Critical Care Explorations最新文献

{"title":"The Effectiveness of the Interventions to Reduce Sound Levels in the ICU: A Systematic Review.","authors":"Jeanette Vreman,&nbsp;Joris Lemson,&nbsp;Cris Lanting,&nbsp;Johannes van der Hoeven,&nbsp;Mark van den Boogaard","doi":"10.1097/CCE.0000000000000885","DOIUrl":"https://doi.org/10.1097/CCE.0000000000000885","url":null,"abstract":"<p><p>Excessive noise is ubiquitous in the ICU, and there is growing evidence of the negative impact on work performance of caregivers. This study aims to determine the effectiveness of interventions to reduce noise in the ICU.</p><p><strong>Data sources: </strong>Databases of PubMed, EMBASE, PsychINFO, CINAHL, and Web of Science were systematically searched from inception to September 14, 2022.</p><p><strong>Study selection: </strong>Two independent reviewers assessed titles and abstracts against study eligibility criteria. Noise mitigating ICU studies were included when having at least one quantitative acoustic outcome measure expressed in A-weighted sound pressure level with an experimental, quasi-experimental, or observational design. Discrepancies were resolved by consensus, and a third independent reviewer adjudicated as necessary.</p><p><strong>Data extraction: </strong>After title, abstract, and full-text selection, two reviewers independently assessed the quality of each study using the Cochrane's Risk Of Bias In Nonrandomized Studies of Interventions tool. Data were synthesized according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, and interventions were summarized.</p><p><strong>Data synthesis: </strong>After screening 12,652 articles, 25 articles were included, comprising either a mixed group of healthcare professionals (<i>n</i> = 17) or only nurses (<i>n</i> = 8) from adult or PICU settings. Overall, the methodological quality of the studies was low. Noise reduction interventions were categorized into education (<i>n</i> = 4), warning devices (<i>n</i> = 3), multicomponent programs (<i>n</i> = 15), and architectural redesign (<i>n</i> = 3). Education, a noise warning device, and an architectural redesign significantly decreased the sound pressure levels.</p><p><strong>Conclusions: </strong>Staff education and visual alert systems seem promising interventions to reduce noise with a short-term effect. The evidence of the studied multicomponent intervention studies, which may lead to the best results, is still low. Therefore, high-quality studies with a low risk of bias and a long-term follow-up are warranted. Embedding noise shielding within the ICU-redesign is supportive to reduce sound pressure levels.</p>","PeriodicalId":10759,"journal":{"name":"Critical Care Explorations","volume":"5 4","pages":"e0885"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6a/e1/cc9-5-e0885.PMC10047617.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9217449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulse Methylprednisolone Versus Dexamethasone in COVID-19: A Multicenter Cohort Study.","authors":"Atsuyuki Watanabe,&nbsp;Ryota Inokuchi,&nbsp;Toshiki Kuno,&nbsp;Kazuaki Uda,&nbsp;Jun Komiyama,&nbsp;Motohiko Adomi,&nbsp;Yoshiko Ishisaka,&nbsp;Toshikazu Abe,&nbsp;Nanako Tamiya,&nbsp;Masao Iwagami","doi":"10.1097/CCE.0000000000000886","DOIUrl":"https://doi.org/10.1097/CCE.0000000000000886","url":null,"abstract":"<p><p>Although pulse (high-dose) methylprednisolone therapy can hypothetically control immune system flare-ups effectively, the clinical benefit of pulse methylprednisolone compared with dexamethasone in COVID-19 remains inconclusive.</p><p><strong>Objectives: </strong>To compare pulse methylprednisolone to dexamethasone as a COVID-19 treatment.</p><p><strong>Design setting and participants: </strong>Using a Japanese multicenter database, we identified adult patients admitted for COVID-19 and discharged between January 2020 and December 2021 treated with pulse methylprednisolone (250, 500, or 1,000 mg/d) or IV dexamethasone (≥ 6 mg/d) at admission day 0 or 1.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was in-hospital mortality. Secondary outcomes were 30-day mortality, new ICU admission, insulin initiation, fungal infection, and readmission. Multivariable logistic regression was conducted to differentiate the dose of pulse methylprednisolone (250, 500, or 1,000 mg/d). Additionally, subgroup analyses by characteristics such as the need for invasive mechanical ventilation (IMV) were also conducted.</p><p><strong>Results: </strong>A total of 7,519, 197, 399, and 1,046 patients received dexamethasone, 250, 500, and 1,000 mg/d of methylprednisolone, respectively. The crude in-hospital mortality was 9.3% (702/7,519), 8.6% (17/197), 17.0% (68/399), and 16.2% (169/1,046) for the different doses, respectively. The adjusted odds ratio (95% CI) was 1.26 (0.69-2.29), 1.48 (1.07-2.04), and 1.75 (1.40-2.19) in patients starting 250, 500, and 1,000 mg/d of methylprednisolone, respectively, compared with those starting dexamethasone. In subgroup analyses, the adjusted odds ratio of in-hospital mortality was 0.78 (0.25-2.47), 1.12 (0.55-2.27), and 1.04 (0.68-1.57) in 250, 500, and 1,000 mg/d of methylprednisolone, respectively, among patients with IMV, whereas the adjusted odds ratio was 1.54 (0.77-3.08), 1.62 (1.13-2.34), and 2.14 (1.64-2.80) among patients without IMV.</p><p><strong>Conclusions and relevance: </strong>Higher doses of pulse methylprednisolone (500 or 1,000 mg/d) may be associated with worse COVID-19 outcomes when compared with dexamethasone, especially in patients not on IMV.</p>","PeriodicalId":10759,"journal":{"name":"Critical Care Explorations","volume":"5 4","pages":"e0886"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5f/ff/cc9-5-e0886.PMC10047604.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9223803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No More Resuscitation a la Carte: Towards a Universal, Simple, Ethical, and Medically Sound Code Status Ordering.","authors":"Mohammed Al Faiyumi","doi":"10.1097/CCE.0000000000000894","DOIUrl":"https://doi.org/10.1097/CCE.0000000000000894","url":null,"abstract":"<p><p>Cardiopulmonary resuscitation is a commonly performed intervention in clinical medicine and determining a patient's code status is paramount. \"Limited/partial code\" has crept into medical practice throughout the years and has become an acceptable practice. We describe here a tiered, clinically sounds and ethical code status ordering that includes the main elements of resuscitation, helps with establishing goals of care, eliminates the use of \"limited/partial code,\" facilitates shared decision-making with patients and surrogates and is easy to communicate to healthcare team members.</p>","PeriodicalId":10759,"journal":{"name":"Critical Care Explorations","volume":"5 4","pages":"e0894"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/70/ad/cc9-5-e0894.PMC10047598.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9217448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vasopressin Use in the Support of Organ Donors: Physiological Rationale and Review of the Literature.","authors":"Sofiane Ouerd,&nbsp;Anne Julie Frenette,&nbsp;David Williamson,&nbsp;Karim Serri,&nbsp;Frederick D'Aragon,&nbsp;Daniel G Bichet,&nbsp;Emmanuel Charbonney","doi":"10.1097/CCE.0000000000000907","DOIUrl":"https://doi.org/10.1097/CCE.0000000000000907","url":null,"abstract":"<p><p>The objective of this review was to depict the physiological and clinical rationale for the use of vasopressin in hemodynamic support of organ donors. After summarizing the physiological, pharmacological concepts and preclinical findings, regarding vasopressin's pathophysiological impacts, we will present the available clinical data.</p><p><strong>Data sources: </strong>Detailed search strategies in PubMed, OVID Medline, and EMBASE were undertaken using Medical Subject Headings and Key Words.</p><p><strong>Study selection: </strong>Physiological articles regarding brain death, and preclinical animal and human studies about the use of vasopressin or analogs, as an intervention in organ support for donation, were considered.</p><p><strong>Data extraction: </strong>Two authors independently screened titles, abstracts, and full text of articles to determine eligibility. Data encompassing models, population, methodology, outcomes, and relevant concepts were extracted.</p><p><strong>Data synthesis: </strong>Following brain death, profound reduction in sympathetic outflow is associated with reduced cardiac output, vascular tone, and hemodynamic instability in donors. In addition to reducing catecholamine needs and reversing diabetes insipidus, vasopressin has been shown to limit pulmonary injury and decrease systemic inflammatory response in animals. Several observational studies show the benefit of vasopressin on hemodynamic parameters and catecholamine sparing in donors. Small trials suggest that vasopressin increase organ procurement and have some survival benefit for recipients. However, the risk of bias is overall concerning, and therefore the quality of the evidence is deemed low.</p><p><strong>Conclusions: </strong>Despite potential impact on graft outcome and a protective effect through catecholamine support sparing, the benefit of vasopressin use in organ donors is based on low evidence. Well-designed observational and randomized controlled trials are warranted.</p>","PeriodicalId":10759,"journal":{"name":"Critical Care Explorations","volume":"5 4","pages":"0907"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/06/d3/cc9-5-e0907.PMC10125506.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9711149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monitoring the Resolution of Acute Exacerbation of Airway Bronchoconstriction in an Asthma Attack Using Capnogram Waveforms.","authors":"Mio Shikama,&nbsp;Miyuki Yamamoto,&nbsp;Itsuki Osawa,&nbsp;Takuya Sato,&nbsp;Ichiro Hirayama,&nbsp;Naoki Hayase,&nbsp;Takehiro Matsubara,&nbsp;Kent Doi","doi":"10.1097/CCE.0000000000000899","DOIUrl":"https://doi.org/10.1097/CCE.0000000000000899","url":null,"abstract":"<p><p>Patients with acute bronchospasm can show a distinct slope of the capnogram (\"shark fin\") as a result of asynchronous alveolar excretion. Although the slope of the upward alveolar plateau (phase III) in the capnogram waveforms of non-intubated patients is known to help monitor the therapeutic response to acute bronchospasm, little is known about the significance of its slope among intubated patients. Therefore, we quantified the phase III slope of an intubated patient with acute asthma to investigate whether capnogram waveforms could be useful for identifying the response to antibronchospasm treatment in real time.</p><p><strong>Case summary: </strong>The patient was a 53-year-old man who had a history of asthma. He presented to the emergency department with the primary complaint of respiratory distress. He was diagnosed with severe asthma attack and required invasive mechanical ventilation for 10 days, during which we quantified the phase III slope of the capnogram. The phase III slope decreased during treatment, with a significant reduction from the third to the fourth day; however, a significant decrease in end-tidal carbon dioxide (EtCO₂) was observed from the fifth to the sixth day. We found that the slope values decreased earlier than EtCO₂ reduction, although the absolute EtCO₂ values eventually decreased in response to antibronchospasm treatment.</p><p><strong>Conclusion: </strong>There were several reports that evaluated the phase III slope in non-intubated patients with asthma, but this is the first report measuring the phase III slope in an intubated patient over several days. Capnogram waveforms may serve as useful real-time indicators to monitor acute bronchospasm among mechanically ventilated patients.</p>","PeriodicalId":10759,"journal":{"name":"Critical Care Explorations","volume":"5 4","pages":"e0899"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/45/5d/cc9-5-e0899.PMC10115549.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9742151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Terlipressin in Patients With Hepatorenal Syndrome-Acute Kidney Injury Admitted to the ICU: A Substudy of the CONFIRM Trial.","authors":"Constantine J Karvellas, Ram Subramanian, Jody C Olson, Khurram Jamil","doi":"10.1097/CCE.0000000000000890","DOIUrl":"10.1097/CCE.0000000000000890","url":null,"abstract":"<p><p>This study assessed the potential advantages of treating hepatorenal syndrome-acute kidney injury (HRS-AKI) with terlipressin versus placebo in the ICU setting.</p><p><strong>Design: </strong>Patients were randomly assigned in a 2:1 ratio to receive terlipressin or placebo for up to 14 days.</p><p><strong>Setting: </strong>A retrospective analysis of data from the phase III CONFIRM study.</p><p><strong>Participants: </strong>Adult patients with HRS-AKI admitted to the ICU.</p><p><strong>Main outcomes and measures: </strong>In this substudy, we evaluated outcomes of the ICU stay and the need for organ support, including renal replacement therapy (RRT).</p><p><strong>Results: </strong>Among 300 patients with HRS-AKI from the CONFIRM study, 45 were treated in the ICU (terlipressin, 31/199 [16%]; placebo, 14/101 [14%]). On ICU admission, baseline demographics were similar across treatment arms, including severity of liver dysfunction. Among patients alive at the end of the ICU stay, those randomized to terlipressin had a significantly shorter median length of ICU stay than placebo (4 vs 11 d; <i>p</i> < 0.001). Terlipressin-treated patients had a significantly larger improvement in renal function from baseline versus placebo (-0.7 vs +0.2 mg/dL; <i>p</i> = 0.001), including when accounting for the interaction between treatment and day-of-patient-admission to the ICU (-0.7 vs +0.9 mg/dL; <i>p</i> < 0.001). Cumulative requirement for RRT through day 90 was improved in the terlipressin arm versus placebo (10/31 [32%] vs 8/14 [57%]; <i>p</i> = 0.12), although not significantly. Of 13 patients who received a liver transplant, five out of five (100%) in the placebo arm needed RRT through day 90 versus five out of eight (63%) in the terlipressin arm.</p><p><strong>Conclusions: </strong>In this subanalysis of CONFIRM, patients admitted to the ICU with HRS-AKI who received terlipressin were more likely to achieve renal function improvement, based on serum creatinine changes by the end of treatment, and had significantly shorter lengths of ICU stay than patients randomized to the placebo arm.</p>","PeriodicalId":10759,"journal":{"name":"Critical Care Explorations","volume":"5 4","pages":"e0890"},"PeriodicalIF":0.0,"publicationDate":"2023-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/90/72/cc9-5-e0890.PMC10060094.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9610547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sustained Perturbation of Metabolism and Metabolic Subphenotypes Are Associated With Mortality and Protein Markers of the Host Response.","authors":"Theodore S Jennaro, Michael A Puskarich, Charles R Evans, Alla Karnovsky, Thomas L Flott, Laura A McLellan, Alan E Jones, Kathleen A Stringer","doi":"10.1097/CCE.0000000000000881","DOIUrl":"10.1097/CCE.0000000000000881","url":null,"abstract":"<p><p>Perturbed host metabolism is increasingly recognized as a pillar of sepsis pathogenesis, yet the dynamic alterations in metabolism and its relationship to other components of the host response remain incompletely understood. We sought to identify the early host-metabolic response in patients with septic shock and to explore biophysiological phenotyping and differences in clinical outcomes among metabolic subgroups.</p><p><strong>Design: </strong>We measured serum metabolites and proteins reflective of the host-immune and endothelial response in patients with septic shock.</p><p><strong>Setting: </strong>We considered patients from the placebo arm of a completed phase II, randomized controlled trial conducted at 16 U.S. medical centers. Serum was collected at baseline (within 24 hr of the identification of septic shock), 24-hour, and 48-hour postenrollment. Linear mixed models were built to assess the early trajectory of protein analytes and metabolites stratified by 28-day mortality status. Unsupervised clustering of baseline metabolomics data was conducted to identify subgroups of patients.</p><p><strong>Patients: </strong>Patients with vasopressor-dependent septic shock and moderate organ dysfunction that were enrolled in the placebo arm of a clinical trial.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Fifty-one metabolites and 10 protein analytes were measured longitudinally in 72 patients with septic shock. In the 30 patients (41.7%) who died prior to 28 days, systemic concentrations of acylcarnitines and interleukin (IL)-8 were elevated at baseline and persisted at T24 and T48 throughout early resuscitation. Concentrations of pyruvate, IL-6, tumor necrosis factor-α, and angiopoietin-2 decreased at a slower rate in patients who died. Two groups emerged from clustering of baseline metabolites. Group 1 was characterized by higher levels of acylcarnitines, greater organ dysfunction at baseline and postresuscitation (<i>p</i> < 0.05), and greater mortality over 1 year (<i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>Among patients with septic shock, nonsurvivors exhibited a more profound and persistent dysregulation in protein analytes attributable to neutrophil activation and disruption of mitochondrial-related metabolism than survivors.</p>","PeriodicalId":10759,"journal":{"name":"Critical Care Explorations","volume":"5 4","pages":"e0881"},"PeriodicalIF":0.0,"publicationDate":"2023-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9c/66/cc9-5-e0881.PMC10047616.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9449687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Exploration of Critical Care Professionals' Strategies to Enhance Daily Implementation of the Assess, Prevent, and Manage Pain; Both Spontaneous Awakening and Breathing Trials; Choice of Analgesia and Sedation; Delirium Assess, Prevent, and Manage; Early Mobility and Exercise; and Family Engagement and Empowerment: A Group Concept Mapping Study.","authors":"Lorraine C Mion, Alai Tan, Audrey Brockman, Judith A Tate, Eduard E Vasilevskis, Brenda T Pun, Scott R Rosas, Michele C Balas","doi":"10.1097/CCE.0000000000000872","DOIUrl":"10.1097/CCE.0000000000000872","url":null,"abstract":"<p><p>The goals of this exploratory study were to engage professionals from the Society for Critical Care Medicine ICU Liberation Collaborative ICUs to: 1) conceptualize strategies to enhance daily implementation of the Assess, prevent, and manage pain; Both spontaneous awakening and breathing trials; Choice of analgesia and sedation; Delirium assess, prevent, and manage; Early mobility and exercise; and Family engagement and empowerment (ABCDEF) bundle from different perspectives and 2) identify strategies to prioritize for implementation.</p><p><strong>Design: </strong>Mixed-methods group concept mapping over 8 months using an online method. Participants provided strategies in response to a prompt about what was needed for successful daily ABCDEF bundle implementation. Responses were summarized into a set of unique statements and then rated on a 5-point scale on degree of necessity (essential) and degree to which currently used.</p><p><strong>Setting: </strong>Sixty-eight academic, community, and federal ICUs.</p><p><strong>Participants: </strong>A total of 121 ICU professionals consisting of frontline and leadership professionals.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>A final set of 76 strategies (reduced from 188 responses) were suggested: education (16 strategies), collaboration (15 strategies), processes and protocols (13 strategies), feedback (10 strategies), sedation/pain practices (nine strategies), education (eight strategies), and family (five strategies). Nine strategies were rated as very essential but infrequently used: adequate staffing, adequate mobility equipment, attention to (patient's) sleep, open discussion and collaborative problem solving, nonsedation methods to address ventilator dyssynchrony, specific expectations for night and day shifts, education of whole team on interdependent nature of the bundle, and effective sleep protocol.</p><p><strong>Conclusions: </strong>In this concept mapping study, ICU professionals provided strategies that spanned a number of conceptual implementation clusters. Results can be used by ICU leaders for implementation planning to address context-specific interdisciplinary approaches to improve ABCDEF bundle implementation.</p>","PeriodicalId":10759,"journal":{"name":"Critical Care Explorations","volume":"5 3","pages":"e0872"},"PeriodicalIF":0.0,"publicationDate":"2023-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a6/7e/cc9-5-e0872.PMC9988323.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9876991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intensive Care and Organ Support Related Mortality in Patients With COVID-19: A Systematic Review and Meta-Analysis.","authors":"Abhimanyu Chandel, Sahar Leazer, Karl C Alcover, Josiah Farley, Joshua Berk, Christopher Jayne, Ryan Mcnutt, Meredith Olsen, Rhonda Allard, Jiahong Yang, Caitlyn Johnson, Ananya Tripathi, Maria Rechtin, Mathew Leon, Mathias Williams, Phorum Sheth, Kyle Messer, Kevin K Chung, Jacob Collen","doi":"10.1097/CCE.0000000000000876","DOIUrl":"10.1097/CCE.0000000000000876","url":null,"abstract":"<p><p>To perform a systematic review and meta-analysis to generate estimates of mortality in patients with COVID-19 that required hospitalization, ICU admission, and organ support.</p><p><strong>Data sources: </strong>A systematic search of PubMed, Embase, and the Cochrane databases was conducted up to December 31, 2021.</p><p><strong>Study selection: </strong>Previously peer-reviewed observational studies that reported ICU, mechanical ventilation (MV), renal replacement therapy (RRT) or extracorporeal membrane oxygenation (ECMO)-related mortality among greater than or equal to 100 individual patients.</p><p><strong>Data extraction: </strong>Random-effects meta-analysis was used to generate pooled estimates of case fatality rates (CFRs) for in-hospital, ICU, MV, RRT, and ECMO-related mortality. ICU-related mortality was additionally analyzed by the study country of origin. Sensitivity analyses of CFR were assessed based on completeness of follow-up data, by year, and when only studies judged to be of high quality were included.</p><p><strong>Data synthesis: </strong>One hundred fifty-seven studies evaluating 948,309 patients were included. The CFR for in-hospital mortality, ICU mortality, MV, RRT, and ECMO were 25.9% (95% CI: 24.0-27.8%), 37.3% (95% CI: 34.6-40.1%), 51.6% (95% CI: 46.1-57.0%), 66.1% (95% CI: 59.7-72.2%), and 58.0% (95% CI: 46.9-68.9%), respectively. MV (52.7%, 95% CI: 47.5-58.0% vs 31.3%, 95% CI: 16.1-48.9%; <i>p</i> = 0.023) and RRT-related mortality (66.7%, 95% CI: 60.1-73.0% vs 50.3%, 95% CI: 42.4-58.2%; <i>p</i> = 0.003) decreased from 2020 to 2021.</p><p><strong>Conclusions: </strong>We present updated estimates of CFR for patients hospitalized and requiring intensive care for the management of COVID-19. Although mortality remain high and varies considerably worldwide, we found the CFR in patients supported with MV significantly improved since 2020.</p>","PeriodicalId":10759,"journal":{"name":"Critical Care Explorations","volume":"5 3","pages":"e0876"},"PeriodicalIF":0.0,"publicationDate":"2023-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/45/97/cc9-5-e0876.PMC9988289.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9089968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperoxemia During Cardiac Surgery Is Associated With Postoperative Pulmonary Complications.","authors":"David J Douin, Jack Pattee, Benjamin Scott, Ana Fernandez-Bustamante, Meghan Prin, Tobias Eckle, Adit A Ginde, Nathan Clendenen","doi":"10.1097/CCE.0000000000000878","DOIUrl":"10.1097/CCE.0000000000000878","url":null,"abstract":"<p><p>The use of hyperoxemia during cardiac surgery remains controversial. We hypothesized that intraoperative hyperoxemia during cardiac surgery is associated with an increased risk of postoperative pulmonary complications.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>We analyzed intraoperative data from five hospitals within the Multicenter Perioperative Outcomes Group between January 1, 2014, and December 31, 2019. We assessed intraoperative oxygenation of adult patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Hyperoxemia pre and post CPB was quantified as the area under the curve (AUC) of Fio₂ above 0.21 in minutes when the corresponding peripheral oxygen saturation was greater than 92% measured by pulse oximetry. We quantified hyperoxemia during CPB as the AUC of Pao₂ greater than 200 mm Hg measured by arterial blood gas. We analyzed the association of hyperoxemia during all phases of cardiac surgery with the frequency of postoperative pulmonary complications within 30 days, including acute respiratory insufficiency or failure, acute respiratory distress syndrome, need for reintubation, and pneumonia.</p><p><strong>Patients: </strong>Twenty-one thousand six hundred thirty-two cardiac surgical patients.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>During 21,632 distinct cardiac surgery cases, 96.4% of patients spent at least 1 minute in hyperoxemia (99.1% pre-CPB, 98.5% intra-CPB, and 96.4% post-CPB). Increasing exposure to hyperoxemia was associated with an increased risk of postoperative pulmonary complications throughout three distinct surgical periods. During CPB, increasing exposure to hyperoxemia was associated with an increased odds of developing postoperative pulmonary complications (<i>p</i> < 0.001) in a linear manner. Hyperoxemia before CPB (<i>p</i> < 0.001) and after CPB (<i>p</i> = 0.02) were associated with increased odds of developing postoperative pulmonary complications in a U-shaped relationship.</p><p><strong>Conclusions: </strong>Hyperoxemia occurs almost universally during cardiac surgery. Exposure to hyperoxemia assessed continuously as an AUC during the intraoperative period, but particularly during CPB, was associated with an increased incidence of postoperative pulmonary complications.</p>","PeriodicalId":10759,"journal":{"name":"Critical Care Explorations","volume":"5 3","pages":"e0878"},"PeriodicalIF":0.0,"publicationDate":"2023-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/77/91/cc9-5-e0878.PMC9984162.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9748380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}