Intensive Care Medicine最新文献

{"title":"Accuracy of continuous glucose monitoring systems in intensive care unit patients: a scoping review","authors":"Christian G. Nielsen, Milda Grigonyte-Daraskeviciene, Mikkel T. Olsen, Morten H. Møller, Kirsten Nørgaard, Anders Perner, Johan Mårtensson, Ulrik Pedersen-Bjergaard, Peter L. Kristensen, Morten H. Bestle","doi":"10.1007/s00134-024-07663-6","DOIUrl":"https://doi.org/10.1007/s00134-024-07663-6","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Glycemic control poses a challenge in intensive care unit (ICU) patients and dysglycemia is associated with poor outcomes. Continuous glucose monitoring (CGM) has been successfully implemented in the type 1 diabetes out-patient setting and renewed interest has been directed into the transition of CGM into the ICU. This scoping review aimed to provide an overview of CGM accuracy in ICU patients to inform future research and CGM implementation.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We systematically searched PubMed and EMBASE between 5th of December 2023 and 21st of May 2024 and reported findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline for scoping reviews (PRISMA-ScR). We assessed studies reporting the accuracy of CGM in the ICU and report study characteristics and accuracy outcomes.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>We identified 2133 studies, of which 96 were included. Most studies were observational (91.7%), conducted in adult patients (74%), in mixed ICUs (47.9%), from 2014 and onward, and assessed subcutaneous CGM systems (80%) using arterial blood samples as reference test (40.6%). Half of the studies (56.3%) mention the use of a prespecified reference test protocol. The mean absolute relative difference (MARD) ranged from 6.6 to 30.5% for all subcutaneous CGM studies. For newer factory calibrated CGM, MARD ranged from 9.7 to 20.6%. MARD for intravenous CGM was 5–14.2% and 6.4–13% for intraarterial CGM.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>In this scoping review of CGM accuracy in the ICU, we found great diversity in accuracy reporting. Accuracy varied depending on CGM and comparator, and may be better for intravascular CGM and potentially lower during hypoglycemia.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"31 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142440842","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}

{"title":"Prolonged versus shorter awake prone positioning in COVID-19: clinical outcomes and future implications","authors":"Ling Liu, Qin Sun, Yi Yang, Haibo Qiu, Arthur Slutsky","doi":"10.1007/s00134-024-07675-2","DOIUrl":"https://doi.org/10.1007/s00134-024-07675-2","url":null,"abstract":"No Abstract","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"57 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142440818","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}

{"title":"Fluid balance neutralization secured by hemodynamic monitoring versus protocolized standard of care in patients with acute circulatory failure requiring continuous renal replacement therapy: results of the GO NEUTRAL randomized controlled trial","authors":"Laurent Bitker, Claire Dupuis, Pierre Pradat, Guillaume Deniel, Kada Klouche, Mehdi Mezidi, Louis Chauvelot, Hodane Yonis, Loredana Baboi, Julien Illinger, Bertrand Souweine, Jean-Christophe Richard","doi":"10.1007/s00134-024-07676-1","DOIUrl":"https://doi.org/10.1007/s00134-024-07676-1","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Net ultrafiltration (UF_NET) during continuous renal replacement therapy (CRRT) can control fluid balance (FB), but is usually 0 ml·h⁻¹ in patients with vasopressors due to the risk of hemodynamic instability associated with CRRT (HIRRT). We evaluated a UF_NET strategy adjusted by functional hemodynamics to control the FB of patients with vasopressors, compared to the standard of care.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>In this randomized, controlled, open-label, parallel-group, multicenter, proof-of-concept trial, adults receiving vasopressors, CRRT since ≤ 24 h and cardiac output monitoring were randomized (ratio 1:1) to receive during 72 h a UF_NET ≥ 100 ml·h⁻¹, adjusted using a functional hemodynamic protocol (intervention), or a UF_NET ≤ 25 ml·h⁻¹ (control). The primary outcome was the cumulative FB at 72 h and was analyzed in patients alive at 72 h and in whom monitoring and CRRT were continuously provided (modified intention-to-treat population [mITT]). Secondary outcomes were analyzed in the intention-to-treat (ITT) population.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Between June 2021 and April 2023, 55 patients (age 69 [interquartile range, IQR: 62; 74], 35% female, Sequential Organ Failure Assessment (SOFA) 13 [11; 15]) were randomized (25 interventions, 30 controls). In the mITT population, (21 interventions, 24 controls), the 72 h FB was −2650 [−4574; −309] ml in the intervention arm, and 1841 [821; 5327] ml in controls (difference: 4942 [95% confidence interval: 2736–6902] ml, <i>P</i> &lt; 0.01). Hemodynamics, oxygenation and the number of HIRRT at 72 h, and day-90 mortality did not statistically differ between arms.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>In patients with vasopressors, a UF_NET fluid removal strategy secured by a hemodynamic protocol allowed active fluid balance control, compared to the standard of care.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"32 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142440817","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}

{"title":"Family support and communication during ICU care: who else if not the intensive care team? Author's reply","authors":"Anne Renet, Frédéric Pochard, Elie Azoulay, Nancy Kentish-Barnes","doi":"10.1007/s00134-024-07673-4","DOIUrl":"https://doi.org/10.1007/s00134-024-07673-4","url":null,"abstract":"No Abstract","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"32 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142440450","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}

{"title":"Correction: Conservative or liberal oxygen targets in patients on venoarterial extracorporeal membrane oxygenation","authors":"Aidan Burrell, Michael J. Bailey, Rinaldo Bellomo, Hergen Buscher, Glenn Eastwood, Paul Forrest, John F. Fraser, Bentley Fulcher, David Gattas, Alisa M. Higgins, Carol L. Hodgson, Edward Litton, Emma-Leah Martin, Priya Nair, Sze J. Ng, Neil Orford, Kelly Ottosen, Eldho Paul, Vincent Pellegrino, Liadain Reid, Kiran Shekar, Richard J. Totaro, Tony Trapani, Andrew Udy, Marc Ziegenfuss, David Pilcher","doi":"10.1007/s00134-024-07677-0","DOIUrl":"https://doi.org/10.1007/s00134-024-07677-0","url":null,"abstract":"<b>Correction: Intensive Care Medicine (2024) 50:1470-1483 </b><b>https://doi.org/10.1007/s00134-024-07564-8</b>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"6 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142440454","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}

{"title":"Postoperative sleep-improving effects of low-dose clonidine: reflections from a randomized controlled trial","authors":"Shunshun Cao, Yangyang Hu","doi":"10.1007/s00134-024-07680-5","DOIUrl":"https://doi.org/10.1007/s00134-024-07680-5","url":null,"abstract":"<p>The recent study by Liu et al. published in Intensive Care Medicine aroused our great interest [1]. We greatly appreciate the authors’ focus on the quality of sleep in postoperative patients, which is critical to improving the quality of sleep in postoperative patients and facilitating the recovery of postoperative patients. This study has greatly improved our understanding of the effects of low-dose clonidine infusion on sleep in postoperative patients. However, we offer some suggestions for interpreting the results of this study.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"65 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142430535","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}

{"title":"Can conservative oxygen targets be achieved and provide benefits in venoarterial ECMO patients?","authors":"Jing Wang, Han Zhang, Tianlong Wang, Bingyang Ji","doi":"10.1007/s00134-024-07658-3","DOIUrl":"https://doi.org/10.1007/s00134-024-07658-3","url":null,"abstract":"No Abstract","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"192 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142397885","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}

{"title":"Preventing stress ulcer bleeding","authors":"Paul J. Young, Deborah J. Cook, Adam M. Deane","doi":"10.1007/s00134-024-07674-3","DOIUrl":"https://doi.org/10.1007/s00134-024-07674-3","url":null,"abstract":"<p>Gastric or duodenal mucosal erosions, or stress ulcers, are a known complication of critical illness [1]. General supportive care and treatment of the underlying cause of the critical illness are the cornerstones of intensive care medicine and may help minimize the risk of stress ulcer bleeding. Stress ulcer prophylaxis is often prescribed to prevent such ulcers and their consequences [2] which include patient and family concerns [3], tests (e.g., endoscopy), treatments (e.g., blood transfusions), and associated morbidity and mortality.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"56 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142385078","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}

{"title":"Distinct immune profiles and clinical outcomes in sepsis subphenotypes based on temperature trajectories","authors":"Sivasubramanium V. Bhavani, Alexandra Spicer, Pratik Sinha, Albahi Malik, Carlos Lopez-Espina, Lee Schmalz, Gregory L. Watson, Akhil Bhargava, Shah Khan, Dennys Urdiales, Lincoln Updike, Alon Dagan, Hugo Davila, Carmen Demarco, Neil Evans, Falgun Gosai, Karthik Iyer, Niko Kurtzman, Ashok V. Palagiri, Matthew Sims, Scott Smith, Anwaruddin Syed, Deesha Sarma, Bobby Reddy, Philip A. Verhoef, Matthew M. Churpek","doi":"10.1007/s00134-024-07669-0","DOIUrl":"https://doi.org/10.1007/s00134-024-07669-0","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Sepsis is a heterogeneous syndrome. Identification of sepsis subphenotypes with distinct immune profiles could lead to targeted therapies. This study investigates the immune profiles of patients with sepsis following distinct body temperature patterns (i.e., temperature trajectory subphenotypes).</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Hospitalized patients from four hospitals between 2018 and 2022 with suspicion of infection were included. A previously validated temperature trajectory algorithm was used to classify study patients into temperature trajectory subphenotypes. Microbiological profiles, clinical outcomes, and levels of 31 biomarkers were compared between these subphenotypes.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The 3576 study patients were classified into four temperature trajectory subphenotypes: hyperthermic slow resolvers (<i>N</i> = 563, 16%), hyperthermic fast resolvers (<i>N</i> = 805, 23%), normothermic (<i>N</i> = 1693, 47%), hypothermic (<i>N</i> = 515, 14%). The mortality rate was significantly different between subphenotypes, with the highest rate in hypothermics (14.2%), followed by hyperthermic slow resolvers 6%, normothermic 5.5%, and lowest in hyperthermic fast resolvers 3.6% (<i>p</i> &lt; 0.001). After multiple testing correction for the 31 biomarkers tested, 20 biomarkers remained significantly different between temperature trajectories: angiopoietin-1 (Ang-1), C-reactive protein (CRP), feline McDonough sarcoma-like tyrosine kinase 3 ligand (Flt-3l), granulocyte colony stimulating factor (G-CSF), granulocyte-macrophage colony stimulating factor (GM-CSF), interleukin (IL)-15, IL-1 receptor antagonist (RA), IL-2, IL-6, IL-7, interferon gamma-induced protein 10 (IP-10), monocyte chemoattractant protein-1 (MCP-1), human macrophage inflammatory protein 3 alpha (MIP-3a), neutrophil gelatinase-associated lipocalin (NGAL), pentraxin-3, thrombomodulin, tissue factor, soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), and vascular cellular adhesion molecule-1 (vCAM-1).The hyperthermic fast and slow resolvers had the highest levels of most pro- and anti-inflammatory cytokines. Hypothermics had suppressed levels of most cytokines but the highest levels of several coagulation markers (Ang-1, thrombomodulin, tissue factor).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Sepsis subphenotypes identified using the universally available measurement of body temperature had distinct immune profiles. Hypothermic patients, who had the highest mortality rate, also had the lowest levels of most pro- and anti-inflammatory cytokines.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"39 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142385080","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}

{"title":"Towards improved management of pulmonary herpes simplex virus and cytomegalovirus in COVID-19 ARDS: a future perspective. Author’s reply","authors":"Leonoor S. Boers, Frank van Someren Gréve, Jarne M. van Hattem, Janke Schinkel, Lieuwe D. J. Bos","doi":"10.1007/s00134-024-07671-6","DOIUrl":"https://doi.org/10.1007/s00134-024-07671-6","url":null,"abstract":"No Abstract","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"192 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142385089","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}