 0.73 (0.33–0.84) at 6 months and 0.76 (0.47–0.88) at 12 months. The median Euro-Quality of Life-Visual Analogue Scale score at 6 months was 70 (55–80) and 75 (50–87.5) at 12 months. Problems in all Euro-Quality of Life-5D-5 L dimension were reported frequently at both time points. Hospital readmission was reported by 23 of 37 patients (62.2%) at 6 months and 16 of 33 (48.5%) at 12 months. Less than half of previously working participants had returned to work by 12 months.
Conclusions:
The majority of in-hospital cardiac arrest survivors had a good functional outcome and health-related quality of life at 6 months, and this was largely unchanged at 12 months. Despite this, many reported problems with mobility, self-care, usual activities, pain, and anxiety/depression. Return to work rates was low, and hospital readmissions were common.
Ms. Pound contributed to concept and study design, visualization, data acquisition, statistical analysis and data interpretation, writing—original draft preparation, and project administration. Prof. Jones, Dr. Eastwood, and Prof. Hodgson contributed to concept and study design, visualization, validation, writing—review and editing, supervision, and project administration. Dr. Paul contributed to statistical analysis and data interpretation, and writing—review and editing. All authors read and approved the final article.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).
The authors have disclosed that they do not have any potential conflicts of interest.
For information regarding this article, E-mail: carol.hodgson@monash.edu
Copyright © by 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Læs mere Tjek på PubMedMehta, Anuj B.; Matlock, Daniel; Douglas, Ivor S.
Critical Care Medicine, 19.11.2021
Tilføjet 30.11.2021
Objectives:
Availability of long-term acute care hospitals has been associated with hospital discharge practices. It is unclear if long-term acute care hospital availability can influence patient care decisions. We sought to determine the association of long-term acute care hospital availability at different hospitals with the likelihood of tracheostomy.
Design:
Retrospective cohort study.
Setting:
California Patient Discharge Database, 2016–2018.
Patients:
Adult patients receiving mechanical ventilation for respiratory failure.
Interventions:
None.
Measurements and Main Results:
Using the California Patient Discharge Database 2016–2018, we identified all mechanically ventilated patients and those who received tracheostomy. We determine the association between tracheostomy and the distance between each hospital and the nearest long-term acute care hospital and the number of long-term acute care hospital beds within 20 miles of each hospital. Among 281,502 hospitalizations where a patient received mechanical ventilation, 22,899 (8.1%) received a tracheostomy. Patients admitted to a hospital closer to a long-term acute care hospital compared with those furthest from a long-term acute care hospital had 38.9% (95% CI, 33.3–44.6%) higher odds of tracheostomy (closest hospitals 8.7% vs furthest hospitals 6.3%, adjusted odds ratio = 1.65; 95% CI, 1.40–1.95). Patients had a 32.4% (95% CI, 27.6–37.3%) higher risk of tracheostomy when admitted to a hospital with more long-term acute care hospital beds in the immediate vicinity (most long-term acute care hospital beds within 20 miles 8.9% vs fewest long-term acute care hospital beds 6.7%, adjusted odds ratio = 1.54; 95% CI, 1.31–1.80). Distance to the nearest long-term acute care hospital was inversely correlated with hospital risk-adjusted tracheostomy rates (ρ = –0.25; p < 0.0001). The number of long-term acute care hospital beds within 20 miles was positively correlated with hospital risk-adjusted tracheostomy rates (ρ = 0.22; p < 0.0001).
Conclusions:
Proximity and availability of long-term acute care hospital beds were associated with patient odds of tracheostomy and hospital tracheostomy practices. These findings suggest a hospital effect on tracheostomy decision-making over and above patient case-mix. Future studies focusing on shared decision-making for tracheostomy are needed to ensure goal-concordant care for prolonged mechanical ventilation.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).
Drs. Mehta and Douglas conceived the study and were responsible for data interpretation. Dr. Mehta was responsible for data collection and analysis and drafted the article. He had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. He conducted all aspects of data analysis. All authors provided critical revisions and meaningful input for the final draft. All authors approved the final draft of the article.
Dr. Mehta is supported by the National Institutes of Health (NIH) K23HL141704 (primary funding source); he is supported by NIH R01HL136403. Dr. Mehta’s institution received funding from the NIH. Dr. Matlock is supported by NIH R01HL136403. Dr. Douglas is supported by NIH R01NR016459.
For information regarding this article, E-mail: anuj.mehta@cuanschutz.edu
Copyright © by 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Læs mere Tjek på PubMedSchwab, Kristin; Buhr, Russell G.; Grossetreuer, Anne V.; Balaji, Lakshman; Lee, Edward S.; Moskowitz, Ari L.; for the American Heart Association’s Get With the Guidelines-Resuscitation Investigators
Critical Care Medicine, 19.11.2021
Tilføjet 30.11.2021
Objectives:
Airway management during in-hospital cardiac arrest represents a fundamental component of resuscitative efforts, yet little is known about temporal trends in intubation during in-hospital cardiac arrest. Our objective was to investigate changes in in-hospital cardiac arrest airway management over time and in response to national guideline updates.
Design:
Observational cohort study of a prospectively collected database.
Setting:
Multicenter study of hospitals participating in the “Get With The Guidelines—Resuscitation” registry from January 1, 2001, to December 31, 2018.
Subjects:
Adult patients who experienced an in-hospital cardiac arrest and did not have an invasive airway in place prior to the arrest.
Interventions:
The primary outcome was the rate of intra-arrest intubation from 2001 to 2018. We constructed multivariable regression models with generalized estimating equations to determine the annual adjusted odds of intubation. We also assessed the timing of intubation relative to the onset of pulselessness and other arrest measures. We used an interrupted time-series analysis to assess the association between the 2010 Advanced Cardiac Life Support guideline update and intubation rates.
Measurements and Main Results:
One thousand sixty-six eight hundred patients from 797 hospitals were included. From 2001 to 2018, the percentage of patients intubated during an arrest decreased from 69% to 55% for all rhythms, 73% to 60% for nonshockable rhythms, and 58% to 36% for shockable rhythms (p < 0.001 for trend for all 3 groups). The median time from onset of pulselessness to intubation increased from 5 minutes in 2001 (interquartile range, 2–8 min) to 6 minutes in 2018 (interquartile range, 4–10 min) (p < 0.001 for trend). Following the 2010 guideline update, there was a downward step change and a steeper decrease over time in the rate of intubation as compared to the preintervention period (p < 0.001).
Conclusions:
Endotracheal intubation rates during in-hospital cardiac arrest have decreased significantly over time, with a more substantial decline following the updated 2010 guideline that prioritized chest compressions over airway management.
This work was performed at University of California, Los Angeles, CA, and Beth Israel Deaconess Medical Center.
New affiliation for Dr. Moskowitz: Division of Critical Care Medicine, Montefiore Medical Center, the Bronx, NY.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).
Dr. Buhr’s institution received funding from the National Institutes of Health (NIH) National Center for Advancing Translational Sciences (NCATS); he received funding from the NIH/ NCATS (KL2TR001882), the National Heart, Lung, and Blood Institute (NHLBI), and the University of California Office of the President; he received personal consulting fees from Mylan/Theravance Biopharma and GlaxoSmithKline; he disclosed he is employed part-time by the Veterans Health Administration; he received support for article research from the NIH. This work does not necessarily represent the views and opinions of the Department of Veterans Affairs. Dr. Balaji. The remaining authors have disclosed that they do not have any potential conflicts of interest.
For information regarding this article, E-mail: KSchwab@mednet.ucla.edu
Copyright © by 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Læs mere Tjek på PubMedMarini, John J.
Critical Care Medicine, 19.11.2021
Tilføjet 30.11.2021
Wessman, Brian T.; Mohr, Nicholas M.
Critical Care Medicine, 19.11.2021
Tilføjet 30.11.2021