Journal of critical care最新文献_第10页

The impact of frailty on survival times up to one year among patients admitted to ICU with in-hospital cardiac arrest 院内心脏骤停患者入住重症监护室后虚弱程度对其一年内存活时间的影响

IF 3.7 3区医学

Journal of critical care Pub Date : 2024-06-11 DOI: 10.1016/j.jcrc.2024.154842

Ryo Ueno MD , Mallikarjuna Ponnapa Reddy MBBS , Daryl Jones PhD , David Pilcher MBBS , Ashwin Subramaniam MMed

{"title":"The impact of frailty on survival times up to one year among patients admitted to ICU with in-hospital cardiac arrest","authors":"Ryo Ueno MD , Mallikarjuna Ponnapa Reddy MBBS , Daryl Jones PhD , David Pilcher MBBS , Ashwin Subramaniam MMed","doi":"10.1016/j.jcrc.2024.154842","DOIUrl":"https://doi.org/10.1016/j.jcrc.2024.154842","url":null,"abstract":"<div><h3>Background</h3><p>In-hospital cardiac arrest (IHCA) is a serious medical emergency. When IHCA occurs in patients with frailty, short-term survival is poor. However, the impact of frailty on long-term survival is unknown.</p></div><div><h3>Methods</h3><p>We performed a retrospective multicentre study of all critically ill adult (age ≥ 16 years) patients admitted to Australian intensive care units (ICU) between 1st January 2018 to 31st March 2022. We included all patients who had an IHCA within the 24 h before ICU admission with a documented Clinical Frail Scale (CFS). The primary outcome was median survival up to one year following ICU admission. The effect of frailty on one-year survival was assessed using a Cox proportional hazards model, adjusting for age, sex, comorbidities, sequential organ failure assessment (SOFA) score, and hospital type.</p></div><div><h3>Results</h3><p>We examined 3769 patients, of whom 30.8% (<em>n</em> = 1160) were frail (CFS ≥ 5). The median survival was significantly shorter for patients with frailty (median [IQR] days 19 [1–365] vs 302 [9–365]; <em>p</em> < 0.001). The overall one-year mortality was worse for the patients with frailty when compared to the non-frail group (64.8% [95%CI 61.9–67.5] vs 36.4% [95%CI 34.5–38.3], p < 0.001). Each unit increment in the CFS was associated with 22% worse survival outcome (adjusted Hazard ratio = 1.22, 95%-CI 1.19–1.26), after adjustment for confounders. The survival trend was similar among patients who survived the hospitalization.</p></div><div><h3>Conclusion</h3><p>In this retrospective multicentre study, frailty was associated with poorer one-year survival in patients admitted to Australian ICUs following an IHCA.</p></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"83 ","pages":"Article 154842"},"PeriodicalIF":3.7,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141303467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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

Letter to the Editor: “Efficacy and safety of corticosteroids for the treatment of community-acquired pneumonia: A systematic review and meta-analysis of randomized controlled trials” 致编辑的信："皮质类固醇治疗社区获得性肺炎的有效性和安全性：随机对照试验的系统回顾和荟萃分析"。

IF 3.2 3区医学

Journal of critical care Pub Date : 2024-06-01 DOI: 10.1016/j.jcrc.2024.154838

引用次数: 0

Authors response: "Efficacy and safety of corticosteroids for the treatment of community-acquired pneumonia: A systematic review and meta-analysis of randomized controlled trials." 作者回复："皮质类固醇治疗社区获得性肺炎的有效性和安全性：随机对照试验的系统回顾和荟萃分析"。

IF 3.2 3区医学

Journal of critical care Pub Date : 2024-05-31 DOI: 10.1016/j.jcrc.2024.154839

引用次数: 0

Letter to the editor: “Efficacy and safety of corticosteroids for the treatment of community-acquired pneumonia: A systematic review and meta-analysis of randomized controlled trials” 致编辑的信：皮质类固醇治疗社区获得性肺炎的有效性和安全性：随机对照试验的系统回顾和荟萃分析。

IF 3.2 3区医学

Journal of critical care Pub Date : 2024-05-29 DOI: 10.1016/j.jcrc.2024.154837

引用次数: 0

Effectiveness of early high-flow nasal oxygen therapy after extubation of patients in the intensive care unit 重症监护室患者拔管后早期高流量鼻氧疗法的效果。

IF 3.7 3区医学

Journal of critical care Pub Date : 2024-05-28 DOI: 10.1016/j.jcrc.2024.154840

Atsushi Ishihara , Hideshi Okada , Teruki Mori , Takashi Yoshizane , Kentaro Morishita , Takuji Yamamoto , Izumi Toyoda , Toshiyuki Noda

{"title":"Effectiveness of early high-flow nasal oxygen therapy after extubation of patients in the intensive care unit","authors":"Atsushi Ishihara , Hideshi Okada , Teruki Mori , Takashi Yoshizane , Kentaro Morishita , Takuji Yamamoto , Izumi Toyoda , Toshiyuki Noda","doi":"10.1016/j.jcrc.2024.154840","DOIUrl":"10.1016/j.jcrc.2024.154840","url":null,"abstract":"<div><h3>Purpose</h3><p>This study aimed to evaluate the impact of early high-flow nasal oxygen (HFNO) therapy initiation using a pre-determined respiratory rate‑oxygenation (ROX) index on reducing reintubation rates and duration of intensive care unit (ICU) stay in post-extubated patients.</p></div><div><h3>Materials and methods</h3><p>We enrolled a total of 145 extubated patients (mean age: 67.1 ± 12.9 years; sex: 96 male and 49 female; acute physiology and chronic health evaluation II score: 18.4 ± 6.8 points) classified into two groups: 71 patients admitted to the ICU before establishing extubation criteria and 74 patients after criteria implementation, over a 6-month period. We compared the HFNO reintubation rates and ROX index at 2 h post-extubation before and after implementing early HFNO criteria.</p></div><div><h3>Results</h3><p>The utilization rate of HFNO pre- and post-establishment of early HFNO criteria did not differ significantly (19.7% vs. 17.6%). However, the reintubation rate significantly decreased (11.3% vs. 4.1%, <em>P</em> < 0.05) with early HFNO use. Additionally, significant differences were observed in the total intubation period (5.2 ± 7.0 vs. 2.5 ± 2.7 days, <em>P</em> < 0.05) and ICU duration (8.6 ± 9.7 vs. 5.8 ± 5.6 days, P < 0.05).</p></div><div><h3>Conclusions</h3><p>Early initiation of HFNO guided by the ROX index threshold post-extubation in patients admitted to ICU is associated with reduced reintubation rates and shorter ICU stays.</p></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"83 ","pages":"Article 154840"},"PeriodicalIF":3.7,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0883944124003277/pdfft?md5=4f0a13dc7ce59edf7fa48475307dfc16&pid=1-s2.0-S0883944124003277-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141173948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

What every intensivist should know about…Systolic arterial pressure targets in shock 每位重症监护医师都应了解......休克时的收缩压目标。

IF 3.7 3区医学

Journal of critical care Pub Date : 2024-05-28 DOI: 10.1016/j.jcrc.2024.154790

Eugene Yuriditsky MD , Jan Bakker MD, PhD

引用次数: 0

Prophylactic versus restrictive platelet transfusion strategy in patients with haematological malignancies in the ICU setting, a propensity-score analysis 重症监护病房血液恶性肿瘤患者预防性与限制性血小板输注策略的倾向得分分析。

IF 3.7 3区医学

Journal of critical care Pub Date : 2024-05-27 DOI: 10.1016/j.jcrc.2024.154817

Jean-Baptiste Berenger , Colombe Saillard , Antoine Sannini , Luca Servan , Frederic Gonzalez , Marion Faucher , Jean-Manuel de Guibert , Marie-Anne Hospital , Magali Bisbal , Laurent Chow-Chine , Djamel Mokart

{"title":"Prophylactic versus restrictive platelet transfusion strategy in patients with haematological malignancies in the ICU setting, a propensity-score analysis","authors":"Jean-Baptiste Berenger , Colombe Saillard , Antoine Sannini , Luca Servan , Frederic Gonzalez , Marion Faucher , Jean-Manuel de Guibert , Marie-Anne Hospital , Magali Bisbal , Laurent Chow-Chine , Djamel Mokart","doi":"10.1016/j.jcrc.2024.154817","DOIUrl":"10.1016/j.jcrc.2024.154817","url":null,"abstract":"<div><h3>Purpose</h3><p>Prophylactic platelet transfusions (PT) aim to reduce bleeding. We assessed whether restrictive PT compared to prophylactic strategy could apply in ICU.</p></div><div><h3>Material and methods</h3><p>We conducted a retrospective monocentric study including patients >18 yo with haematological malignancy admitted to the ICU with thrombocytopenia <20 G/L between 2018 and 2021. Patients were classified in 2 groups according transfusion strategy applied during the first 3 days: prophylactic or restrictive transfusion.</p></div><div><h3>Results</h3><p>180 patients were included, 87 and 93 in the restrictive and prophylactic groups respectively. After propensity-score analysis, 2 groups of 54 matched patients were analyzed. Restrictive strategy led to a significant reduction in PT with incidence rate for 100-ICU-patients-days of 34.9 and 49.9, incidence rate ratio = 0.699 [0.5–0.9], <em>p</em> = 0.006, representing a 31% decrease. Decreased PT persisted until day 28 with platelet concentrates transfusions-free days at day 28 of 21 [13–25] and 16.5 [10.2–21] in the 2 groups (<em>p</em> = 0.04). Restrictive strategy did not result in higher grade ≥ 2 bleeding. Transfusion efficiency was low with similar number of days with platelet <10 or < 20 G/L regardless of strategy. Platelet transfusion strategy was not associated with 28-day mortality. Platelet nadir <5G/L was associated with day-28 mortality with HR = 1.882 [1.011–3.055], <em>p</em> = 0.046.</p></div><div><h3>Conclusion</h3><p>A restrictive PT strategy appears feasible in the ICU.</p></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"83 ","pages":"Article 154817"},"PeriodicalIF":3.7,"publicationDate":"2024-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141161021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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

Prevalence and prognostic relevance of invasive fungal disease during veno-arterial ECMO: A retrospective single-center study 静脉-动脉 ECMO 期间侵袭性真菌病的患病率和预后相关性：单中心回顾性研究

IF 3.7 3区医学

Journal of critical care Pub Date : 2024-05-25 DOI: 10.1016/j.jcrc.2024.154831

Jens M. Poth , Mathias Schmandt , Jens-Christian Schewe , Felix Lehmann , Stefan Kreyer , Zaki Kohistani , Farhad Bakhtiary , Gunnar Hischebeth , Christian Putensen , Johannes Weller , Stefan F. Ehrentraut

{"title":"Prevalence and prognostic relevance of invasive fungal disease during veno-arterial ECMO: A retrospective single-center study","authors":"Jens M. Poth , Mathias Schmandt , Jens-Christian Schewe , Felix Lehmann , Stefan Kreyer , Zaki Kohistani , Farhad Bakhtiary , Gunnar Hischebeth , Christian Putensen , Johannes Weller , Stefan F. Ehrentraut","doi":"10.1016/j.jcrc.2024.154831","DOIUrl":"https://doi.org/10.1016/j.jcrc.2024.154831","url":null,"abstract":"<div><h3>Purpose</h3><p>To assess the prevalence and relevance of invasive fungal disease (IFD) during veno-arterial (V-A) extracorporeal membrane oxygenation (ECMO).</p></div><div><h3>Methods</h3><p>Retrospective analysis from January 2013 to November 2023 of adult V-A ECMO cases at a German University Hospital. Parameters relating to IFD, demographics, length of stay (LoS), days on ECMO and mechanical ventilation, prognostic scores and survival were assessed. Multivariable logistic regression analyses with IFD and death as dependent variables were performed. Outcome was assessed after propensity score matching IFD-patients to non-IFD-controls.</p></div><div><h3>Results</h3><p>421 patients received V-A ECMO. 392 patients with full electronic datasets were included. The prevalence of IFD, invasive candidiasis and probable invasive pulmonary aspergillosis was 4.6%, 3.8% and 1.0%. Severity of acute disease, pre-existing moderate-to-severe renal disease and continuous kidney replacement therapy were predictive of IFD. In-hospital mortality (94% (17/18) compared to 67% (252/374) in non-IFD patients (<em>p</em> = 0.0156)) was predicted by female sex, SOFA score at admission, SAVE score and IFD (for IFD: OR: 8.31; CI: 1.60–153.18; <em>p</em>: 0.044). There was no difference in outcome after matching IFD-cases to non-IFD-controls.</p></div><div><h3>Conclusions</h3><p>IFD are detected in about one in 20 patients on V-A ECMO, indicating mortality >90%. However, IFD do not contribute to prognosis in this population.</p></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"83 ","pages":"Article 154831"},"PeriodicalIF":3.7,"publicationDate":"2024-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0883944124003186/pdfft?md5=01aa5821897019080734e243540aa3c9&pid=1-s2.0-S0883944124003186-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141095994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Corrigendum to “An update on ICU outcomes in patients after CAR-T therapy: A four-year tertiary UK centre experience” [J Crit Care. 2024 Apr:80:154511]. CAR-T疗法患者重症监护室治疗结果的更新：J Crit Care. 2024 Apr:80:154511]的更正。

IF 3.7 3区医学

Journal of critical care Pub Date : 2024-05-25 DOI: 10.1016/j.jcrc.2024.154836

Lily Scourfield , Tasneem Pirani , Neeraj Singh , Rohit Saha , Andrea Kuhnl , Robin Sanderson , Victoria Metaxa

引用次数: 0

Urea to creatinine ratio as a predictor of persistent critical illness 尿素与肌酐比值作为持续危重症的预测指标

IF 3.7 3区医学

Journal of critical care Pub Date : 2024-05-22 DOI: 10.1016/j.jcrc.2024.154834

Liran Statlender , Tzippy Shochat , Eyal Robinson , Guy Fishman , Moran Hellerman-Itzhaki , Itai Bendavid , Pierre Singer , Ilya Kagan

{"title":"Urea to creatinine ratio as a predictor of persistent critical illness","authors":"Liran Statlender , Tzippy Shochat , Eyal Robinson , Guy Fishman , Moran Hellerman-Itzhaki , Itai Bendavid , Pierre Singer , Ilya Kagan","doi":"10.1016/j.jcrc.2024.154834","DOIUrl":"https://doi.org/10.1016/j.jcrc.2024.154834","url":null,"abstract":"<div><h3>Introduction</h3><p>Persistent critical illness (PCI) is a syndrome in which the acute presenting problem has been stabilized, but the patient's clinical state does not allow ICU discharge. The burden associated with PCI is substantial. The most obvious marker of PCI is prolonged ICU length of stay (LOS), usually greater than 10 days. Urea to Creatinine ratio (UCr) has been suggested as an early marker of PCI development.</p></div><div><h3>Methods</h3><p>A single-center retrospective study. Data of patients admitted to a general mixed medical-surgical ICU during Jan 1st 2018 till Dec 31st 2022 was extracted, including demographic data, baseline characteristics, daily urea and creatinine results, renal replacement therapy (RRT) provided, and outcome measures – length of stay, and mortality (ICU, and 90 days). Patients were defined as PCI patients if their LOS was >10 days. We used Fisher exact test or Chi-square to compare PCI and non-PCI patients. The association between UCr with PCI development was assessed by repeated measures linear model. Multivariate Cox regression was used for 1 year mortality assessment.</p></div><div><h3>Results</h3><p>2098 patients were included in the analysis. Patients who suffered from PCI were older, with higher admission prognostic scores. Their 90-day mortality was significantly higher than non-PCI patients (34.58% vs 12.18%, <em>p</em> < 0.0001). A significant difference in UCr was found only on the first admission day among all patients. This was not found when examining separately surgical, trauma, or transplantation patients. We did not find a difference in UCr in different KDIGO (Kidney Disease Improving Global Outcomes) stages. Elevated UCr and PCI were found to be significantly associated with 1 year mortality.</p></div><div><h3>Conclusion</h3><p>In this single center retrospective cohort study, UCr was not found to be associated with PCI development.</p></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"83 ","pages":"Article 154834"},"PeriodicalIF":3.7,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141083408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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