Journal of critical care最新文献

{"title":"Letter to the editor: “What every intensivist should know about: Trust in the icu”","authors":"Hannah M. Vincent BSN, RN , Jan Bakker","doi":"10.1016/j.jcrc.2024.154949","DOIUrl":"10.1016/j.jcrc.2024.154949","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154949"},"PeriodicalIF":3.2,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621566","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}

{"title":"Decreased renal cortical perfusion post-EGDT is associated with MAKE-30 in sepsis","authors":"Qiqi Li ,&nbsp;Rong Li ,&nbsp;Can Wang ,&nbsp;Qian Zhang ,&nbsp;Qian Zhang ,&nbsp;Yan Huo ,&nbsp;Yangong Chao ,&nbsp;Xiaoting Wang ,&nbsp;Zhenjie Hu ,&nbsp;Lixia Liu ,&nbsp;for the Chinese Critical UltraSound Study Group(CCUSG)","doi":"10.1016/j.jcrc.2024.154943","DOIUrl":"10.1016/j.jcrc.2024.154943","url":null,"abstract":"<div><h3>Objective</h3><div>This study explores alterations in renal cortical perfusion post-Early Goal-Directed Therapy (EGDT) in sepsis patients, to investigate its association with major adverse kidney events within 30 days (MAKE-30) and identify hemodynamic factors associated with renal cortical perfusion.</div></div><div><h3>Methods</h3><div>Sepsis patients admitted to the ICU from Jan 2022 to Jul 2023 were prospectively enrolled. Contrast-enhanced ultrasound (CEUS) assessed renal cortical perfusion post-EGDT. Hemodynamic parameters and renal resistive index (RRI) were collected. Patients were categorized into MAKE-30 and non-MAKE-30 groups. The study examined the association between renal cortical perfusion and MAKE-30, explored the hemodynamic factors related to renal cortical perfusion.</div></div><div><h3>Results</h3><div>Of 94 sepsis patients, 46 (48.9 %) experienced MAKE-30. Distinctions in pulmonary (<em>P</em> = 0.012) and abdominal infection sites (<em>P</em> = 0.001) and significant SOFA (<em>P</em> &lt; 0.001) and APACHE II scores (<em>P</em> = 0.003) differences were observed. No significant differences in baseline characteristics, vasopressor, or diuretic doses were noted (<em>P</em> &gt; 0.05). Hemodynamic parameters in MAKE-30 and non-MAKE-30 patients showed no significant differences. RRI was higher in MAKE-30 patients (0.71 vs 0.66 <em>P</em> = 0.005). Renal microcirculation parameters, including AUC (<em>p</em> = 0.035), rBV (<em>p</em> = 0.021), and PI (<em>p</em> = 0.003), were lower in MAKE-30. Reduced cortical renal perfusion was associated with an increased risk of MAKE-30. Renal cortical perfusion RT was identified as an independent factor associated with this risk (HR 2.278, 95 % CI (1.152–4.507), <em>P</em> = 0.018). RRI correlated with renal cortical perfusion AUC (<em>r</em> = −0.220 p 0.033).</div></div><div><h3>Conclusion</h3><div>Despite normal systemic hemodynamics post-sepsis EGDT, MAKE-30 patients show reduced renal cortical perfusion. CEUS-derived RT is an independent factor associated with this change. RRI correlates with renal cortical perfusion.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154943"},"PeriodicalIF":3.2,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593767","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}

{"title":"Optimizing fosfomycin dosing regimens in critically ill patients with and without continuous renal replacement therapy","authors":"Taniya Charoensareerat ,&nbsp;Phongphak Bunrit ,&nbsp;Sasina Phanpoka ,&nbsp;Thananya Netthanomsak ,&nbsp;Dhakrit Rungkitwattanakul ,&nbsp;Sutthiporn Pattharachayakul ,&nbsp;Nattachai Srisawat ,&nbsp;Weerachai Chaijamorn","doi":"10.1016/j.jcrc.2024.154946","DOIUrl":"10.1016/j.jcrc.2024.154946","url":null,"abstract":"<div><h3>Purpose</h3><div>To define the optimal fosfomycin dosing regimens for drug-resistant gram-negative bacteria in critically ill patients and those receiving continuous renal replacement therapy (CRRT) via Monte Carlo simulations.</div></div><div><h3>Materials and methods</h3><div>A pharmacokinetic model for patients with and without CRRT was created to predict fosfomycin deposition in these patients. The pharmacodynamics (PD) targets were AUC/MIC ratio &gt; 21.5, 28.2, and 98.8 for drug-resistant <em>Klebsiella pneumoniae</em> (KP), <em>Pseudomonas aeruginosa</em> (PA) and <em>Escherichia coli</em> (EC) infections, respectively. The optimal regimen was defined when the probability of target attainment (PTA) was &gt;90 % of the virtual patients.</div></div><div><h3>Results</h3><div>The fosfomycin dosing regimens for KP infections with MIC 64 mg/L in critically ill patients and who received CRRT were 6 g every 8 h and 8 g every 12 h, respectively. For PA infections, the regimens of 6 g every 6 h and 7 g every 8 h achieved the target in critically ill patients and those undergoing CRRT. No regimen achieved the 90 % PTA against the EC infection with MIC &gt;32 mg/L.</div></div><div><h3>Conclusions</h3><div>Dosing regimens for bacteria with high MICs as 64 mg/L in these patients were 18–24 g/day. Dose adjustments were required in those undergoing CRRT. Clinical validation is strongly needed.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154946"},"PeriodicalIF":3.2,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593768","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}

{"title":"Long-term characteristics and outcomes of septic critically ill patients with and without COVID-19","authors":"Felix Niebhagen ,&nbsp;Lars Heubner ,&nbsp;Anna Kirsch ,&nbsp;Andreas Güldner ,&nbsp;Hanns-Christoph Held ,&nbsp;Ralph Schneider ,&nbsp;Ulf Bodechtel ,&nbsp;Jan Mehrholz ,&nbsp;Thea Koch ,&nbsp;Mario Menk ,&nbsp;Peter Spieth","doi":"10.1016/j.jcrc.2024.154942","DOIUrl":"10.1016/j.jcrc.2024.154942","url":null,"abstract":"<div><h3>Background</h3><div>In-hospital mortality of septic critically ill patients with COVID-19 is significantly higher than in those without COVID-19. The knowledge on long-term outcomes remains scarce. In this retrospective analysis, we compare clinical characteristics, long-term functional outcomes, and survival in septic critically ill patients with and without COVID-19.</div></div><div><h3>Methods</h3><div>Data of septic critically ill patients without COVID-19 were collected as part of the Comprehensive Sepsis Center Dresden-Kreischa registry from 2020 to 2023. The data of septic critically ill patients with COVID-19 were collected as part of the local ARDS/COVID-19 registry over the same period. Diagnosis of sepsis was based on the Sepsis-3 definition. Variables collected for analyses were obtained from electronic health records. Long-term follow-up was performed 6–12 months after sepsis diagnosis. Survival was depicted using Kaplan-Meier curves. Associations between long-term mortality and risk factors were modeled by Cox Regression.</div></div><div><h3>Results</h3><div>372 septic patients without COVID-19 and 301 with COVID-19 were enrolled. Septic patients with COVID-19 were significantly younger, had a significantly lower Charlson Comorbidity Index, and had a significantly higher SOFA score at ICU admission. Long-term follow-up showed a significantly higher mortality in septic patients with COVID-19 (73.4 % vs. 30.1 %; HR 3.4 (95 % CI 2.73–4.27; <em>p</em> &lt; 0.05)). COVID-19 infection was associated with significant increased mortality (adjusted HR 3.27; 95 % CI 2.48–4.33; <em>p</em> &lt; 0.05) and reduced health-related quality of life, measured by the EQ-5D-3 L Index, (0.56 (0.16–0.79) vs. 0.79 (0.69–0.99); p &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>In our cohort of septic critically ill patients, health-related quality of life and long-term survival were considerably reduced in patients with concomitant COVID-19. Furthermore, COVID-19 could be identified as an independent risk factor for higher long-term mortality in these patients.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154942"},"PeriodicalIF":3.2,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142561229","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}

{"title":"Letter to the editor: \"Effectiveness of early high-flow nasal oxygen therapy after extubation of patients in the intensive care unit\"","authors":"Rashid Nadeem ,&nbsp;Reham Helmy Amin Saad","doi":"10.1016/j.jcrc.2024.154940","DOIUrl":"10.1016/j.jcrc.2024.154940","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154940"},"PeriodicalIF":3.2,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142552400","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}

{"title":"Cumulative impact of hypotension during intermittent hemodialysis on kidney recovery in critically ill patients with AKI-D","authors":"Jae Ho Kim ,&nbsp;Joonhee Yoon ,&nbsp;Ji-Eun Kim ,&nbsp;Seongho Jo ,&nbsp;Yuri Lee ,&nbsp;Ji Won Kim ,&nbsp;Seun Deuk Hwang ,&nbsp;Seoung Woo Lee ,&nbsp;Joon Ho Song ,&nbsp;Kipyo Kim","doi":"10.1016/j.jcrc.2024.154944","DOIUrl":"10.1016/j.jcrc.2024.154944","url":null,"abstract":"<div><h3>Background</h3><div>Intermittent hemodialysis (IHD) is commonly implemented in patients with AKI-D, irrespective of the initial kidney replacement therapy (KRT) modality. However, concerns remain regarding the hemodynamic instability during IHD. This study aimed to assess the association between hypotensive episodes during IHD and kidney recovery in AKI-D patients.</div></div><div><h3>Methods</h3><div>We retrospectively enrolled AKI-D survivors who received IHD in the intensive care units of a tertiary care hospital in Korea from January 2018 to February 2024.</div></div><div><h3>Results</h3><div>A total of 1791 IHD sessions from 209 AKI-D survivors were analyzed. The patients underwent a median of 7 IHD sessions (interquartile range [IQR] 3–11), with an incidence of intradialytic hypotension (IDH) of 16.8 % per patient. Of these, 43.1 % were dialysis-dependent at hospital discharge. The number of IDH was a significant predictor of dialysis dependence (odds ratio [OR] 1.56; 95 % confidence interval [CI] 1.16–2.22). Patients experiencing ≥3 IDH episodes had a substantially higher risk of dialysis dependence compared to those without IDH (OR 9.41; 95 % CI 2.41–41.69). In per-session analysis, the target ultrafiltration rate was identified as an independent risk factor for IDH occurrence.</div></div><div><h3>Conclusions</h3><div>Our study revealed that IHD-related hypotension during hospitalization has a cumulative negative impact on kidney recovery in AKI-D survivors.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154944"},"PeriodicalIF":3.2,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545740","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}

{"title":"Is it a case of higher, the worse, or are beta-lactam antibiotics the innocent bystanders?","authors":"Aaron J. Heffernan ,&nbsp;Jason A. Roberts","doi":"10.1016/j.jcrc.2024.154934","DOIUrl":"10.1016/j.jcrc.2024.154934","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154934"},"PeriodicalIF":3.2,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535346","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}

{"title":"Effectiveness of early high-flow nasal oxygen therapy after extubation of patients in the intensive care unit","authors":"Dipasri Bhattacharya ,&nbsp;Antonio M. Esquinas ,&nbsp;Mohanchandra Mandal","doi":"10.1016/j.jcrc.2024.154939","DOIUrl":"10.1016/j.jcrc.2024.154939","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154939"},"PeriodicalIF":3.2,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535801","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}

{"title":"Letter to the Editor: “Portal hypertension-like pattern in coronavirus disease 2019 acute respiratory distress syndrome”","authors":"Kashish Zehra Manjee,&nbsp;Aniqa Dejwani,&nbsp;Umaima Arif,&nbsp;Neeraj Kumar","doi":"10.1016/j.jcrc.2024.154941","DOIUrl":"10.1016/j.jcrc.2024.154941","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154941"},"PeriodicalIF":3.2,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501228","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}

{"title":"Protective effect of intravenous amino acid on kidney function: A systematic review and meta-analysis of randomized controlled trials","authors":"Wei Jiang ,&nbsp;Keran Shi ,&nbsp;Jun Shao ,&nbsp;Lin Song ,&nbsp;Ying Shi ,&nbsp;Haoran Wang ,&nbsp;Lulun Zhou ,&nbsp;Luanluan Li ,&nbsp;Yunfan Feng ,&nbsp;Jiangquan Yu ,&nbsp;Ruiqiang Zheng","doi":"10.1016/j.jcrc.2024.154937","DOIUrl":"10.1016/j.jcrc.2024.154937","url":null,"abstract":"<div><h3>Background</h3><div>Acute kidney injury (AKI) is a common complication in critically ill and cardiac surgery patients. Intravenous amino acids can increase renal perfusion and replenish renal functional reserves. However, the exact therapeutic efficacy of intravenous amino acids in reducing the incidence of AKI remains uncertain. Therefore, this study aims to comprehensively review the existing evidence to assess the potential of intravenous amino acids in kidney protection.</div></div><div><h3>Methods</h3><div>EMBASE, PubMed, MEDLINE, and the Cochrane Library were searched for randomized controlled trials published on or before July 2, 2024, that examined the relationship between Intravenous amino acids and renal function. We extracted population characteristics and outcome variables related to renal function from randomized controlled trials comparing intravenous amino acid supplementation with no supplementation. We assessed this evidence using the Risk of Bias 2 (RoB2) tool for randomized controlled trials. Data were synthesized using a random-effects model.</div></div><div><h3>Results</h3><div>This review included 7 randomized controlled trials with a total of 505 patients. The results showed that compared with the control group, intravenous amino acid administration significantly reduced the incidence of AKI (RR: 0.81, 95 % CI: 0.68–0.97, <em>P</em> = 0.02) and increased urine output (MD: 308.87, 95 % CI: 168.68–449.06, <em>P</em> &lt; 0.0001). However, intravenous amino acids did not reduce mortality or the incidence of kidney replacement therapy, with no statistical difference in 30-day mortality (RR: 0.93, 95 % CI: 0.65–1.34, <em>P</em> = 0.71), 90-day mortality (RR:1.00, 95 % CI: 0.77–1.29, <em>P</em> = 0.98), or need for kidney replacement therapy (RR: 0.92, 95 % CI: 0.41–2.06, <em>P</em> = 0.83). Subgroup analysis suggested that, regardless of sample size, intravenous amino acid administration reduced the incidence of AKI and was particularly significant in patients undergoing cardiac and major vascular surgery. Furthermore, intraoperative intravenous amino acid therapy demonstrated a significant reduction in the incidence of AKI compared to postoperative administration.</div></div><div><h3>Conclusions</h3><div>Intravenous amino acids protect renal function in patients at high risk of AKI, particularly after cardiac surgery. It reduces the incidence of AKI and increases urine output, but has no significant effect on KRT and mortality.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154937"},"PeriodicalIF":3.2,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501229","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}