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Chlorhexidine-alcohol compared with povidone-iodine-alcohol skin antisepsis protocols in major cardiac surgery: a randomized clinical trial
IF 38.9 1区 医学
Intensive Care Medicine Pub Date : 2024-11-12 DOI: 10.1007/s00134-024-07693-0
Matthieu Boisson, Géraldine Allain, Jean-Christian Roussel, Nicolas d’Ostrevy, Silvia Burbassi, Pierre Demondion, Paul-Michel Mertes, François Labaste, Thomas Kerforne, Bertrand Rozec, Vedat Eljezi, Konstantinos Zannis, Pascal Leprince, Walid Oulehri, Vincent Minville, Sabrina Seguin, Ambre Loiodice, Stéphane Ruckly, Jean-Christophe Lucet, Jean-François Timsit, Olivier Mimoz
{"title":"Chlorhexidine-alcohol compared with povidone-iodine-alcohol skin antisepsis protocols in major cardiac surgery: a randomized clinical trial","authors":"Matthieu Boisson, Géraldine Allain, Jean-Christian Roussel, Nicolas d’Ostrevy, Silvia Burbassi, Pierre Demondion, Paul-Michel Mertes, François Labaste, Thomas Kerforne, Bertrand Rozec, Vedat Eljezi, Konstantinos Zannis, Pascal Leprince, Walid Oulehri, Vincent Minville, Sabrina Seguin, Ambre Loiodice, Stéphane Ruckly, Jean-Christophe Lucet, Jean-François Timsit, Olivier Mimoz","doi":"10.1007/s00134-024-07693-0","DOIUrl":"https://doi.org/10.1007/s00134-024-07693-0","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Whether skin disinfection of the surgical site using chlorhexidine-alcohol is superior to povidone-iodine-alcohol in reducing reoperation and surgical site infection rates after major cardiac surgery remains unclear.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>CLEAN 2 was a multicenter, open-label, randomized, two-arm, assessor-blind, superiority trial conducted in eight French hospitals. We randomly assigned adult patients undergoing major heart or aortic surgery via sternotomy, with or without saphenous vein or radial artery harvesting, to have all surgical sites disinfected with either 2% chlorhexidine-alcohol or 5% povidone-iodine-alcohol. The primary outcome was any resternotomy by day 90 or any reoperation at the peripheral surgical site by day 30.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Of 3242 patients (1621 in the chlorhexidine-alcohol group [median age, 69 years; 1276 (78.7%) men] and 1621 in the povidone-iodine-alcohol group [median age, 69 years; 1247 (76.9%) men], the percentage required reoperation within 90 days was similar (7.7% [125/1621] in the chlorhexidine-alcohol group vs 7.5% [121/1621] in the povidone-iodine-alcohol group; risk difference, 0.25 [95% confidence interval (CI), − 1.58–2.07], <i>P</i> = 0.79). The incidence of surgical site infections at the sternum or peripheral sites was similar (4% [65/1621] in the chlorhexidine-alcohol group vs 3.3% [53/1621] in the povidone-iodine-alcohol group; risk difference, 0.74 [95% CI − 0.55–2.03], <i>P</i> = 0.26). Length of hospital stay, intensive care unit or hospital readmission, mortality and surgical site adverse events were similar between the two groups.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Among patients requiring sternotomy for major heart or aortic surgery, skin disinfection at the surgical site using chlorhexidine-alcohol was not superior to povidone-iodine-alcohol for reducing reoperation and surgical site infection rates.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":null,"pages":null},"PeriodicalIF":38.9,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142599745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Beta-blockers as antiarrhythmics in septic shock: a light at the end of the tunnel?
IF 38.9 1区 医学
Intensive Care Medicine Pub Date : 2024-11-12 DOI: 10.1007/s00134-024-07713-z
Martin Balik, G. Tavazzi, M. Slama
{"title":"Beta-blockers as antiarrhythmics in septic shock: a light at the end of the tunnel?","authors":"Martin Balik, G. Tavazzi, M. Slama","doi":"10.1007/s00134-024-07713-z","DOIUrl":"https://doi.org/10.1007/s00134-024-07713-z","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":null,"pages":null},"PeriodicalIF":38.9,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142599743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Sepsis: key insights, future directions, and immediate goals. A review and expert opinion
IF 38.9 1区 医学
Intensive Care Medicine Pub Date : 2024-11-12 DOI: 10.1007/s00134-024-07694-z
Ignacio Martin-Loeches, Mervyn Singer, Marc Leone
{"title":"Sepsis: key insights, future directions, and immediate goals. A review and expert opinion","authors":"Ignacio Martin-Loeches, Mervyn Singer, Marc Leone","doi":"10.1007/s00134-024-07694-z","DOIUrl":"https://doi.org/10.1007/s00134-024-07694-z","url":null,"abstract":"<p>This review explores the current landscape and evolving understanding of sepsis, highlighting both challenges and future directions. Sepsis remains a major global health burden, with diverse clinical presentations complicating timely diagnosis and management. Existing definitions, including the Sepsis-3 criteria, emphasize the importance of organ dysfunction, yet early sepsis detection remains limited by available tools. The Sequential Organ Failure Assessment (SOFA) score, though widely used, may not fully capture early stages of infection or account for complex presentations like noncatecholamine-resistant shock. Additionally, the review underscores the pressing need for standardized terminology across sepsis and shock characterization to ensure consistency in diagnosis and treatment strategies. Accessible, resource-adapted solutions are particularly crucial in low- and middle-income countries where sepsis-related mortality rates are higher due to limited resources. Future research should focus on developing and validating integrated, multi-parameter tools that combine clinical, biochemical, and microbiological data to improve sepsis outcomes globally. Advancing sepsis care will require both technological innovation and collaborative, globally consistent guidelines to bridge disparities in healthcare delivery.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":null,"pages":null},"PeriodicalIF":38.9,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142599807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Air pollutant exposure and mortality risk of critically ill patients
IF 38.9 1区 医学
Intensive Care Medicine Pub Date : 2024-11-12 DOI: 10.1007/s00134-024-07700-4
Chen Li, Huzhi Yao, Zhanpeng Wang, Zhicheng Fang, Peng Jia, Jingjun Lv
{"title":"Air pollutant exposure and mortality risk of critically ill patients","authors":"Chen Li, Huzhi Yao, Zhanpeng Wang, Zhicheng Fang, Peng Jia, Jingjun Lv","doi":"10.1007/s00134-024-07700-4","DOIUrl":"https://doi.org/10.1007/s00134-024-07700-4","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":null,"pages":null},"PeriodicalIF":38.9,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142599742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Personalized positive end-expiratory pressure in spontaneously breathing patients with acute respiratory distress syndrome by simultaneous electrical impedance tomography and transpulmonary pressure monitoring: a randomized crossover trial 通过同步电阻抗断层扫描和跨肺压力监测为急性呼吸窘迫综合征自主呼吸患者提供个性化呼气末正压:随机交叉试验
IF 38.9 1区 医学
Intensive Care Medicine Pub Date : 2024-11-11 DOI: 10.1007/s00134-024-07695-y
Tommaso Mauri, Domenico L. Grieco, Elena Spinelli, Marco Leali, Joaquin Perez, Valentina Chiavieri, Tommaso Rosà, Pierluigi Ferrara, Gaetano Scaramuzzo, Massimo Antonelli, Savino Spadaro, Giacomo Grasselli
{"title":"Personalized positive end-expiratory pressure in spontaneously breathing patients with acute respiratory distress syndrome by simultaneous electrical impedance tomography and transpulmonary pressure monitoring: a randomized crossover trial","authors":"Tommaso Mauri, Domenico L. Grieco, Elena Spinelli, Marco Leali, Joaquin Perez, Valentina Chiavieri, Tommaso Rosà, Pierluigi Ferrara, Gaetano Scaramuzzo, Massimo Antonelli, Savino Spadaro, Giacomo Grasselli","doi":"10.1007/s00134-024-07695-y","DOIUrl":"https://doi.org/10.1007/s00134-024-07695-y","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Personalized positive end-expiratory pressure (PEEP) might foster lung and diaphragm protection in patients with acute respiratory distress syndrome (ARDS) who are undergoing pressure support ventilation (PSV). We aimed to compare the physiologic effects of personalized PEEP set according to synchronized electrical impedance tomography (EIT) and driving transpulmonary pressure (∆PL) monitoring against a classical lower PEEP/FiO<sub>2</sub> table in intubated ARDS patients undergoing PSV.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>A cross-over randomized multicenter study was conducted in 30 ARDS patients with simultaneous recording of the airway, esophageal and transpulmonary pressure, together with EIT during PSV. Following a decremental PEEP trial (18 cmH<sub>2</sub>O to 4 cmH<sub>2</sub>O), PEEP<sub>EIT-∆PL</sub> was identified as the level with the smallest difference between lung overdistension and collapse. A low PEEP/FiO<sub>2</sub> table was used to select PEEP<sub>TABLE</sub>. Each PEEP strategy was applied for 20 min, and physiologic data were collected at the end of each step.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The PEEP trial was well tolerated. Median PEEP<sub>EIT-∆PL</sub> was higher than PEEP<sub>TABLE</sub> (10 [8–12] vs. 8 [5–10] cmH<sub>2</sub>O; <i>P</i> = 0.021) and, at the individual patient level, PEEP<sub>EIT-∆PL</sub> level differed from PEEP<sub>TABLE</sub> in all patients. Overall, PEEP<sub>EIT-∆PL</sub> was associated with lower dynamic ∆PL (<i>P</i> &lt; 0.001) and pressure–time product (<i>P</i> &lt; 0.001), but there was variability among patients. PEEP<sub>EIT-∆PL</sub> also decreased respiratory drive and effort (<i>P</i> &lt; 0.001), improved regional lung mechanics (<i>P</i> &lt; 0.05) and reversed lung collapse (<i>P</i> = 0.007) without increasing overdistension (<i>P</i> = 0.695).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Personalized PEEP selected using synchronized EIT and transpulmonary pressure monitoring could be associated with reduced dynamic lung stress and metabolic work of breathing in ARDS patients undergoing PSV.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":null,"pages":null},"PeriodicalIF":38.9,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142598507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comment on: European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unit. 评论:欧洲重症医学会重症监护病房生命终结与姑息治疗指南。
IF 27.1 1区 医学
Intensive Care Medicine Pub Date : 2024-11-06 DOI: 10.1007/s00134-024-07702-2
Michael J O'Leary
{"title":"Comment on: European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unit.","authors":"Michael J O'Leary","doi":"10.1007/s00134-024-07702-2","DOIUrl":"https://doi.org/10.1007/s00134-024-07702-2","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":null,"pages":null},"PeriodicalIF":27.1,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Identifying and treating hypoactive delirium: back to square one? 识别和治疗低能谵妄:回到原点?
IF 27.1 1区 医学
Intensive Care Medicine Pub Date : 2024-11-06 DOI: 10.1007/s00134-024-07703-1
Julia Tavares-Pereira, Luísa Pereira Novaes, Mariana Luz, Bruna Brandao Barreto, Dimitri Gusmao-Flores
{"title":"Identifying and treating hypoactive delirium: back to square one?","authors":"Julia Tavares-Pereira, Luísa Pereira Novaes, Mariana Luz, Bruna Brandao Barreto, Dimitri Gusmao-Flores","doi":"10.1007/s00134-024-07703-1","DOIUrl":"https://doi.org/10.1007/s00134-024-07703-1","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":null,"pages":null},"PeriodicalIF":27.1,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Reflections on awake prone positioning in COVID-19: considerations on body inclination, respiratory support, and patient variability. 对 COVID-19 中清醒俯卧位的思考:对身体倾斜、呼吸支持和患者变异性的考虑。
IF 27.1 1区 医学
Intensive Care Medicine Pub Date : 2024-11-04 DOI: 10.1007/s00134-024-07710-2
Yuxian Wang, Shengyu Hao, Jieqiong Song, Ming Zhong
{"title":"Reflections on awake prone positioning in COVID-19: considerations on body inclination, respiratory support, and patient variability.","authors":"Yuxian Wang, Shengyu Hao, Jieqiong Song, Ming Zhong","doi":"10.1007/s00134-024-07710-2","DOIUrl":"https://doi.org/10.1007/s00134-024-07710-2","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":null,"pages":null},"PeriodicalIF":27.1,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Non-synchronized unassisted spontaneous ventilation may minimize the risk of high global tidal volume and transpulmonary pressure, but it is not free from pendelluft. 非同步无辅助自主通气可最大限度地降低高潮气量和跨肺压的风险,但并不能避免垂体通气。
IF 27.1 1区 医学
Intensive Care Medicine Pub Date : 2024-11-04 DOI: 10.1007/s00134-024-07707-x
Rodrigo A Cornejo, Roberto Brito, Daniel H Arellano, Caio C A Morais
{"title":"Non-synchronized unassisted spontaneous ventilation may minimize the risk of high global tidal volume and transpulmonary pressure, but it is not free from pendelluft.","authors":"Rodrigo A Cornejo, Roberto Brito, Daniel H Arellano, Caio C A Morais","doi":"10.1007/s00134-024-07707-x","DOIUrl":"https://doi.org/10.1007/s00134-024-07707-x","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":null,"pages":null},"PeriodicalIF":27.1,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Central venous catheter insertion site and infection prevention in 2024. Author's reply. 2024 年中心静脉导管插入部位和感染预防。作者回复。
IF 27.1 1区 医学
Intensive Care Medicine Pub Date : 2024-11-04 DOI: 10.1007/s00134-024-07705-z
Nicolas Massart, Vincent Cosme, Florian Reizine, Arnaud Friggeri, Alain Lepape
{"title":"Central venous catheter insertion site and infection prevention in 2024. Author's reply.","authors":"Nicolas Massart, Vincent Cosme, Florian Reizine, Arnaud Friggeri, Alain Lepape","doi":"10.1007/s00134-024-07705-z","DOIUrl":"https://doi.org/10.1007/s00134-024-07705-z","url":null,"abstract":"","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":null,"pages":null},"PeriodicalIF":27.1,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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