Journal of critical care最新文献

{"title":"Clinical outcomes of cardiogenic shock among critically ill patients admitted to intensive care units in Australia and New Zealand from 2003 to 2022","authors":"Wisam Al-Bassam ,&nbsp;Samer Noaman ,&nbsp;Rahul Kumar ,&nbsp;Neil Glassford ,&nbsp;Daryl Jones ,&nbsp;Carys Jones ,&nbsp;William Chan ,&nbsp;David M. Kaye ,&nbsp;David Pilcher ,&nbsp;Rinaldo Bellomo ,&nbsp;Yehya shehabi ,&nbsp;Ary Serpa Neto","doi":"10.1016/j.jcrc.2024.155001","DOIUrl":"10.1016/j.jcrc.2024.155001","url":null,"abstract":"<div><h3>Purpose</h3><div>Patients with Cardiogenic shock (CS) admitted to intensive care units (ICUs) have high mortality rates. We aimed to investigate the changes patient characteristics and outcomes over time among patients admitted to the ICU with CS.</div></div><div><h3>Methods</h3><div>Retrospective study utilizing a large bi-national ICU database from 2003 to 2022. Patient characteristics and outcomes based on the ICU admission diagnosis of CS were evaluated and changes in outcomes over time after adjusting for key baseline variables were assessed.</div></div><div><h3>Results</h3><div>During the study period, among CS patients, there were significant reductions in severity of illness (APACHE III from 80 to 72 and Australian and New Zealand Risk of Death Scores from 0.34 to 0.30, both <em>p</em> &lt; 0.001). There was also a significant increase in admissions from emergency departments (32 % to 41 %, p &lt; 0.001). Over time, unadjusted hospital mortality decreased from 57 % in 2003 to 41 % in 2022 (<em>P</em> &lt; 0.001). After adjustment for severity of illness, the odds ratios for hospital mortality also decreased to 0.49 (95 % CI, 0.38 to 0.64) compared with 2003 (<em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Over twenty years period, among patients with CS admitted to ICU, there has been a significant change in the epidemiological characteristics and a decrease in absolute and adjusted mortality rates.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"86 ","pages":"Article 155001"},"PeriodicalIF":3.2,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846875","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":"Furosemide with adjunctive acetazolamide vs furosemide only in critically ill patients: A pilot two-center randomized controlled trial","authors":"Akinori Maeda ,&nbsp;Alastair Brown ,&nbsp;Sofia Spano ,&nbsp;Anis Chaba ,&nbsp;Atthaphong Phongphithakchai ,&nbsp;Yukiko Hikasa ,&nbsp;Nuttapol Pattamin ,&nbsp;Nuanprae Kitisin ,&nbsp;Jonathan Nübel ,&nbsp;Bethany Nielsen ,&nbsp;Jennifer Holmes ,&nbsp;Leah Peck ,&nbsp;Helen Young ,&nbsp;Glenn Eastwood ,&nbsp;Rinaldo Bellomo ,&nbsp;Ary Serpa Neto","doi":"10.1016/j.jcrc.2024.155002","DOIUrl":"10.1016/j.jcrc.2024.155002","url":null,"abstract":"<div><h3>Purpose</h3><div>Furosemide is the most commonly used diuretic in intensive care units (ICU). We aimed to evaluate the physiological effects of adjunctive acetazolamide with furosemide on diuresis and the prevention of potential furosemide-induced metabolic alkalosis.</div></div><div><h3>Materials and methods</h3><div>We performed a two-center, pilot, open-label, randomized trial. Where the treating physicians planned intravenous diuretic therapy, we randomized ICU patients to a bolus of furosemide (40 mg) plus acetazolamide (500 mg) (<em>n</em> = 15) or furosemide alone (40 mg) (n = 15). Urine output, additional furosemide use, acid-base parameters, and electrolytes were compared following a Bayesian framework.</div></div><div><h3>Results</h3><div>Adjunctive acetazolamide didn't increase urine output in the first six hours (mean difference: −112 ml, credible interval: [−742, 514]). However, compared with furosemide alone, it maintained a greater urine output response to furosemide over 24 h, with 100 % probability. Acetazolamide also acidified plasma (pH difference: −0.045, [−0.081, −0.008]) while alkalinizing urine (1.10, [0.04, 2.11]) at six hours, compared to furosemide alone with &gt;95 % probability. Finally, we didn't observe severe acidosis or electrolyte disturbances over 24 h.</div></div><div><h3>Conclusions</h3><div>Adjunctive acetazolamide may increase diuretic efficacy and counterbalance furosemide-induced metabolic alkalosis without safety concerns. Larger trials are warranted to verify these findings and assess their impacts on clinical outcomes.</div></div><div><h3>Registration number</h3><div>ACTRN12623000624684.</div></div><div><h3>Registration title</h3><div>A pilot trial of single versus dual diuretic therapy in the intensive care unit.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"86 ","pages":"Article 155002"},"PeriodicalIF":3.2,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846876","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: “Malnutrition in survivors of critical illness and long-term survival outcomes: A cohort study”","authors":"Chen Zhou ,&nbsp;Chenglong Liang","doi":"10.1016/j.jcrc.2024.155003","DOIUrl":"10.1016/j.jcrc.2024.155003","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"86 ","pages":"Article 155003"},"PeriodicalIF":3.2,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142835958","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":"Early high-dose vasopressors in refractory septic shock: A cohort study","authors":"Hailey A. Thompson ,&nbsp;Hannah M. Brinkman ,&nbsp;Kianoush B. Kashani ,&nbsp;Kristin C. Cole ,&nbsp;Erica D. Wittwer ,&nbsp;Patrick M. Wieruszewski","doi":"10.1016/j.jcrc.2024.155004","DOIUrl":"10.1016/j.jcrc.2024.155004","url":null,"abstract":"<div><h3>Purpose</h3><div>Septic shock refractory to high-dose vasopressors confers unacceptably high mortality, however, the impact of timing of peak vasopressor dose exposure on outcomes is unknown.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included adults who required a vasopressor dose ≥0.5 μg/kg/min norepinephrine-equivalents in the first 24 h of septic shock. We used the median time to peak vasopressor dose to stratify patients into ‘early’ and ‘late’ groups. Multivariable Cox proportional hazards regression was used to assess the impact of time to peak vasopressor exposure on mortality.</div></div><div><h3>Results</h3><div>The median time to peak vasopressor dose exposure was 6 (3,13) hours, defining the early (<em>n</em> = 351) and late (n = 351) groups. In the severity-adjusted multivariable analysis, the early group was less likely to die within 28 days (HR 0.76, 95 % CI 0.58–0.99). The early group experienced significantly more days alive and free from renal replacement therapy, vasopressors, mechanical ventilation, and quicker independence from vasopressors (HR 1.40, 95 % CI 1.17–1.69). Mesenteric ischemia and arrhythmias were more frequent in the late group.</div></div><div><h3>Conclusions</h3><div>In vasopressor-refractory septic shock, achieving the peak vasopressor dose within the first six hours of shock onset was associated with reduced mortality and more days alive and free from organ-support therapies.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"86 ","pages":"Article 155004"},"PeriodicalIF":3.2,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828753","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 Medullary Renal Perfusion","authors":"Arnaud Robert ,&nbsp;Julien Moury ,&nbsp;Emily Perriens ,&nbsp;Sydney Blackman ,&nbsp;Patrick M. Honore","doi":"10.1016/j.jcrc.2024.154989","DOIUrl":"10.1016/j.jcrc.2024.154989","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"86 ","pages":"Article 154989"},"PeriodicalIF":3.2,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822270","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":"Effect of pulmonary artery catheter, type & combination of vasoactives for optimizing lactate clearance in acute myocardial infarction complicated by cardiogenic shock","authors":"Jorge A. Ortega-Hernández ,&nbsp;Héctor González-Pacheco ,&nbsp;Mauricio García-Ruiz ,&nbsp;Daniel Manzur-Sandoval ,&nbsp;Rodrigo Gopar-Nieto ,&nbsp;Daniel Sierra-Lara-Martínez ,&nbsp;Diego Araiza-Garaygordobil ,&nbsp;Salvador Mendoza-García ,&nbsp;Arturo Arzate-Ramírez ,&nbsp;Álvaro Montañez-Orozco ,&nbsp;Luis Augusto Baeza-Herrera ,&nbsp;Alfredo Altamirano-Castillo ,&nbsp;Adrian Aquiles Valdespino Trejo ,&nbsp;Jaime Hernández-Montfort ,&nbsp;Alexandra Arias-Mendoza","doi":"10.1016/j.jcrc.2024.154990","DOIUrl":"10.1016/j.jcrc.2024.154990","url":null,"abstract":"<div><h3>Introduction</h3><div>Lactate clearance(LC) is critical in managing critically ill patients. We hypothesized that treatment allocation with different vasoactive drugs or the presence of a pulmonary artery catheter (PAC) could affect the behavior of lactate dynamics and, ultimately, the mortality in AMI-CS.</div></div><div><h3>Materials and methods</h3><div>In 651 patients with AMI-CS, we examined the relationship of LC time with clinical, laboratory, and CS-management variables. Complete LC time was defined as serum lactate levels less than &lt;2 mmol/L. We explore the impact of vasoactive drugs and PAC with LC. The CART method defined the vasoactive combinations (permutations) in relation with early (&lt;96 h) complete LC.</div></div><div><h3>Results</h3><div>PAC presence correlated with faster LC (−17.54 h) and was independently associated with lower mortality (HR = 0.61). Levosimendan and dobutamine were associated with lower lactate levels and faster LC (−8.82 &amp; -8.77 h), while vasopressin was linked to slower LC (9.16 h). Slow LC (&gt;96 h) was associated with increased mortality. CART analysis identified specific vasoactive drug combinations associated lactate clearance and mortality, without dobutamine, with vasopressin having higher mortality (80.6 %, HR = 5.53), and with dobutamine, with norepinephrine, without vasopressin, with levosimendan the lowest (35 %) and higher complete LC and a trend for higher %LC.</div></div><div><h3>Conclusion</h3><div>The right combination of vasoactive medications and the probable use of a PAC could significantly impact the achievement of complete LC in &lt;96 h. The findings support the need for further research and the development of strategies to optimize lactate clearance and improve overall patient survival in this high-risk population.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"86 ","pages":"Article 154990"},"PeriodicalIF":3.2,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818272","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":"Role of diaphragmatic dysfunction in extubation failure among patients at high risk of reintubation: A prospective cohort study","authors":"Jie Zhang ,&nbsp;Qian Xie ,&nbsp;Rong Jiang ,&nbsp;Yang Yang ,&nbsp;Yuting Yang ,&nbsp;Chaoqi Zhou ,&nbsp;Wei Zhang ,&nbsp;Tian Zhang ,&nbsp;Yixin Liu ,&nbsp;Huiming Yao","doi":"10.1016/j.jcrc.2024.154983","DOIUrl":"10.1016/j.jcrc.2024.154983","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aims to evaluate the role of diaphragmatic dysfunction in extubation failure among patients at high risk of reintubation.</div></div><div><h3>Material and methods</h3><div>This prospective cohort study was carried out at a intensive care unit in China. Adult patients who had been intubated for more than 24 h and ready for extubation were included in the study if they exhibited a high risk of extubation failure. Diaphragm dysfunction was defined as a diaphragmatic thickening fraction &lt;30 % or diaphragmatic excursion &lt;10 mm. The primary outcome was defined as extubation failure, which includes either reintubation or death within the initial 7 days following extubation.</div></div><div><h3>Results</h3><div>Out of the 113 patients, 27 (23.89 %) experienced extubation failure, with diaphragm dysfunction diagnosed in 63 (55.75 %) individuals. Patients who failed extubation were significantly more likely to have diaphragm dysfunction (85.19 % vs. 46.51 %, <em>p</em> &lt; 0.01). In the Cox-proportional hazards regression analysis, diaphragm dysfunction and the Medical Research Council score were found to be associated with extubation failure. The adjusted hazard ratios were 4.56 [95 % CI: 1.56–13.33] and 0.93 [95 % CI: 0.88–0.99]. Both variables were closely correlated with extubation failure showing statistical significance.</div></div><div><h3>Conclusion</h3><div>Diaphragm dysfunction could contribute to an elevated extubation failure rate.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"86 ","pages":"Article 154983"},"PeriodicalIF":3.2,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813379","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":"Surrogates may not accurately estimate resilience and spirituality in neurologically critically ill patients","authors":"Michael Hill-Oliva ,&nbsp;Srinivas Medavarapu MBBS ,&nbsp;Deeksha Chada MPH ,&nbsp;Maggie Keogh MEd ,&nbsp;Errol Gordon MD ,&nbsp;Stephan A. Mayer MD ,&nbsp;Neha S. Dangayach MD MSCR","doi":"10.1016/j.jcrc.2024.154975","DOIUrl":"10.1016/j.jcrc.2024.154975","url":null,"abstract":"<div><h3>Background</h3><div>Surrogates often provide substituted judgement for neurologically critically ill patients. Resilience and spirituality are understudied constructs in this patient population.</div><div>In this study we examine how accurately surrogates estimate measures of resilience and spirituality for neurologically critically ill patients.</div></div><div><h3>Methods</h3><div>A convenience sample of English/Spanish speaking neurologically critically ill patient-surrogate dyads was enrolled from March 2016 to 2018. Questionnaires related to resilience (CD-RISC-10), spiritual wellbeing (positive Brief R-COPE), and spiritual turmoil (negative Brief R-cope) were completed by patients for themselves and surrogates on behalf of patients while in the Neurosciences Intensive Care Unit. Responses were evaluated by Spearman's rank-order correlation, Bland-Altman analysis and Cohen's weighted kappa.</div></div><div><h3>Results</h3><div>51 dyads were included. No correlation was found between patient and surrogate CD-RISC-10 (0.17, <em>p</em> = 0.238); moderate, positive correlations for positive (0.47, <em>p</em> &lt; 0.001) and negative (0.33, <em>p</em> = 0.021) Brief R-COPE. Mean differences between patient and surrogate scores were low for CD-RISC-10 (−1.0 point), positive R-COPE (− 0.14 point), and negative R-COPE (0.02 point) suggesting lack of bias towards over/under-estimation. Kappa scores demonstrate fair inter-rater agreement for positive/negative R-COPE and no agreement for CD-RISC-10.</div></div><div><h3>Conclusion</h3><div>Surrogate evaluations lack systematic bias, but may not estimate resilience and spirituality reliably for neurologically critically ill patients.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"86 ","pages":"Article 154975"},"PeriodicalIF":3.2,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813380","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":"Authors response: “Urea to creatinine ratio as a predictor of persistent critical illness”","authors":"Liran Statlender ,&nbsp;Tzippy Shochat ,&nbsp;Pierre Singer","doi":"10.1016/j.jcrc.2024.154988","DOIUrl":"10.1016/j.jcrc.2024.154988","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"86 ","pages":"Article 154988"},"PeriodicalIF":3.2,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794891","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":"Weekly flipped classroom modules in intensive care medical training: Feasibility and acceptance","authors":"Johannes B.J. Scholte,&nbsp;Johannes C. Strehler","doi":"10.1016/j.jcrc.2024.154986","DOIUrl":"10.1016/j.jcrc.2024.154986","url":null,"abstract":"<div><h3>Background</h3><div>Teaching intensive care medicine competencies poses challenges due to trainees' heterogenous backgrounds, shift schedules, and short rotations. To address these challenges, weekly flipped classroom modules (FCMs) were introduced, combining online preparation, control questions, and an on-site course co-facilitated by a trainee and an intensivist. This study aimed to evaluate the feasibility and acceptance of these FCMs.</div></div><div><h3>Methods</h3><div>This pre-post intervention study used a triangulated methodology. Learning management system (LMS) user data were analysed regarding preparation and mobile access. Pre- and post-surveys assessed trainees' perception of training formats, learning motivation, and preparation benefits using Likert scales. Open-ended responses were evaluated through content analysis.</div></div><div><h3>Results</h3><div>All 30 trainees accessed the LMS, with an average online participation rate of 78 %, higher among fellows (89 %) than residents (71 %). Mobile devices were used by 20 trainees (67 %), and over half of FCM activities were accessed this way. Training formats with FCMs scored significantly higher post-implementation. The FCMs scored 4.7 (SD = 0.5), outperforming other teaching formats (p &lt; 0.04). Perceived learning motivation scores increased from 19.0 (SD = 4.5) pre-FCM to 23.8 (SD = 3.0) post-FCM (p &lt; 0.001). Median perceived preparation benefit rose from 15 to 18 (p &lt; 0.001). Trainees appreciated the flexibility, quality, variety of materials, and control question. Acknowledging FCMs as relevant starting point for acquiring fundamental ICU knowledge.</div></div><div><h3>Conclusions</h3><div>Weekly FCMs are both feasibly and well-accepted and may enhance learning motivation in intensive care training. Further multicentre and qualitative studies are recommended to validate their impact.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"86 ","pages":"Article 154986"},"PeriodicalIF":3.2,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791729","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}