Journal of Intensive Care Medicine最新文献

{"title":"Implementing a Bedside Percutaneous Tracheostomy and Ultrasound Gastrostomy Team Reduces Length of Stay and Hospital Costs Across Multiple Critical Care Units in a 1500 Bed Tertiary Care Center.","authors":"Douglas Houghton, Samarth Patel, Sergey Gerasim, Yaroslav Buryk, Nina Massad, Ayham Alkhachroum, Hany Y Atallah, Kristine O'Phelan","doi":"10.1177/08850666241289115","DOIUrl":"10.1177/08850666241289115","url":null,"abstract":"<p><p><b>Background:</b> Thousands of critically ill patients every year in the United States receive tracheostomy and gastrostomy procedures. Recent research has investigated the benefits of a combined team approach to these procedures, with associated decreases in length of stay (LOS) and hospital costs. This study's objective was to determine if implementing a bedside percutaneous tracheostomy and percutaneous ultrasound gastrostomy (PUG) team would reduce LOS and hospital costs. <b>Design and Methods:</b> This retrospective chart review compares the impact of implementing an ICU bedside percutaneous tracheostomy and PUG service team to the hospital's previous workflow (ie, pre-implementation). Inclusion criteria were adult patients with Ventilator Dependent Respiratory Failure (VDRF), a clinical indication for both procedures while admitted to the ICU and received both tracheostomy and gastrostomy procedures while admitted to the hospital. Pre- and post-implementation groups were compared across patients' demographics, clinical characteristics, and outcomes. ICU LOS, hospital LOS and total hospital costs were the primary outcome measures. <b>Results:</b> A total of 101 adult critically ill patients were included in the analysis; 49 patients were in the pre-implementation group and 52 patients in the post-implementation group (ie, PUG group). Patients in the PUG group had a significantly shorter mean ICU LOS and hospital LOS, 10.9- and 14.7-day reductions respectively (p = 0.010, p = 0.006). PUG group patients also had a significant reduction in total hospital costs, a per patient cost savings of $34 778 (p = 0.043). <b>Conclusions:</b> This study supports implementing a bedside percutaneous tracheostomy and PUG team to reduce LOS and total hospital costs in patients with VDRF.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"404-409"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12003929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467752","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":"Utilization of NIRS Monitor to Compare the Regional Cerebral Oxygen Saturation Between Dexmedetomidine and Propofol Sedation in Mechanically Ventilated Critically ill Patients with Sepsis- A Prospective Randomized Control Trial.","authors":"Atul Kumar Patidar, Puneet Khanna, Lokesh Kashyap, Bikash R Ray, Souvik Maitra","doi":"10.1177/08850666241288141","DOIUrl":"10.1177/08850666241288141","url":null,"abstract":"<p><p><b>Aim & Background:</b> Delirium frequently occurs in the acute phase of sepsis and is associated with increased ICU and hospital length of stay, duration of mechanical ventilation, and higher mortality rates. We utilized the Near-Infrared Spectroscopy monitor to measure and compare the regional cerebral oxygen saturation in mechanically ventilated patients of sepsis receiving either dexmedetomidine or propofol sedation and assessed the association between delirium and regional cerebral oxygen saturation. <b>Methods:</b> A single center prospective randomized control trial conducted over a period of two years, 54 patients were included, equally divided between propofol and dexmedetomidine groups. Patients received a blinded study drug, propofol (10 mg/mL) or dexmedetomidine (5 mcg/mL) via infusion pump according to randomization. Infusion rates were adjusted every 10 min based on weight-based titration tables, aiming for target sedation (RASS -2 to 0). Management components included pain monitoring using the CPOT score and delirium assessment using CAM-ICU score. <b>Results:</b> Dexmedetomidine group showed higher mean regional cerebral oxygen saturation as compared to propofol group (<i>P</i> = .036). No significant differences were found in mechanical ventilation or ICU stay durations, delirium-free days, or sedation cessation reasons. Delirium occurred in 36 patients, with lower mean regional cerebral oxygen saturation as compared to non-delirious patients. <b>Conclusion:</b> The dexmedetomidine group had higher regional cerebral oxygen saturation compared to the propofol group. Delirious patients showed lower cerebral oxygen saturation than non-delirious patients, suggesting a link between sedation type, cerebral oxygenation, and delirium. <b>CTRI registration:</b> REF/2021/11/048655 N.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"379-387"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381026","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":"Transtracheal Ultrasound as a Preventive Tool for ETT Related Adverse Events and Malpositioning in the ICU.","authors":"David Yamane, Philip Dela Cruz, Mary Heekin Wilby, Sasa Ivanovic, Mark Munoz, Katrina Hawkins, Danielle Davison","doi":"10.1177/08850666241296523","DOIUrl":"10.1177/08850666241296523","url":null,"abstract":"<p><p>Introduction: Endotracheal tube (ETT) malpositioning can result in a myriad of complications. Daily chest radiographs (CXR) is the gold standard in monitoring these complications. Point-of-care transtracheal ultrasound (TTUS) is an emerging imaging modality for ETT positioning. We compared ETT malpositioning related adverse events and diagnostic accuracy of ETT malpositioning of a combined TTUS and CXR surveillance protocol to CXR alone. Methods: We performed a randomized control trial of mechanically ventilated patients in an academic multidisciplinary ICU. In the intervention group, the clinical team was provided the results of the TTUS with CXR results to aid in clinical decision making. In the control group only CXR results were used. Adverse events included bronchial migration, vocal cord herniation, balloon rupture, unplanned extubation, and the development of aspiration pneumonia. Data was analyzed via Fisher's Exact Test. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"441-446"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950165","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":"Real-World Outcomes of Hemoadsorption with CytoSorb^® in Patients with Septic Shock: Insights from a Single-Center Study.","authors":"Giorgio Berlot, Paolo Carocci, Valentina Votrico, Barbara Iacoviello, Nicolò Taverna, Ugo Gerini, Vittorio di Maso, Ariella Tomasini","doi":"10.1177/08850666251331905","DOIUrl":"https://doi.org/10.1177/08850666251331905","url":null,"abstract":"<p><p>BackgroundHemoadsorption is currently employed to treat septic shock and other clinical conditions involving massive inflammatory mediator release. CytoSorb^®, a device utilizing synthetic resin microbeads, provides a large adsorption surface for blood purification. This study aimed to review the clinical course of patients with septic shock treated with CytoSorb^® in our hospital's intensive care unit (ICU).Patients and MethodsThis study retrospectively analyzed the clinical course of patients with septic shock treated with CytoSorb^®, focusing on treatment timing and the volume of blood processed.ResultsBetween July 1, 2016, and December 31, 2023, 175 patients (106 men, 69 women; median age: 67 years, interquartile [IQR]: 58-85) received CytoSorb^® therapy. Survivors exhibited a significantly lower simplified acute physiology score at admission than nonsurvivors. CytoSorb^® was initiated within 24 h of shock onset in 102 patients (58%, early starters) and between 25 and 48 h in 73 patients (42%, late starters). Hemodynamic improvements elevated mean arterial pressure and reduced lactate, procalcitonin, C-reactive protein, sequential organ failure assessment scores, and noradrenaline doses in survivors. These effects were more pronounced in early starters receiving intensive treatment, who also demonstrated significantly lower lactate levels and higher mean arterial pressure at the end of therapy. Overall, 86 patients (49%) died in the ICU. Survivors underwent longer treatment durations and processed greater blood volumes than nonsurvivors.ConclusionsIn patients with septic shock treated with CytoSorb^® within 48 h of onset, treatment intensity-rather than timing-was associated with lower ICU mortality rates.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251331905"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764129","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":"Phenobarbital Addition to Alcohol Withdrawal Treatment Offers Better Outcomes than Dexmedetomidine in Hospitalized Patients.","authors":"Mary Matecki, Ahmed Noureldin, Riad Akkari, Zachary Cohen, Matthew McMullan, Katrina Hawkins, Jeffrey Williams, Azuka Nwude, David Yamane, Babak Sarani, Sean M Lee, Susan Kartiko","doi":"10.1177/08850666251328881","DOIUrl":"https://doi.org/10.1177/08850666251328881","url":null,"abstract":"<p><p>BackgroundThis study directly compares outcomes of phenobarbital and dexmedetomidine as adjuncts to symptom-triggered benzodiazepine treatment for alcohol withdrawal syndrome (AWS).MethodsThis is a retrospective cohort analysis at a single tertiary referral institution in a major urban center in the United States. In hospitalized patients above 18 years with AWS between May 1, 2018, and July 31, 2021 we compared the hospital length of stay (LOS), ICU LOS, mechanical ventilation incidence and duration of patients who received dexmedetomidine versus phenobarbital as adjuncts to lorazepam-based treatment. Patients were divided into two cohorts based on treatment they received - dexmedetomidine/lorazepam (DEX) versus phenobarbital/lorazepam (PHENO). The use of phenobarbital or dexmedetomidine was left to the discretion of the treating bedside physician.ResultsOne hundred fifty-six patients met inclusion criteria with 102 patients (65%) in the DEX group and 54 patients (35%) in the PHENO group. The PHENO group had a lower probability of intubation (OR 0.33, 95% CI 0.15-0.70, p = 0.005) and shorter hospital LOS (IRR 0.45, 95% CI 0.31-0.64, p < 0.001), and ICU LOS (IRR 0.58, 95% CI 0.34-1.00, p = 0.050). For both hospital and ICU LOS, the PHENO group had shorter LOS than dexmedetomidine at lower doses of lorazepam (<3 mg), but this protective effect diminished at higher doses of lorazepam, at a rate of 10% (hospital LOS, IRR 1.10, 95% CI 1.05-1.16, p < 0.001) and 6% (ICU LOS, IRR 1.06, 95% CI 0.99-1.13, p = 0.074) per milligram increase in lorazepam.ConclusionsA symptom- triggered lorazepam regimen including early phenobarbital administration for severe alcohol withdrawal syndrome is associated with lower hospital LOS and need for intubation compared to a symptom triggered lorazepam regimen with dexmedetomidine adjunct.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251328881"},"PeriodicalIF":3.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729965","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":"\"Unlocking Airway Predictability: The Role of Ultrasound in Assessing Cormack-Lehane Grade Through Anterior Neck Soft Tissue Thickness at the Level of Vocal Cords and Hyoid Bone\".","authors":"D G S R Krishnamoorthy, K J Devendra Prasad, K Rajesh, Y Nikhil Reddy, S R Aravind","doi":"10.1177/08850666251323257","DOIUrl":"10.1177/08850666251323257","url":null,"abstract":"<p><p><b>Introduction:</b> Endotracheal intubation in the emergency department can be challenging due to difficult airways. The Cormack-Lehane score helps assess intubation difficulty based on laryngoscopic views, with higher scores indicating poorer visibility. This study examines whether point-of-care ultrasound measurements of anterior neck soft tissue thickness at the vocal cords and hyoid bone can predict difficult intubations with Macintosh blade. <b>Methodology:</b> Prospective observational study included 100 patients over 18 years old who required rapid sequence intubation in emergency department at a tertiary care hospital in India, from March to December 2023. Patients with cervical spine pathology and pregnant women were excluded. Ultrasound measurements of anterior neck soft tissue thickness were taken at the vocal cords and hyoid bone. Direct laryngoscopy with a Macintosh blade was then performed, and the CL grade was recorded. Intubation difficulty was categorized based on CL grades 1-2 (easy) and 3-4 (difficult). Diagnostic performance metrics, including sensitivity, specificity, and Area under the Receiver Operating Characteristic Curve (AUROC), were calculated. <b>Results:</b> The study found that increased anterior neck soft tissue thickness at both the hyoid bone and vocal cords was significantly associated with higher CL grades (<i>P</i> < .001). The AUROC values were 0.961 for hyoid bone measurements and 0.970 for vocal cords measurements, indicating high diagnostic accuracy. The sensitivity and specificity of these measurements suggest they are effective predictors of difficult intubation. Notably, higher ANS measurements correlated with a higher likelihood of requiring multiple intubation attempts. <b>Conclusion:</b> This study supports the use of ultrasound-measured anterior neck soft tissue thickness at the hyoid bone and vocal cords as effective predictors of difficult intubation. The high accuracy and statistical significance of these measurements suggest they can improve pre-intubation assessments and guide clinical decisions. Using these ultrasound measurements in routine practice could help better predict intubation challenges and improve patient outcome.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251323257"},"PeriodicalIF":3.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700474","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":"Incidence of Acute Kidney Injury (AKI) in Critically Ill Patients Receiving Concomitant Vancomycin with Piperacillin-Tazobactam or Cefepime; a Systemic Review and Meta-analysis.","authors":"Lamees Alaradi, Nada Albariqi, Mona Alanazi, Naif Alghassab, Tief Aseri, Lujain Alahmadi, Ahmad Alahmadi, Aseel Althobaiti, Yousef Alqarafi, Habeeba Bokhari, Rayan A Qutob, Mohanad Almaimani","doi":"10.1177/08850666251323265","DOIUrl":"https://doi.org/10.1177/08850666251323265","url":null,"abstract":"<p><p><b>Background:</b> Nephrotoxicity remains a significant concern in the management of critically ill patients receiving antibiotic therapy. The combination of Vancomycin and Piperacillin-Tazobactam (VPT) is frequently employed to combat multidrug-resistant infections. However, emerging evidence suggests a potential increase in the risk of acute kidney injury (AKI) associated with this combination. This study aims to systematically review and analyze the nephrotoxic risk of the VPT combination in comparison to Vancomycin with Cefepime (VC) combination therapy. <b>Methodology:</b> We conducted a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was performed in databases including PubMed and Google Scholar for studies published until 2024. Studies that reported AKI incidence in patients treated with VPT, or VC were included. The data were analyzed using random-effects models to estimate pooled incidence rates of AKI. Subgroup analyses were performed based on patient demographics and baseline renal function. <b>Results:</b> A total of six studies involving 23 794 patients were included in the analysis. The pooled incidence of AKI in the VPT group was found to be 29.9% (95% CI: 25.3%-38.4%), significantly higher than that of the VC (22.7%) (<i>P</i> < .05). A comparative analysis demonstrated a significantly higher risk of AKI in patients on VPT compared to VC (1.503; 95% CI: 1.221-1.849 <i>P</i> < .001). <b>Conclusion:</b> The findings of this study underscore a significant increase in the risk of AKI associated with the Vancomycin and Piperacillin-Tazobactam combination in critically ill patients. Clinicians should exercise caution when prescribing this combination, particularly for patients with pre-existing renal dysfunction.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251323265"},"PeriodicalIF":3.0,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692521","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":"The Relationship Between the Type of Microorganisms Isolated in Cultures and Outcomes in Children on Extracorporeal Membrane Oxygenation Support Following Corrective Surgery for Congenital Heart Disease.","authors":"Mónica Arias-Andrade, Carlos Miguel Santacruz, Martha Cecilia Reyes Casas, Juan Sebastián Barajas, Marco Fidel Sierra-Zuñiga, Catalina Duque, Martha I Àlvarez-Olmos, Nestor Sandoval, Jaime Fernández-Sarmiento","doi":"10.1177/08850666251327995","DOIUrl":"https://doi.org/10.1177/08850666251327995","url":null,"abstract":"<p><p>ObjetivesExtracorporeal membrane oxygenation (ECMO) after surgery for congenital heart disease (CHD) provides hemodynamic support to patients when their myocardial function is temporarily affected. Postoperative infections in children with CHD on ECMO are a significant challenge, as they complicate recovery and affect outcomes during this critical period of hemodynamic support. The objective of this study was to analyze the mortality related to the micro-organism isolated in children with ECMO after surgery for CHD.MethodsRetrospective cohort study from January 2014 to December 2021 at a university hospital in Colombia. The primary outcome was the infection-related inpatient mortality of children undergoing surgery for CHD who received ECMO support, according to the type of microorganisms isolated in cultures.ResultsA total of 3307 surgeries for CHD were performed during the study period. Of these, 108 (3.3%) required veno-arterial ECMO after surgery. We found positive cultures in 35% of these patients. The incidence of infection was 14.5 cases per 1000 days of ECMO. The overall mortality of infected patients was 54.1%. Isolation of Gram-negative bacteria in cultures was associated with higher odds of dying compared with other isolations, regardless of age and type of CHD (aOR 6.92 95% CI 1.91-25.02; p < .01). We found no differences in hospital length of stay or PICU stay based on the type of bacteria isolated. The most commonly isolated Gram-negative bacteria was <i>Klebsiella pneumoniae</i>, which was associated with longer mechanical ventilation [26 (IQR 18.2-31.0) versus 11 (IQR 8.0-15.0) days; p < .01].ConclusionsThe presence of a Gram-negative bacterium as the cause of infection in any sample was associated with increased odds of mortality in children receiving ECMO support in the postoperative period following corrective surgery for congenital heart disease. Infections occurred in 1 out of 3 children on ECMO following surgery for CHD.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251327995"},"PeriodicalIF":3.0,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692589","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":"The Cleveland Clinic Post-ICU Recovery Clinic: Early Experience During the COVID-19 Pandemic.","authors":"Kavya Kommaraju, Heather Torbic, Joshua Veith, Xiaofeng Wang, Michelle Biehl","doi":"10.1177/08850666251326551","DOIUrl":"https://doi.org/10.1177/08850666251326551","url":null,"abstract":"<p><p>BackgroundOver half of ICU survivors experience post intensive care syndrome (PICS). Few PICS clinics were operational in the United States at the onset of the COVID-19 pandemic. Here we describe early experience of such a clinic at a large academic medical center. Our objective was to describe the (a) model of care (b) clinic interventions (c) short-term cognitive, psychiatric, and functional outcomes (d) one-year outcomes of COVID-19 ICU survivors at the Cleveland Clinic post-ICU recovery clinic (PIRC).MethodsWe conducted a retrospective cohort study through a chart review of all patients seen in PIRC from April 2020 - December 2020. A total of 59 patients completed the visit with 49% being virtual, and 51% being in-person. The cohort was predominantly white (50.8%), and male (57.6%) with a median age of 58.2 years. We screened for cognitive and psychiatric impairments using several different validated questionnaires. Functional impairments were self-reported and detected after assessment by a physical therapist. Quantifiable clinic interventions were referrals, pharmacy medication reconciliation, and vaccine administration. One-year outcomes were health care utilization, and death.ResultsIn our cohort, 36%, 39.6%, and 17% of patients screened positive for cognitive impairment, anxiety and/or depression, and PTSD respectively. 42.3% of patients had lower extremity mobility impairment. 57.6% of patients required at least one referral after clinic. Of the 67.9% of patients who were working and 93.9% driving prior to hospitalization, only 24.6% and 73.2% had returned to those activities, respectively. The most common pharmacy intervention was discontinuation of a medication no longer in use. By one year, 34% of patients had hospital re-admissions with 5% requiring the ICU. There were no deaths.ConclusionsAdult survivors of COVID-19 critical illness have impairments in all PICS domains as well as high health care utilization in the first year after hospital discharge.MeSH TermsPost intensive care syndrome, COVID-19Key Points/SummaryAdult survivors of COVID-19 critical illness have impairments in all PICS domains as well as high health care utilization in the first year after hospital discharge. Post-ICU recovery clinics can help survivors with recovery.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251326551"},"PeriodicalIF":3.0,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692577","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":"A Retrospective Cohort Study of the Role of Palliative Care Consultation for Patients on Extracorporeal Membrane Oxygenation.","authors":"Samira Teeri, Pooja Singh, Ritika Gadodia, Shikha Kapil, Maxwell Hockstein, Keki Balsara, Akram M Zaaqoq, Anirudh Rao","doi":"10.1177/08850666251327105","DOIUrl":"https://doi.org/10.1177/08850666251327105","url":null,"abstract":"<p><p>BackgroundExtracorporeal membrane oxygenation (ECMO) serves as a critical intervention for patients with severe cardiac and pulmonary dysfunction. Given the high rates of mortality and morbidity, as well as the impact on families, palliative care (PC) integration is recommended. We aimed to examine the indications and outcomes of ECMO patients at a tertiary care hospital and evaluate the impact of PC consultation on patient outcomes.MethodsWe conducted a retrospective cohort study of 306 patients cannulated for venovenous (VV) or venoarterial (VA) ECMO from January 2020 to December 2022. We analyzed demographics, ECMO indications, and outcomes, comparing those who received PC consultations with those who did not.ResultsOf the 306 patients analyzed, 220 were on VA-ECMO and 86 on VV-ECMO. The overall in-hospital mortality rate was 49%. Patients on VV-ECMO had longer ECMO durations (8 vs 4 days) and hospital stays (31 vs 16 days, P < 0.001) than patients on VA-ECMO. PC consultations were associated with increased ECMO duration and hospital stay in both groups (P < 0.001). Mortality among patients who received PC consultations was not statistically different from those who did not (P = 0.68). Notably, patients with obesity on VA-ECMO had 2.3 times higher odds of in-hospital death (P = 0.027).ConclusionPC consultation is integral in managing patients on ECMO, focusing on holistic support for patients and their families. Further prospective studies are warranted to explore the psychosocial benefits of PC for patients on ECMO and their family members.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251327105"},"PeriodicalIF":3.0,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692438","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}