Journal of Intensive Care Medicine最新文献

{"title":"Parameters Predictive of Propofol-Associated Acute Pancreatitis in Critically Ill Patients with COVID-19 Pneumonia: A Retrospective Cohort Study.","authors":"Iyiad Alabdul Razzak, Nikolay Korchemny, Daniel Smoot, Aju Jose, Allison Jones, Lori Lyn Price, Bertrand L Jaber, Andrew H Moraco","doi":"10.1177/08850666241265671","DOIUrl":"10.1177/08850666241265671","url":null,"abstract":"<p><strong>Background: </strong>Propofol, a commonly used agent for short- and long-term sedation, is associated with acute pancreatitis. The main indirect mechanism of propofol-associated acute pancreatitis is by inducing hypertriglyceridemia. Patients with severe coronavirus disease 2019 (COVID-19) pneumonia often require prolonged mechanical ventilation and sedation. We examined the incidence rate of acute pancreatitis among critically ill adults with COVID-19 pneumonia on mechanical ventilation receiving propofol. In addition, we attempted to determine cutoff levels of serum triglycerides and doses of propofol that are predictive of propofol-associated acute pancreatitis.</p><p><strong>Methods: </strong>This was a multicenter retrospective cohort study using a large dataset of hospitalized patients with COVID-19. The collected data included the number of days on propofol, cumulative doses of propofol, peak levels of serum triglycerides, serum lipase levels, and abdominal imaging findings. We used receiver-operating characteristic analysis in conjunction with Youden's index to identify the optimal thresholds for propofol administration parameters and levels of triglycerides that would provide maximal sensitivity and specificity for predicting acute pancreatitis.</p><p><strong>Results: </strong>Out of 499 critically ill patients with COVID-19 pneumonia, 154 met the inclusion criteria. Six (4%) patients had suspected acute pancreatitis based on elevated serum lipase levels. Cutoff values greater than 688 mg/dL for peak level of triglycerides, 4.5 days on propofol, 3007 mg/day for average daily propofol dose, and 24 113 mg for cumulative propofol dose were associated with high risk of suspected acute pancreatitis. The negative predictive values for suspected acute pancreatitis using these cutoffs ranged from 98% to 100%.</p><p><strong>Conclusions: </strong>Propofol use in critically ill COVID-19 patients is associated with a low incidence rate of acute pancreatitis. We identified cutoff values for serum triglycerides and cumulative propofol dose that are linked to higher risk of propofol-associated pancreatitis. More research is needed to examine the true incidence of propofol-associated pancreatitis and help develop optimal cutoff values for certain parameters to help guide safe propofol administration.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"67-73"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141751922","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":"Patterns and Outcomes of Opioid Use Before and After Hospitalization for Critical Illness: A Population-Based Cohort Study.","authors":"Nicole R Henry, Matthew A Warner, Andrew C Hanson, Phillip J Schulte, Nafisseh S Warner","doi":"10.1177/08850666241268473","DOIUrl":"10.1177/08850666241268473","url":null,"abstract":"<p><p><b>Background:</b> Hospitalization represents a major access point for prescription opioids, yet little is known regarding patterns and outcomes of opioid exposures before and after hospitalization for critical illness. <b>Methods:</b> This is an observational, population-based cohort study of adults (≥18 years) hospitalized for critical illness from 2010 to 2019. Multivariable models assess associations between opioid exposures prior to hospitalization, classified according to the Consortium to Study Opioid Risks and Trends, and posthospitalization opioid exposures and clinical outcomes through 1-year posthospitalization. <b>Results:</b> Of 11 496 patients, 6318 (55%) were men with a median age of 66 (51, 79) years and 40% (n = 4623) surgical admissions. Prehospitalization opioid availability included 8449 (73%) none, 2117 (18%) short-term, 471 (4%) episodic, and 459 (4%) long-term. Thirty-nine percent (4144/10 708) of hospital survivors were discharged with opioids, with higher prescribing rates for surgical admissions (55%). Greater preadmission opioid exposures were associated with higher prevalent opioid availability at 1 year (odds ratio [95% confidence interval] 24.1 [18.3-31.8], 9.42 [7.18-12.3], and 2.55 [2.08-3.12] for long-term, episodic, and short-term exposures, respectively, vs none, <i>P</i> < .001). Greater preadmission opioid exposures were associated with longer hospitalizations (1.13 [1.04-1.23], 1.15 [1.06-1.25], and 1.08 [1.04-1.13] multiplicative increase in geometric mean, <i>P</i> < .001), more readmissions (hazard ratio [HR] 2.08 [1.74-2.49], 1.88 [1.56-2.26], and 1.48 [1.33-1.64], <i>P</i> < .001), and higher 1-year mortality (HR 1.59 [1.28-1.98], 1.75 [1.41-2.18], and 1.49 [1.32-1.69], <i>P</i> < .001). Similar associations were observed across surgical and nonsurgical admissions. <b>Conclusions:</b> Prehospitalization opioid exposures in survivors of critical illness are associated with clinical outcomes through 1 year and may serve as important prognostic markers.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"85-93"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893531","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":"Evaluation of Effectiveness and Safety of Dexmedetomidine in non-Mechanically Ventilated COVID-19 Critically ill Patients: A Multicentre Cohort Study.","authors":"Ahmed Basilim, Khalid Eljaaly, Ohoud Aljuhani, Ghazwa B Korayem, Ali F Altebainawi, Wadha J Aldhmadi, Abdulrahman Alissa, Mashael AlFaifi, Abdullah F Alharthi, Ramesh Vishwakarma, Reem Alqahtani, Ghaida D Alahmari, Afnan M Ibn Khamis, Abeer A Alenazi, Aisha Alharbi, Lulwa Alfaraj, Yasser F Alshammari, Marwah I Abdulqader, Mada B Alharbi, Bayan M Alanazi, Atheer E Alhamazani, Khalid Al Sulaiman","doi":"10.1177/08850666241268498","DOIUrl":"10.1177/08850666241268498","url":null,"abstract":"<p><p><b>Background:</b> Dexmedetomidine (DEX) is a highly favored sedative agent in critically ill patients owing to its anxiolytic and analgesic properties, lower risk of delirium, and minimal respiratory depression. Additionally, DEX exhibits anti-inflammatory properties, which have prompted its use in managing COVID-19 patients to mitigate cytokine storm and multi-organ dysfunction. Thus, this study aims to evaluate the safety and effectiveness of DEX use in critically ill patients with COVID-19. <b>Method:</b> This multicenter, retrospective cohort study included adult patients with confirmed COVID-19 who were admitted to the ICUs and did not require invasive mechanical ventilation (MV). Patients were categorized into two groups based on receiving DEX use within 72 h of ICU admission. The primary outcome was respiratory failure requiring invasive MV; other outcomes were considered secondary. <b>Results:</b> A total of 155 patients were included in the study after propensity matching. DEX did not reduce respiratory failure requiring invasive MV (HR 0.66; 95% CI (0.28, 1.53), <i>P</i> = .33). However, the time for invasive MV was statistically significantly shorter in the DEX group compared with the control group (beta coefficient (95%CI): - 1.05 (-2.03, -0.07), <i>P</i> = .03). In contrast, ICU and hospital Length of stay (LOS) were not statistically significant compared to the control group (beta coefficient 0.04 (95% CI -0.29, 0.38), <i>P</i> = .80, and beta coefficient - 0.03 (95% CI -0.33, 0.26), <i>P</i> = .81, respectively). In addition, the 30-day and in-hospital mortality rates were similar between the two groups (HR 1.1; 95% CI 0.97, 1.20, <i>P</i> = .14, and HR 1.01; 95% CI 0.95, 1.06, <i>P</i> = .90, respectively). <b>Conclusion:</b> Dexmedetomidine did not appear to lower the risk of respiratory failure necessitating invasive mechanical ventilation in critically ill patients. However, the mean time for invasive mechanical ventilation was shorter in the DEX group. Future interventional studies are required to confirm our findings.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"74-84"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648288","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":"Pathogenic Burden, Antimicrobial Resistance Pattern and Clinical Outcome of Nosocomial Bloodstream Infections in Intensive Care Unit.","authors":"Deepak Kumar, Monika Chaudhary, Naresh Kumar Midha, Gopal Krishana Bohra, Durga Shankar Meena, Vibhor Tak, Hembala Rathore, Vishavjeet Rathore, Meruvu Hari Vaishnavi, Neetha Tr, Sadik Mohammed, Nikhil Kothari, Pradeep Bhatia","doi":"10.1177/08850666241305043","DOIUrl":"https://doi.org/10.1177/08850666241305043","url":null,"abstract":"<p><p><b>Purpose:</b> Nosocomial bloodstream infections with multidrug-resistant microorganisms have become a common health threat in intensive care settings worldwide. Understanding antimicrobial resistance and the outcomes of these infections is crucial for addressing this issue. This study aimed to investigate the burden, antimicrobial resistance, and 28-day outcomes of nosocomial bloodstream infections in the intensive care unit. <b>Materials and Methods:</b> This retrospective study was conducted in a multispecialty intensive care unit at a tertiary care hospital in western India. Adult patients aged ≥18 years with bloodstream infections acquired after 48 h of admission were included in the analysis. <b>Results:</b> A total of 245 patients suspected of having nosocomial infections in the intensive care unit were evaluated, and 179 were included in the study. Gram-negative bacteremia was identified in the majority of cases, affecting 111 (62%) patients. Carbapenem-resistant <i>Acinetobacter baumannii</i> was the most prevalent pathogen, found in 21.2% (38/179) of patients. <i>Candida</i> species were detected in 37 (20.6%) cases, and gram-positive cocci were identified in 31 (17.3%) patients, with vancomycin-sensitive <i>Enterococci</i> being the most common gram-positive cocci isolated from blood. The central venous catheter was the most frequent source of bloodstream infection, identified in 66 (36.9%) patients. Among all patients, 28-day mortality was observed in 102 (57%) patients. Higher quick sepsis-related organ failure (qSOFA) scores at the onset of bloodstream infection, central venous catheters as a source of infection, inability to initiate early appropriate therapy and septic shock at the onset of bloodstream infection were identified as independent predictors of mortality in patients with nosocomial bloodstream infections. <b>Conclusion:</b> An increased burden of gram-negative bacilli and <i>Candida</i> was found to cause nosocomial bloodstream infections, with very high rates of antimicrobial resistance. Early appropriate diagnosis and treatment play a critical role in improving survival. Additionally, enhanced infection prevention and control practices are necessary to mitigate the heavy burden of infections caused by multidrug-resistant organisms in critical care settings.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666241305043"},"PeriodicalIF":3.0,"publicationDate":"2024-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877174","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":"Examination of Risk Factors Affecting the Development of BSI and Mortality in Critically Ill COVID-19 Patients Hospitalized in Intensive Care Unit (ICU): A Single-Center Retrospective Study.","authors":"Çağla Keskin Sarıtaş, Halit Özsüt, Aysun Benli, Seniha Başaran","doi":"10.1177/08850666241305347","DOIUrl":"https://doi.org/10.1177/08850666241305347","url":null,"abstract":"<p><strong>Background: </strong>Various studies have shown that the incidence of BSI is greater in COVID-19 patients hospitalized in the intensive care unit (ICU).</p><p><strong>Aims: </strong>Our study aimed to determine the risk factors for BSI, mortality rates, and factors affecting mortality in adult COVID-19 patients hospitalized in the ICU.</p><p><strong>Methods: </strong>All COVID-19 patients who met the study criteria and stayed in intensive care for more than 2 days at a tertiary university hospital during the two-year pandemic period were included in the study. Logistic regression analysis was used to determine the risk factors for BSI and mortality.</p><p><strong>Results: </strong>We found that respiratory rate (RR) ≥ 30 breaths per minute at the time of admission [OR: 2.342 (95% CI: 1.12-4.897)] and antibiotic use in the month before admission ICU [OR: 3.137 (95% CI: 1.321-7.451)] were independent risk factors for BSI in COVID-19 patients. Subanalysis was also performed according to the doses of immunomodulators such as anakinra, tocilizumab, and corticosteroids, and it was found that they had no effect on the BSI (<i>P</i> > .05). The predominant causative pathogens were <i>K. pneumoniae</i>, <i>A. baumannii</i> and enterococci. The multidrug resistant rate among bacteria was 78%. Although their comorbidities and disease severity at the time of ICU admission were similar, patients with BSIs had a higher mortality rate (58.1 to 81.9%, <i>P</i> = .000). The SAPS-2 score at ICU admission [OR: 3.095 (95% CI: 1.969-4.865)] and mechanical ventilation requirement throughout the ICU admission [OR: 9.314 (95% CI: 3.878-22.37)] were found to be independent risk factors for mortality by multivariate analysis. BSI was not found to be a risk factor for mortality (> .05).</p><p><strong>Conclusions: </strong>Antibiotic use in patients with severe COVID-19 significantly increases the risk of BSI; unnecessary antibiotic use should be avoided.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666241305347"},"PeriodicalIF":3.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864604","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":"Ig-M and Ig-A Enriched Ig-G Infusion as Adjuvant Therapy in the Critically ill Patients Experiencing SARS-CoV-2 Severe Infection.","authors":"Alberto Corona, Sara Simoncini, Giuseppe Richini, Ivan Gatti, Clemente Santorsola, Andrea Patroni, Giacomina Tomasini, Alice Capone, Elena Zendra, Myriam Shuman","doi":"10.1177/08850666241301689","DOIUrl":"https://doi.org/10.1177/08850666241301689","url":null,"abstract":"<p><strong>Introduction: </strong>SARS-CoV-2 in patients who need Intensive Care (ICU) is associated with a mortality rate ranging from 10 to 40%-45%, with an increase in morbidity and mortality in presence of sepsis.</p><p><strong>Methods: </strong>We assumed that immunoglobulin (Ig) M and IgA enriched IgG (IGAM) therapy may support SARS COV-2 sepsis-related phase improving patient outcome. We conducted a retrospective case-control study on all the patients admitted to our ICU during the three pandemic waves between February 2020 and April 2021. Upon ICU admission, patients received anticoagulants with the standard supportive treatment (ST) ± IGAM therapy. After matching for the baseline characteristics and treatments, the patients receiving IGAM therapy too (group A), were compared with those undergoing ST (group B) only.</p><p><strong>Results: </strong>85 patients were enrolled in group A, whereas 111 in group B. The mortality resulted lower in group A [37.6% versus 55.8%, OR: 0.7 (02-08), <i>P</i> = .01)]. A logistic regression analysis identified IGAM treatment as a survival predictor [OR: 0.35 (95%CI, 0.2-0.8)], whereas experiencing a super-infection [OR: 1.88 (95%CI, 1.5-4.9)] and a septic shock [OR: 1.92 (95%CI, 1.4-4.3)] as predictors of death. On day 7, the probability of dying was 3 times higher in patients treated with ST only. Variable life adjustment display (VLAD) was equal to 2.4 in group A, while - 2.2 group B (in terms of lives saved in relation with those expected, in according with Simplified Acute Physiology Score II (SAPS II) score.</p><p><strong>Conclusion: </strong>The treatment based on IGAM infusion seems to give an advantage chance of survival in SARS-CoV-2 severe infection. Further prospective studies are warranted.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666241301689"},"PeriodicalIF":3.0,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794924","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":"Palliative Care Outcomes for Critically ill Children After Rapid Whole Genome Sequencing.","authors":"Katherine Perofsky, Ami Doshi, Zaineb Boulil, Julia Beauchamp Walters, Euyhyun Lee, David Dimmock, Stephen Kingsmore, Nicole G Coufal","doi":"10.1177/08850666241304320","DOIUrl":"https://doi.org/10.1177/08850666241304320","url":null,"abstract":"<p><strong>Objectives: </strong>Clinical utility of rapid whole genome sequencing (rWGS) has been reported in 30-70% of pediatric ICU patients who receive a molecular diagnosis. Rapid molecular diagnostic techniques have been increasingly integrated into critical care, yet the influence of genetic test results on palliative care related decision making is largely unknown. This study evaluates palliative care related outcomes after rWGS.</p><p><strong>Design: </strong>Retrospective chart review.</p><p><strong>Setting: </strong>Tertiary children's hospital.</p><p><strong>Patients: </strong>Acutely ill children <math><mo>≤</mo></math> 18 years of age who received rWGS due to suspected genetic disease between July 2016 and November 2019.</p><p><strong>Interventions: </strong>rWGS with associated precision medicine.</p><p><strong>Measurements and main results: </strong>536 patients underwent rWGS, of whom 152 (28.4%) received a molecular diagnosis. Diagnostic rWGS was associated with more code status modifications, an increase in palliative care inpatient consultations, and greater enrollment in home-based palliative services. A comparison of diagnostic and nondiagnostic rWGS groups where palliative decisions were made prior to reporting of genomic testing results did not identify differences between the groups. In the subset of patients who had palliative care interventions (<i>n </i>= 57, 53% with diagnostic rWGS), time to palliative care consultation and time to compassionate extubation were shorter for patients with rWGS-based diagnoses (Kaplan-Meier method, <i>P </i>= .008; <i>P </i>= .015). Significantly more patients in this subgroup with diagnostic rWGS received home-based palliative care (Chi-squared, <i>P = </i>.025, 95% CI [-0.47, -0.05]). Univariate Poisson regression indicated that diagnostic rWGS is associated with significantly fewer emergency visits, PICU admissions, and unplanned intubations.</p><p><strong>Conclusions: </strong>Diagnostic rWGS correlates with more rapid engagement of pediatric palliative care services, higher enrollment rates in home-based palliative care, and shorter time to compassionate extubation. Further studies are needed with larger cohort sizes and validated pediatric palliative care outcome measurement tools to accurately determine if this change in care is driven by the underlying condition or knowledge of a molecular diagnosis.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666241304320"},"PeriodicalIF":3.0,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794941","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":"Valproic Acid for Hyperactive Delirium and Agitation in Critically Ill Patients.","authors":"Olivia Nuti, Cristian Merchan, Tania Ahuja, Serena Arnouk, John Papadopoulos, Alyson Katz","doi":"10.1177/08850666241302760","DOIUrl":"https://doi.org/10.1177/08850666241302760","url":null,"abstract":"<p><strong>Background: </strong>Delirium and agitation are common syndromes in critically ill patients. Valproic acid (VPA) has shown benefit in intensive care unit (ICU)-associated delirium and agitation, but further evaluation is needed.</p><p><strong>Objective: </strong>The purpose of this study was to evaluate the effectiveness and safety of VPA for hyperactive delirium and agitation in critically ill adult patients.</p><p><strong>Methods: </strong>A retrospective cohort study at NYU Langone Health was conducted in critically ill patients treated with VPA for hyperactive delirium or agitation from October 1, 2017 to October 1, 2022. The primary outcome was effectiveness of VPA, defined as a reduction in the total number of any concomitant psychoactive medication by day 3 of VPA treatment. Secondary outcomes included the effect of VPA on the doses of concomitant medications and adverse events.</p><p><strong>Results: </strong>A total of 87 patients were included in the final analysis. By day 3 of VPA treatment, a 33% reduction (<i>P</i> < .001) in the total number of concomitant psychoactive medications was observed. VPA decreased the need for sedatives, as assessed by midazolam equivalents, but no significant changes were seen with dexmedetomidine alone, opioids, or antipsychotics. A 10 mg/kg loading dose was utilized in 36% of the cohort and its use decreased the risk for initiating additional psychoactive medications by day 3 of therapy (OR 2.8, 95% CI 1.0-7.8, <i>P</i> = .047), with benefits noted as early as 48 h after initiation. Adverse events were low in the total cohort (10.3%).</p><p><strong>Conclusion and relevance: </strong>The addition of VPA to a complex pharmacologic regimen for hyperactive delirium and agitation is safe and can assist in the prevention of polypharmacy and overall workload in critically ill patients admitted primarily for cardiogenic shock and respiratory failure requiring mechanical ventilation.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666241302760"},"PeriodicalIF":3.0,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794945","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":"Cardiooncology in the ICU - Cardiac Urgencies in Cancer Care.","authors":"Stephanie Wu, Faizi Jamal","doi":"10.1177/08850666241303461","DOIUrl":"https://doi.org/10.1177/08850666241303461","url":null,"abstract":"<p><p>Cardiovascular disease is an increasing risk of morbidity and mortality in cancer patients, related to an growing number of aging survivors with pre-existing cardiovascular disease and the use of traditional and novel cancer therapies with cardiotoxic effects. While many cardiac complications are chronic processes that develop over time, there are many acute processes that may arise in hospitalized patients. It is important for hospitalists and critical care physicians to be familiar with the recognition and management of these conditions in this unique population. This article reviews the presentation and management of common cardiac urgencies in critically ill cancer patients including acute decompensated heart failure, acute coronary syndromes, arrhythmias, hypertensive crises, pulmonary embolism, pericardial tamponade and myocarditis.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666241303461"},"PeriodicalIF":3.0,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780361","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":"Prognostic Factors of Hospital Mortality After Near Hanging: A Retrospective two-Center French Study.","authors":"Yanis Gueddoum, Antoine Goury, Vincent Legros, Thierry Floch, Bruno Mourvillier, Guillaume Thery","doi":"10.1177/08850666241303881","DOIUrl":"https://doi.org/10.1177/08850666241303881","url":null,"abstract":"<p><strong>Introduction: </strong>suicide is a global public health issue, with over 800 000 people taking their own lives every year. However, most suicide attempts do not result in death. Hanging is the most common method used in France, often leading to post-hanging coma (PHC). The prognosis for patients admitted in intensive care unit (ICU) following PHC is poor, yet predictive criteria of mortality have been poorly evaluated.</p><p><strong>Methods: </strong>we retrospectively collected prehospital and in-hospital data from 65 patients hospitalized in 2 French ICU for PHC, between first March 2010 and first August 2023, and compared characteristics between patients alive and dead.</p><p><strong>Results: </strong>hospital mortality was 52%. Among baseline characteristics, SAPSII and pre-hospital cardiac arrest were associated with mortality, respectively 47 versus 62 (<i>P</i> = .005) and 32% versus 85% (<i>P</i> = .001). Concerning neuroprognostication, abnormal pupillary light reflex (PLR) was more frequent in patients who died (14% vs 56%, <i>P</i> = .002), as abnormal EEG (0% vs 32%, <i>P</i> = .002) and abnormal transcranial doppler (10% vs 35%, <i>P</i> = .031).</p><p><strong>Conclusion: </strong>we identified several poor prognostic factors associated with hospital mortality after PHC. Further larger-scale studies are needed to supplement these findings.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666241303881"},"PeriodicalIF":3.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780373","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}