Journal of critical care最新文献

{"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}

{"title":"Letter to the Editor: Urea to creatinine ratio as a predictor of persistent critical illness","authors":"Chen Liu ,&nbsp;Jie Weng ,&nbsp;Zhe Xu ,&nbsp;Keying Li ,&nbsp;Zhenshen Ma ,&nbsp;Zhiyi Wang","doi":"10.1016/j.jcrc.2024.154987","DOIUrl":"10.1016/j.jcrc.2024.154987","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"86 ","pages":"Article 154987"},"PeriodicalIF":3.2,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142759129","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":"Contemporary assessment of short- and functional 90-days outcome in old intensive care patients suffering from COVID-19","authors":"Raphael Romano Bruno ,&nbsp;Bernhard Wernly ,&nbsp;Antonio Artigas ,&nbsp;Kristina Fuest ,&nbsp;Stefan J. Schaller ,&nbsp;Lisa Dannenberg ,&nbsp;Detlef Kindgen-Milles ,&nbsp;Malte Kelm ,&nbsp;Michael Beil ,&nbsp;Sigal Sviri ,&nbsp;Muhammed Elhadi ,&nbsp;Michael Joannidis ,&nbsp;Sandra Oeyen ,&nbsp;Eumorfia Kondili ,&nbsp;Rui Moreno ,&nbsp;Susannah Leaver ,&nbsp;Bertrand Guidet ,&nbsp;Dylan W. De Lange ,&nbsp;Hans Flaatten ,&nbsp;Wojciech Szczeklik ,&nbsp;Christian Jung","doi":"10.1016/j.jcrc.2024.154984","DOIUrl":"10.1016/j.jcrc.2024.154984","url":null,"abstract":"<div><h3>Purpose</h3><div>There are limited data about the outcome of old intensive care (ICU) patients suffering from Covid-19 in the post-vaccination era. This study distinguishes the pre- and post-acute illness living conditions of ICU survivors from non-survivors.</div></div><div><h3>Methods</h3><div>This prospective international multicenter study included 642 old (≥ 70 years) ICU patients, including data ranging from pre-illness condition to functional 90-days follow-up. The primary endpoint was the difference of living conditions of ICU-survivors before ICU admission and 90-days after ICU discharge. Secondary outcomes were 90-days mortality, and quality of life.</div></div><div><h3>Results</h3><div>A total of 642 patients were included. Significantly more ICU survivors lived at their own homes without support before ICU admission than non-survivors (<em>p</em> = 0.016), while more non-survivors resided in nursing homes (p = 0.016). ICU mortality was 39 %, 30-days and 90 days mortality were 47 %and 55 %. After 90 days, only 22 % maintained the same living conditions. Surviving patients viewed ICU admission positively after 90 days, while relatives were more uncertain. Quality of life indicated a self-reported average score of 60 (50–75).</div></div><div><h3>Conclusion</h3><div>Living conditions influence the outcome of critically ill old patients suffering from Covid-19. Only a minority returned to their initial habitat after ICU survival.</div><div><strong>Trial registration number</strong> <span><span>NCT04321265</span><svg><path></path></svg></span></div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"86 ","pages":"Article 154984"},"PeriodicalIF":3.2,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779033","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":"Challenges and opportunities in antibiotic allergy de-labeling in intensive care units: The time is now!","authors":"Marcela de Almeida Lopes ,&nbsp;Aurelie Gouel-Cheron ,&nbsp;Saad Nseir","doi":"10.1016/j.jcrc.2024.154978","DOIUrl":"10.1016/j.jcrc.2024.154978","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154978"},"PeriodicalIF":3.2,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142744000","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":"Platelet dysfunction in heatstroke-induced coagulopathy: A retrospective observational study","authors":"Yuri Endo ,&nbsp;Ryota Inokuchi ,&nbsp;Miyuki Yamamoto ,&nbsp;Ryohei Horie ,&nbsp;Toshifumi Asada ,&nbsp;Koichi Kashiwa ,&nbsp;Kazuki Fujishiro ,&nbsp;Masao Iwagami ,&nbsp;Kent Doi","doi":"10.1016/j.jcrc.2024.154982","DOIUrl":"10.1016/j.jcrc.2024.154982","url":null,"abstract":"<div><h3>Purpose</h3><div>Severe heatstroke is often complicated by disseminated intravascular coagulation (DIC). The aim of this study was to evaluate platelet function assessed through thromboelastography (TEG) at the emergency department (ED) and DIC severity among patients with heatstroke.</div></div><div><h3>Materials and methods</h3><div>We performed a retrospective single-tertiary hospital cohort study. Patients admitted to an intensive care unit (ICU) with heatstroke were enrolled. Platelet function was evaluated as the difference between citrated functional fibrinogen-maximum amplitude (CFF-MA) and citrated rapid TEG-maximum amplitude (CRT-MA) at the ED. DIC was defined as a score ≥ 4 points based on the Japanese Association of Acute Medicine score.</div></div><div><h3>Results</h3><div>A total of 31 patients with heatstroke were enrolled. The median platelet count was 18.1 × 10⁴/μL, (interquartile range [IQR]: 12.6–25.0 × 10⁴/μL), and the median platelet function evaluated as CFF-MA-CRT-MA was 34.4 mm (IQR: 27.8–37.8 mm). Among several clinical and TEG-related parameters, the platelet function was strongly correlated with the DIC score (<em>R</em> = −0.63, <em>p</em> &lt; 0.001) and significantly associated with DIC development (area under the receiver operating characteristic curve 0.87 [95 % confidence interval: 0.72–0.99]).</div></div><div><h3>Conclusions</h3><div>These results suggested that platelet dysfunction occurs in heatstroke-induced DIC, indicating that platelet function evaluation by TEG can provide complementary information and enhance our understanding about the subtypes of heatstroke.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154982"},"PeriodicalIF":3.2,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142743993","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":"Letter to the Editor: “Outcomes of continuous renal replacement therapy versus peritoneal dialysis as a renal replacement therapy modality in patients undergoing venoarterial 72 extracorporeal membrane oxygenation”","authors":"Wei-Zhen Tang,&nbsp;Wei-Ze Xu,&nbsp;Tai-Hang Liu","doi":"10.1016/j.jcrc.2024.154979","DOIUrl":"10.1016/j.jcrc.2024.154979","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154979"},"PeriodicalIF":3.2,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142744001","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":"Antibiotic allergy de-labeling in the intensive care unit: The prospective ADE-ICU study","authors":"Salma Alamin ,&nbsp;Rachel Egan ,&nbsp;Barbara Cusack ,&nbsp;Amanda Sherwin ,&nbsp;Emily Naylor ,&nbsp;Fiona Carroll ,&nbsp;Marie E. Ward ,&nbsp;Mary Kelly ,&nbsp;Deirdre Doyle ,&nbsp;Ignacio Martin-Loeches ,&nbsp;Niall Conlon ,&nbsp;Sean Keane","doi":"10.1016/j.jcrc.2024.154977","DOIUrl":"10.1016/j.jcrc.2024.154977","url":null,"abstract":"<div><h3>Purpose</h3><div>Critically ill patients in the intensive care unit (ICU) are frequently prescribed antibiotics, with many reporting an antibiotic allergy label, predominantly to penicillin. Mislabeling contributes to suboptimal antibiotic use, increasing multidrug-resistant organisms and <em>Clostridium difficile</em> infections, and increased hospital length of stay. This prospective study implemented an antibiotic allergy assessment and testing program in the ICU, independently of clinical immunology/allergy services.</div></div><div><h3>Materials and methods</h3><div>Trained ICU staff prospectively identified and risk assessed eligible patients as having a non-immune mediated drug reaction, or a low, intermediate or high risk antibiotic allergy. Non-immune mediated reactions were directly de-labeled. Low-risk allergies underwent direct drug provocation testing, while intermediate-risk allergies included skin testing followed by drug provocation testing. High-risk allergies were confirmed without testing.</div></div><div><h3>Results</h3><div>Of 71 eligible patients, 62 underwent assessment. Antibiotic allergy de-labeling occurred in 48 of 51 patients (94 %) with a non-immune, low or intermediate risk allergy. High risk allergies were confirmed in 11 patients (18 %). The study resulted in increased penicillin use and decreased broad-spectrum antibiotic use. No adverse events occurred from testing.</div></div><div><h3>Conclusions</h3><div>This study shows the feasibility of ICU led antibiotic allergy assessment and testing, highlighting a potential model for implementation in settings lacking immunology/allergy services.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154977"},"PeriodicalIF":3.2,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721017","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":"The interplay between organizational culture and burnout among ICU professionals: A cross-sectional multicenter study","authors":"Niek Kok ,&nbsp;Cornelia Hoedemaekers ,&nbsp;Malaika Fuchs ,&nbsp;Alexander D. Cornet ,&nbsp;Esther Ewalds ,&nbsp;Harold Hom ,&nbsp;Esther Meijer ,&nbsp;Iwan Meynaar ,&nbsp;Margo van Mol ,&nbsp;Walther van Mook ,&nbsp;Mariëlle van der Steen-Dieperink ,&nbsp;Arthur van Zanten ,&nbsp;Hans van der Hoeven ,&nbsp;Jelle van Gurp ,&nbsp;Marieke Zegers","doi":"10.1016/j.jcrc.2024.154981","DOIUrl":"10.1016/j.jcrc.2024.154981","url":null,"abstract":"<div><h3>Purpose</h3><div>Organizational culture is considered a protective factor against burnout among ICU professionals. The aim of this study is to study the association between organizational culture as a potential antecedent to previously found mediating risk factors for burnout, namely, work-life balance and moral distress.</div></div><div><h3>Materials and methods</h3><div>Multicenter cross sectional study in eleven Dutch ICUs. The primary outcome measure was the core symptom of burnout, emotional exhaustion, measured using the validated Dutch version of the Maslach Burnout Inventory. Organizational culture was assessed using the Culture of Care Barometer, which measures five aspects of organizational culture. Moral distress and work-life balance were measured with validated questionnaires.</div></div><div><h3>Results</h3><div>696 ICU professionals (39.7 %) responded. All aspects of the CoCB were negatively associated with the emotional exhaustion component of burnout, both in univariable and multivariable models. Four aspects of organizational culture were significantly associated to the serial association between moral distress, work-to-home spillovers, and emotional exhaustion. For these aspects, the total indirect association was equal or larger than the total direct association.</div></div><div><h3>Conclusions</h3><div>Multiple aspects of organizational culture reduce burnout among ICU professionals in a largely indirect manner, via moral distress and work-life balance. Improving organizational culture can mitigate burnout symptoms among ICU clinicians.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154981"},"PeriodicalIF":3.2,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721479","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":"Authors reply: “Outcomes of continuous renal replacement therapy versus peritoneal dialysis as a renal replacement therapy modality in patients undergoing venoarterial 72 extracorporeal membrane oxygenation\"","authors":"Peerapat Thanapongsatorn ,&nbsp;Nisha Wanichwecharungruang ,&nbsp;Nattachai Srisawat","doi":"10.1016/j.jcrc.2024.154980","DOIUrl":"10.1016/j.jcrc.2024.154980","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154980"},"PeriodicalIF":3.2,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142703332","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":"Postoperative oliguria after intermediate and high-risk surgeries in critical care, A cohort analysis","authors":"Rodolpho Augusto de Moura Pedro ,&nbsp;Guilherme Bittar Cunha ,&nbsp;Igor Pietrobom ,&nbsp;Bruna Carla Scharanch ,&nbsp;Daniel Caraca Cubos ,&nbsp;Rafael Alves Franco ,&nbsp;Fernando Zampieri ,&nbsp;Thiago Gomes Romano","doi":"10.1016/j.jcrc.2024.154976","DOIUrl":"10.1016/j.jcrc.2024.154976","url":null,"abstract":"<div><h3>Introduction</h3><div>Oliguria is commonly used as a cutoff for acute kidney injury (AKI), however, a decrease in urine output is common during surgery and may represent an adaptative response in the perioperative setting rather than a reduction in glomerular filtration rate, leading to a possible overestimation of postoperative AKI incidence. Although this dilemma has been addressed in the intraoperative scenario, the incidence and impact of oliguria in the first postoperative day represents a gap in the current literature. Our main goal is to describe the incidence, risk factors and clinical outcomes related to postoperative oliguria.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort conducted in four intensive care units (ICUs) across two private Brazilian hospitals, analyzing patients admitted after intermediate and high-risk surgeries between January 1, 2018 and December 31, 2022.</div></div><div><h3>Results</h3><div>1476 patients were included in the final analysis. Overall, 656 (44,5 %) were males, and the median age was 61,7 years. Oliguria was identified in 508 (34,4 %) patients within the first 24 h after surgery. Vasopressor requirement at admission, non-elective procedures, male sex and baseline serum creatinine were higher among oliguric patients. Among oliguric patients, age and basal serum creatine were higher among those who experienced AKI. Although only 12,4 % of oliguric patients developed AKI according to serum creatinine criterion, this incidence was significantly higher than in non-oliguric group (3,6 %), RR 3.42, IC 95 % 2.3–5.1 (<em>p</em> &lt; 0.01). AKI recovery, RRT, ICU and hospital free days, and mortality were similar between the groups.</div></div><div><h3>Conclusions</h3><div>Postoperative oliguria is common after intermediate and high-risk surgical procedures and increases the risk of AKI. However, oliguria was largely unrelated with kidney disfunction measured by serum creatinine (87,6 %), raising doubts on whether diuresis overestimates AKI incidence in the postoperative setting.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154976"},"PeriodicalIF":3.2,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692897","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}