Journal of critical care最新文献

{"title":"Advance directives in the intensive care unit: An eight-year vanguard cohort study","authors":"Sira M. Baumann ,&nbsp;Simon A. Amacher ,&nbsp;Yasmin Erne ,&nbsp;Pascale Grzonka ,&nbsp;Sebastian Berger ,&nbsp;Sabina Hunziker ,&nbsp;Caroline E. Gebhard ,&nbsp;Mathias Nebiker ,&nbsp;Luca Cioccari ,&nbsp;Raoul Sutter","doi":"10.1016/j.jcrc.2024.154918","DOIUrl":"10.1016/j.jcrc.2024.154918","url":null,"abstract":"<div><h3>Purpose</h3><p>To investigate the frequency, content, and clinical translation of advance directives in intensive care units (ICUs).</p></div><div><h3>Material and methods</h3><p>Retrospective cohort study in a Swiss tertiary ICU, including patients with advance directives treated in ICUs ≥48 h. The primary endpoint was the violation of directives. Key secondary endpoints were the directives' prevalence and their translation into clinical practice.</p></div><div><h3>Results</h3><p>Of 5′851 patients treated ≥48 h in ICUs, 2.7 % had documented directives. Despite 92 % using templates, subjective or contradictory wording was found in 19 % and 12 %. Nine percent of directives were violated. Patients with directive violations had worse in-hospital outcomes (<em>p</em> = 0.012). At admission, 64 % of patients experiencing violations could not communicate, and directives were missing/unrecognized in 30 %. Mostly, directives were not followed regarding life-prolonging measures (6 %), ICU admission (5 %), and mechanical ventilation (3 %). Kaplan Meier statistics revealed a lower survival rate with directives recognized at admission (<em>p</em> = 0.04) and when treatment was withheld (<em>p</em> &lt; 0.001).</p></div><div><h3>Conclusions</h3><p>Advance directives are available in a minority of ICU patients and often contain subjective/contradictory wording. Physicians respected directives in 90 % of patients, with treatment adapted following their wishes. However, violation of directives may have serious consequences with unfavorable in-hospital outcomes and decreased long-term survival with treatment adaption following directives.</p></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154918"},"PeriodicalIF":3.2,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0883944124004052/pdfft?md5=20d348e6b3fa9407e981ead184ca11e6&pid=1-s2.0-S0883944124004052-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142239430","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":"Target attainment of beta-lactam antibiotics and ciprofloxacin in critically ill patients and its association with 28-day mortality.","authors":"Sarah Dräger, Tim M J Ewoldt, Alan Abdulla, Wim J R Rietdijk, Nelianne J Verkaik, Peter van Vliet, Ilse M Purmer, Michael Osthoff, Birgit C P Koch, Henrik Endeman","doi":"10.1016/j.jcrc.2024.154904","DOIUrl":"https://doi.org/10.1016/j.jcrc.2024.154904","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to assess pharmacodynamic target attainment in critically ill patients and identify factors influencing target attainment and mortality outcomes.</p><p><strong>Methods: </strong>We analysed data from the DOLPHIN trial. Beta-lactam and ciprofloxacin peak and trough concentration were measured within the first 36 h (T1) after initiation of treatment. The study outcome included the rate of pharmacodynamic target attainment of 100 % ƒT_{>1xEpidemiological cut-off value (ECOFF)} for beta-lactams, and of fAUC_0-24h/ECOFF>125 for ciprofloxacin at T1.</p><p><strong>Results: </strong>The target attainment rates were 78.1 % (n = 228/292) for beta-lactams, and 41.5 % (n = 39/94) for ciprofloxacin, respectively. Lower estimated glomerular filtration rate and higher SOFA score were associated with target attainment. In patients receiving beta-lactams, 28-day mortality was significantly higher in patients who attained 100 % ƒT_>1xECOFF (28.9 % vs. 12.5 %; p = 0.01). In the multivariate analysis, attainment of 100 % ƒT_>4xECOFF, but not 100 % ƒT_>1xECOFF, was associated with a higher 28-day mortality (OR 2.70, 95 % CI 1.36-5.48 vs. OR 1.28, 95 % CI 0.53-3.34).</p><p><strong>Conclusions: </strong>A high rate of target attainment (100 % ƒT_>1xECOFF) for beta-lactams and a lower rate for ciprofloxacin was observed. Achieving exposures of 100 % ƒT_>4xECOFF was associated with 28-day mortality. The impact of antibiotic target attainment on clinical outcome needs to be a focus of future research.</p>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":" ","pages":"154904"},"PeriodicalIF":3.2,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142288297","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":"What every intensivist should know about augmented renal clearance (ARC)","authors":"Tim J.L. Smeets ,&nbsp;Chantal A. Boly ,&nbsp;John Papadopoulos ,&nbsp;Henrik Endeman ,&nbsp;Nicole G.M. Hunfeld","doi":"10.1016/j.jcrc.2024.154541","DOIUrl":"10.1016/j.jcrc.2024.154541","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"84 ","pages":"Article 154541"},"PeriodicalIF":3.2,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0883944124000285/pdfft?md5=70a171f7bb6a696e7295eaf218ac2766&pid=1-s2.0-S0883944124000285-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142164204","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":"Correlation of venous excess ultrasound (VExUS) score to fluid responsiveness in critically ill patients","authors":"Kyriakos K. Trigkidis,&nbsp;Christina Routsi,&nbsp;Stelios Kokkoris","doi":"10.1016/j.jcrc.2024.154905","DOIUrl":"10.1016/j.jcrc.2024.154905","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154905"},"PeriodicalIF":3.2,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142150781","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":"Understanding ventilator-induced lung injury: The role of mechanical power","authors":"Stephan von Düring MD MSc ,&nbsp;Ken Kuljit S. Parhar MD MSc ,&nbsp;Neill K.J. Adhikari MDCM MSc ,&nbsp;Martin Urner MD PhD ,&nbsp;S. Joseph Kim MD PhD ,&nbsp;Laveena Munshi MD MSc ,&nbsp;Kuan Liu PhD ,&nbsp;Eddy Fan MD PhD","doi":"10.1016/j.jcrc.2024.154902","DOIUrl":"10.1016/j.jcrc.2024.154902","url":null,"abstract":"<div><p>Mechanical ventilation stands as a life-saving intervention in the management of respiratory failure. However, it carries the risk of ventilator-induced lung injury. Despite the adoption of lung-protective ventilation strategies, including lower tidal volumes and pressure limitations, mortality rates remain high, leaving room for innovative approaches. The concept of mechanical power has emerged as a comprehensive metric encompassing key ventilator parameters associated with the genesis of ventilator-induced lung injury, including volume, pressure, flow, resistance, and respiratory rate. While numerous animal and human studies have linked mechanical power and ventilator-induced lung injury, its practical implementation at the bedside is hindered by calculation challenges, lack of equation consensus, and the absence of an optimal threshold. To overcome the constraints of measuring static respiratory parameters, dynamic mechanical power is proposed for all patients, regardless of their ventilation mode. However, establishing a causal relationship is crucial for its potential implementation, and requires further research. The objective of this review is to explore the role of mechanical power in ventilator-induced lung injury, its association with patient outcomes, and the challenges and potential benefits of implementing a ventilation strategy based on mechanical power.</p></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154902"},"PeriodicalIF":3.2,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0883944124003897/pdfft?md5=b8f1b200f2d3926b6607a9775490d85b&pid=1-s2.0-S0883944124003897-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145740","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":"Practice survey on recent changes in post cardiac arrest care and temperature management in French intensive care units","authors":"Clément Haddadi ,&nbsp;Antoine Kimmoun ,&nbsp;Marine Jacquier ,&nbsp;Bruno Megarbane ,&nbsp;Nicolas Deye ,&nbsp;Bruno Levy","doi":"10.1016/j.jcrc.2024.154903","DOIUrl":"10.1016/j.jcrc.2024.154903","url":null,"abstract":"<div><h3>Background</h3><p>Recent guidelines for post-cardiac arrest (CA) management have undergone significant changes regarding targeted therapeutic management (TTM), transitioning from hypothermia to temperature control. We aimed to assess changes in post-CA management in French intensive care units following the new recommendations.</p></div><div><h3>Methods</h3><p>Two declarative web surveys were conducted from March to August 2023. We compared the doctors' survey to that previously published in 2015. We contacted 389 departments from 276 French centers.</p></div><div><h3>Results</h3><p>Three hundred thirty-four physicians from 189 distinct ICUs departments participated in the survey. TTM was used by 95.5 % of respondents. TTM with temperature feedback device was used by 64 % of respondents. In multivariate analysis, use of TTM with temperature feedback was associated with university hospital responder [OR 1.99 (1.19–3.34, <em>p</em> = 0.009)], high CA admissions rate [OR 2.25 (1.13–4.78, <em>p</em> = 0.026)], use of a written CA procedure [OR 1.76 (1.07–2.92, <em>p</em> = 0.027)] and presence of a cath-lab performing coronary angiography [OR 2.42 (1.33–4.44, <em>p</em> = 0.004)]. The targeted temperature rose from 32 to 34 °C in 2015, to 35–36 °C in 2023 (<em>p</em> &lt; 0.001). Proportions of TTM with temperature feedback devices switched from 45 % to 65 % (p &lt; 0.001). 660 nurses responses from 150 ICUs were analyzed. According to TTM users, gel-coated water circulating pads and intravascular cooling were considered the most effective devices and were found to be easily adjustable.</p></div><div><h3>Conclusions</h3><p>These surveys provide insights into post-resuscitation care and TTM practice in France. One year after their publication, the latest recommendations concerning TTM have not been fully implemented, as the majority of ICUs continue to use moderate hypothermia. They widely reported employing specific TTM, with the use of TTM with temperature feedback devices increasing significantly. Heterogeneity exists regarding the TTM systems used, with a significant proportion lacking temperature feedback. This aspect requires specific attention, depending on local constraints and devices costs.</p></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"84 ","pages":"Article 154903"},"PeriodicalIF":3.2,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142099243","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":"Sustained elevation of calprotectin associates with delayed appearance of myeloid-derived suppressor cells in patients with septic shock","authors":"Muzhda Haem Rahimi ,&nbsp;Cécile Poussineau ,&nbsp;Charlotte Cuerq ,&nbsp;Martin Cour ,&nbsp;Anne-Claire Lukaszewicz ,&nbsp;Fabienne Venet ,&nbsp;Guillaume Monneret","doi":"10.1016/j.jcrc.2024.154899","DOIUrl":"10.1016/j.jcrc.2024.154899","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"84 ","pages":"Article 154899"},"PeriodicalIF":3.2,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142099244","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":"Preload responsiveness–guided fluid removal in mechanically ventilated patients with fluid overload: A comprehensive clinical–physiological study","authors":"Ricardo Castro ,&nbsp;Pablo Born ,&nbsp;Eric Roessler ,&nbsp;Christian Labra ,&nbsp;Paul McNab ,&nbsp;Sebastián Bravo ,&nbsp;Dagoberto Soto ,&nbsp;Eduardo Kattan ,&nbsp;Glenn Hernández ,&nbsp;Jan Bakker","doi":"10.1016/j.jcrc.2024.154901","DOIUrl":"10.1016/j.jcrc.2024.154901","url":null,"abstract":"<div><p>This study investigated fluid removal strategies for critically ill patients with fluid overload on mechanical ventilation. Traditionally, a negative fluid balance (FB) is aimed for. However, this approach can have drawbacks. Here, we compared a new approach, namely removing fluids until patients become fluid responsive (FR) to the traditional empiric negative balance approach.</p><p>Twelve patients were placed in each group (<em>n</em> = 24). FR assessment was performed using passive leg raising (PLR). Both groups maintained stable blood pressure and heart function during fluid management. Notably, the FR group weaned from the ventilator significantly faster than negative FB group (both for a spontaneous breathing trial (14 h vs. 36 h, <em>p</em> = 0.031) and extubation (26 h vs. 57 h, <em>p</em> = 0.007); the difference in total ventilator time wasn't statistically significant (49 h vs. 62 h, <em>p</em> = 0.065). Additionally, FR group avoided metabolic problems like secondary alkalosis and potential hypokalemia seen in the negative FB group.</p><p>FR-guided fluid-removal in fluid overloaded mechanically ventilated patients was a feasible, safe, and maybe superior strategy in facilitating weaning and disconnection from mechanical ventilation than negative FB-driven fluid removal. FR is a safe endpoint for optimizing cardiac function and preventing adverse consequences during fluid removal.</p></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"84 ","pages":"Article 154901"},"PeriodicalIF":3.2,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142083153","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":"Reducing plastic waste in intensive care from longer use of intravenous administration and invasive monitoring sets: A before-and-after study","authors":"Marc Schluep ,&nbsp;Martijn Minheere ,&nbsp;Michelle Baus ,&nbsp;Stefan Machielse ,&nbsp;Anita Donkers ,&nbsp;Heleen Vroman","doi":"10.1016/j.jcrc.2024.154900","DOIUrl":"10.1016/j.jcrc.2024.154900","url":null,"abstract":"<div><h3>Introduction</h3><p>Intensive care unit (ICU) treatment carries a large environmental burden. Extending routine replacement of plastic line sets that belong to intravenous administration or invasive monitoring might lower waste from single-use plastics in ICUs. We extended the routine replacement interval of line sets from 4 to 7 days and assessed plastic waste reduction.</p></div><div><h3>Methods</h3><p>In this single center retrospective study the extension of the time interval from 4 to 7 days for routine replacement of line sets and its effect on plastic waste was assessed. The intervention was done at the start of 2022. Secondary outcomes were catheter-related bloodstream infections (CRBSI), nursing workload, costs and material durability.</p></div><div><h3>Results</h3><p>In total 1221 patients were admitted to ICU; 636 in the pre-intervention period and 585 in the post-intervention period. There was a reduction of 881 replacement sets, 182 kg of waste and 96 nursing hours in 2022. There was no difference in CRBSI incidence.</p></div><div><h3>Conclusion</h3><p>This study demonstrates the benefits of 7-day replacement intervals for intravenous administration and invasive monitoring sets. We established this in terms of waste reduction, patient safety and costs.</p></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"84 ","pages":"Article 154900"},"PeriodicalIF":3.2,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0883944124003873/pdfft?md5=771874915710ae8915886e9a59e7c2b2&pid=1-s2.0-S0883944124003873-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142049674","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":"Influence of contrast medium on long-term renal function and outcomes in patients with septic acute kidney injury: A propensity-matched cohort study","authors":"Jinnam Kim ,&nbsp;Se Ju Lee ,&nbsp;Jung Ho Kim ,&nbsp;Jin Young Ahn ,&nbsp;Su Jin Jeong ,&nbsp;Jun Yong Choi ,&nbsp;Joon-Sup Yeom ,&nbsp;Hyung Jung Oh ,&nbsp;Yong Eun Chung ,&nbsp;Nam Su Ku","doi":"10.1016/j.jcrc.2024.154898","DOIUrl":"10.1016/j.jcrc.2024.154898","url":null,"abstract":"<div><h3>Purpose</h3><p>To investigate the relationship between contrast medium administration and long-term mortality and renal function in patients with septic acute kidney injury (AKI).</p></div><div><h3>Materials and methods</h3><p>We performed a retrospective, propensity-matched cohort study involving 1521 adult patients admitted with septic shock. Patients with septic AKI who underwent contrast or non-contrast CT scans were enrolled. The primary outcomes were the rates of 90-day mortality and dialysis within 90 days. The secondary outcomes included worsening of AKI, in-hospital mortality, and maintenance of dialysis after 90 days.</p></div><div><h3>Results</h3><p>During the study period, 609 patients with septic AKI were identified; 220 (36.1%) underwent contrast CT and 389 (63.9%) underwent non-contrast CT. After propensity score matching, 133 pairs were obtained. There were no significant differences between the contrast and non-contrast CT groups in 90-day mortality (54.9% vs. 58.6%, <em>P</em> = 0.579), dialysis within 90 days (6.8% vs. 8.3%, <em>P</em> = 0.655), worsening AKI (2.3% vs. 3.0%, <em>P</em> = 0.706), in-hospital mortality (10.6% vs. 14.4%, <em>P</em> = 0.369), or maintenance of dialysis after 90 days (0.0% vs. 0.8%, <em>P</em> &gt; 0.99).</p></div><div><h3>Conclusions</h3><p>The administration of intravenous contrast medium was not associated with long-term mortality, deterioration of renal function, or dialysis in patients with septic AKI.</p></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"84 ","pages":"Article 154898"},"PeriodicalIF":3.2,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S088394412400385X/pdfft?md5=aecd4e92741eb45a0bd358c01bab5b86&pid=1-s2.0-S088394412400385X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008811","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}