Critical Care Research and Practice最新文献

{"title":"Safety of Early Mobilization in Adult Neurocritical Patients: An Exploratory Review.","authors":"Leonardo Arzayus-Patiño, José Luis Estela-Zape, Valeria Sanclemente-Cardoza","doi":"10.1155/ccrp/4660819","DOIUrl":"10.1155/ccrp/4660819","url":null,"abstract":"<p><p><b>Introduction:</b> Early mobilization has shown significant benefits in the rehabilitation of critically ill patients, including improved muscle strength, prevention of physical deconditioning, and reduced hospital length of stay. However, its safety in neurocritical patients, such as those with strokes, traumatic brain injuries, and postsurgical brain surgeries, remains uncertain. This study aims to map and examine the available evidence on the safety of early mobilization in adult neurocritical patients. <b>Methods:</b> A scoping review was conducted following PRISMA-SCR guidelines and the Joanna Briggs Institute (JBI) methodology. The research question focused on the safety of early mobilization in neurocritical patients, considering adverse events, neurological changes, hemodynamic changes, and respiratory changes. A comprehensive search was performed in databases such as PubMed, BVS-LILACS, Ovid MEDLINE, and ScienceDirect, using specific search strategies. The selected studies were assessed for methodological quality using JBI tools. <b>Results:</b> Of 1310 identified articles, 25 were included in the review. These studies comprised randomized controlled trials, prospective observational studies, retrospective studies, and pre- and postimplementation intervention studies. The review found that early mobilization in neurocritical patients is generally safe, with a low incidence of severe adverse events, and does not increase the risk of vasospasm, and most complications were manageable with protocol adjustments and continuous monitoring. <b>Conclusion:</b> Early mobilization in neurocritical patients has been shown to be potentially safe under specific conditions, without a significant increase in severe complications when properly monitored. However, the available evidence is limited by the heterogeneity of protocols and study designs, emphasizing the need for further research. The importance of tailoring mobilization protocols to each patient and ensuring continuous monitoring is highlighted. Additional studies with larger sample sizes are needed to fully understand the associated risks and optimize mobilization strategies.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2025 ","pages":"4660819"},"PeriodicalIF":1.8,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rurality and Outcomes of Patients Undergoing Mechanical Thrombectomy for Acute Ischemic Stroke.","authors":"Cassidy Lavin, Jacob Epstein, Alvin Huanwen Chen, Minahil Cheema, Jerry Yang, Alexa Aquino, Angie Chan, Nancy Le, Gillian Cooper, Ambra Palushi, Chad Schrier, Dheeraj Gandhi, Seemant Chaturvedi, Jessica Downing, Quincy K Tran","doi":"10.1155/ccrp/4995600","DOIUrl":"10.1155/ccrp/4995600","url":null,"abstract":"<p><p><b>Objective:</b> To investigate differences in outcomes among patients with acute ischemic stroke from large vessel occlusion (AIS-LVO) transferred from rural and urban hospitals to University of Maryland Medical Center (UMMC) for mechanical thrombectomy (MT). <b>Methods:</b> We identified patients with AIS-LVO transferred to UMMC for MT from July 2016 to June 2023. Primary outcome was good neurologic outcome, defined as 90-day modified Rankin score 0-2. Multivariable logistic regression was used to identify predictors for the primary outcome. <b>Results:</b> We analyzed 526 patients, 233 (44%) transferred from rural hospitals in Maryland. Median NIHSS was 17 [IQR 14-20] and was similar between groups. Patients from state-designated rural hospitals were transferred from a longer distance (difference of 57.8 km, <i>p</i>=0.001), but had shorter intervals from last known well time to recanalization (difference 19 min, <i>p</i>=0.24). They had similar odds of good neurologic outcome (OR 0.88, 95% CI 0.43-1.78, <i>p</i>=0.72). <b>Conclusions:</b> Patients transferred from rural areas for MT for AIS-LVO, at our institution, had a similar likelihood of achieving 90-day mRS 0-2 as those transferred from urban areas.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2025 ","pages":"4995600"},"PeriodicalIF":1.8,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11824784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Hemodynamic Management and Postoperative Outcomes After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Prospective Observational Study.","authors":"Sohan Lal Solanki, Vandana Agarwal, Reshma P Ambulkar, Malini P Joshi, Shreyas Chawathey, Shivacharan Patel Rudrappa, Manish Bhandare, Avanish P Saklani","doi":"10.1155/ccrp/8815211","DOIUrl":"https://doi.org/10.1155/ccrp/8815211","url":null,"abstract":"<p><p><b>Background:</b> Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) has become standard treatment for peritoneal cancers and metastases, significantly enhancing survival rates. This study evaluated the relationship between tumor burden, hemodynamic management, and postoperative outcomes after CRS-HIPEC. <b>Methodology:</b> This study included 203 patients undergoing CRS-HIPEC. The study was registered with ClinicalTrials.gov (NCT02754115). Routine and advanced hemodynamic monitoring was performed. Data on fluid and blood transfusions, coagulation management, body temperature, blood gases, Peritoneal Carcinomatosis Index (PCI), and chemotherapeutic agents used were collected. Postoperatively, complications using the Clavien-Dindo classification were employed. Primary outcomes assessed PCI's impact on hemodynamic parameters and fluid management, with secondary outcomes including postoperative complications, mortality, and length of ICU and hospital stays. <b>Results:</b> Patients with PCI > 20 experienced significantly longer surgeries (796.2 ± 158.3 min) as compared with patients with PCI 0-10 (551 ± 127 min) and patients with PCI between 11 and 20 (661.78 ± 137.7 min) (<i>p</i> ≤ 0.01). Patients with PCI > 20 received higher fluid requirements (mean: 5497.7 ± 2401.9 mL) as compared with PCI 0-10 (2631.2 ± 1459.9 mL) and PCI 10-20 (3964.65 ± 2044.6 mL) (<i>p</i> ≤ 0.01). Patients with PCI > 20 also had a prolonged ICU stays (median: 4 days) as compared with PCI 0-20 (median: 3 days). However, these differences were not significant in patients with PCI between 10 and 20. Significant differences in CI and SVI were observed among PCI groups during and after HIPEC. Significant differences were also observed among PCI groups for postoperative complications. Although 30-day survival rates varied clinically, they did not reach statistical significance. <b>Conclusion:</b> A higher PCI score was significantly associated with increased duration of surgery, fluid requirements, the need for invasive hemodynamic monitoring, postoperative complications, and longer ICU stays. Tailoring perioperative strategies based on PCI scores has the potential to optimize these outcomes. <b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT02754115.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2024 ","pages":"8815211"},"PeriodicalIF":1.8,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11698608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of COVID-19 Treatments in Intensive Care Unit: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Mahmoud Alwakeel, Francois Abi Fadel, Abdelrahman Nanah, Yan Wang, Mohamed K A Awad, Fatima Abdeljaleel, Mohammed Obeidat, Talha Saleem, Saira Afzal, Dina Alayan, Mary Pat Harnegie, Xiaofeng Wang, Abhijit Duggal, Peng Zhang","doi":"10.1155/ccrp/2973795","DOIUrl":"10.1155/ccrp/2973795","url":null,"abstract":"<p><p><b>Objectives:</b> Examining the cumulative evidence from randomized controlled trials (RCTs), evaluating the use of pharmacological agents for the treatment of COVID-19 infections in patients with critical illness. <b>Data Sources:</b> Databases Medline, Embase, Web of Science, Scopus, CINAHL, and Cochrane. Study Selection: Inclusion criteria were RCTs that enrolled patients with confirmed or suspected COVID-19 infection who are critically ill. Only RCTs that examined therapeutic agents against one another or no intervention, placebo, or standard of care, were included. <b>Data Extraction:</b> Pairs of reviewers extracted data independently. Outcomes of interest included the overall reported mortality defined as either the ICU mortality, hospital mortality, mortality within 28 days or mortality within 90 days. <b>Data Synthesis:</b> A total of 40 studies (11,613 patients) evaluated 50 therapeutic intervention arms divided into five main therapy categories; steroids, antiviral medications, immunomodulators, plasma therapies [intravenous immunoglobulins (IVIG), convalescent plasma and/or, therapeutic plasma exchange], and therapeutic anticoagulation. Immunomodulators was the only group with possible mortality benefit, risk ratio (RR) 0.83 (95% CI 0.73; 0.95), with nonsignificant heterogeneity (<i>I</i> ² = 8%, <i>p</i>=0.36). In contrast, the other therapy groups showed no significant impact on mortality, as indicated by their respective pooled RRs: steroids [RR 0.91 (95% CI 0.82; 1.01), <i>I</i> ² = 31%], antiviral medications [RR 1.11 (95% CI 0.82; 1.49), <i>I</i> ² = 57%], plasma therapies [RR 0.77 (95% CI 0.58; 1.01), <i>I</i> ² = 36%], and anticoagulation [RR 1.06 (95% CI 0.95; 1.18), <i>I</i> ² = 0%]. <b>Conclusions:</b> This meta-analysis highlights both the heterogeneity and a lack of benefit from therapies evaluated during the COVID-19 pandemic. Many of the RCTs were developed based on limited observational data. Future RCTs investigating pharmaceutical interventions in critically ill patients during pandemics need to be designed based on better evidence.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2024 ","pages":"2973795"},"PeriodicalIF":1.8,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11617054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Satisfaction Levels Among Families of Intensive Care Unit Patients in Saudi Arabia: A Cross-Sectional Study.","authors":"Abdullah Shbeer, Mohammed Ageel","doi":"10.1155/2024/8481083","DOIUrl":"10.1155/2024/8481083","url":null,"abstract":"<p><p><b>Background:</b> Regularly measuring family satisfaction with intensive care unit (ICU) experience is crucial for ensuring high-quality care and identifying areas for improvement. This study aimed to evaluate family satisfaction with the ICU in Saudi Arabia. <b>Methods:</b> A cross-sectional survey was conducted among 248 family members of patients admitted to various ICUs. The survey assessed family satisfaction via a validated questionnaire, the Critical Care Family Satisfaction Survey (CCFSS), which includes five subscales: assurance, information, comfort, proximity, and support. Demographic data were also collected. Descriptive and inferential statistics were calculated. <b>Results:</b> The demographic distribution revealed that a majority of the participants were female (70.97%, <i>n</i> = 176), with the relationships with the patients predominantly being parents (41.94%, <i>n</i> = 104) or offspring (33.87%, <i>n</i> = 84). The overall satisfaction score was 3.79 ± 1.26, with 66.13% of the participants reporting high satisfaction, 20.97% reporting intermediate satisfaction, and 12.90% reporting low satisfaction. The mean subscale scores were as follows: assurance (3.82 ± 1.2), information (3.83 ± 1.25), comfort (3.81 ± 1.27), proximity (3.72 ± 1.28), and support (3.78 ± 1.28). The highest satisfaction scores were observed for sharing in decisions, noise levels, and staff honesty, whereas the lowest scores were for visiting hours flexibility, transfer preparation, and staff responsiveness. Males reported significantly greater satisfaction (4.24 ± 1.20) than females did (3.61 ± 1.11, <i>p</i> = 0.007). <b>Conclusions:</b> This study revealed moderate to high levels of family satisfaction with the ICU, with significant differences based on sex. The findings highlight the importance of effective communication, family involvement in decision-making, and supportive ICU policies. ICUs should regularly assess family satisfaction and use the results to guide quality improvement efforts, with a focus on areas with lower satisfaction scores.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2024 ","pages":"8481083"},"PeriodicalIF":1.8,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11524694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum Concentration at 24 h With Intensive Beta-Lactam Therapy in Sepsis and Septic Shock: A Prospective Study: Beta-Lactam Blood Levels in Sepsis.","authors":"Evelyne Thériault, Massilia Benali, Samuel Starnino, Hugues Blain, Nicolas Goettel, Bianca Beloin-Jubinville, Amélie Marsot, Francois Lamontagne","doi":"10.1155/2024/9757792","DOIUrl":"https://doi.org/10.1155/2024/9757792","url":null,"abstract":"<p><p><b>Introduction:</b> Early administration of appropriate antibiotics has been shown to be among the most effective interventions to reduce mortality in septic patients. We evaluated the attainment of efficacy and safety targets at 24 h associated with the use of intensive beta-lactam therapy in patients admitted to the intensive care unit for sepsis. <b>Methods:</b> This was a prospective study with patients who received beta-lactams for sepsis or septic shock between February 2023 and September 2023. The antibiotic dose was unadjusted for renal function and administered by a loading dose followed by extended infusions, according to local practices. Blood samples were taken at the trough 24 h after the start of the beta-lactam to obtain serum levels. These levels were compared to efficacy and innocuity thresholds found in the literature. <b>Results:</b> Among 36 included patients, all of them achieved serum concentrations above the minimum inhibitory concentration (MIC) for 100% of the therapeutic interval and 75% of them achieved serum concentrations above four times the MIC for 100% of the therapeutic interval. The predefined toxicity thresholds were reached by 8.3% of patients. Renal impairment was the factor most associated with the achievement of higher serum levels. <b>Conclusion:</b> Nonrenally adjusted doses of beta-lactams administered by extended infusion showed good attainment of effective concentrations and few toxic concentrations in critically ill patients with sepsis or septic shock. Further studies are needed to better define the association between toxic concentrations and toxicity manifestations.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2024 ","pages":"9757792"},"PeriodicalIF":1.8,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11519078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the Impact of Simulation-Based Learning on Student Satisfaction and Self-Confidence in Critical Care Medicine.","authors":"Mohammed Ageel","doi":"10.1155/2024/6908005","DOIUrl":"10.1155/2024/6908005","url":null,"abstract":"<p><p><b>Background:</b> Simulation-based learning (SBL) is increasingly used in medical education to prepare students for clinical practice. This study aimed to evaluate the satisfaction and self-confidence of final-year medical students after attending SBL in critical care medicine. <b>Methods:</b> A cross-sectional study was conducted among 117 final-year medical students at Jazan University, Saudi Arabia. Participants attended SBL sessions focusing on critical care skills and scenarios. Data were collected using a self-administered questionnaire, which included demographic information and the Student Satisfaction and Self-Confidence in Learning Scale. Statistical analyses included descriptive and inferential statistics. <b>Results:</b> The study population comprised 61.54% females and 38.46% males, with a majority aged 24 years. Students who rated their overall learning experience as \"Good\" showed significantly higher satisfaction (4.20 ± 0.77) and self-confidence (4.20 ± 0.69) scores. The overall mean scores for satisfaction and self-confidence were 3.71 ± 0.88 and 3.70 ± 0.87, respectively. A strong positive correlation (<i>p</i> < 0.001) was found between satisfaction and self-confidence levels. The highest satisfaction and self-confidence scores were associated with the variety of learning materials and the instructors' helpfulness. <b>Conclusion:</b> The SBL intervention was effective in enhancing student satisfaction and self-confidence in critical care medicine. The strong correlation between satisfaction and self-confidence highlights the importance of well-designed SBL programs in preparing medical students for clinical practice in critical care settings.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2024 ","pages":"6908005"},"PeriodicalIF":1.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11511592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparison of the Outcomes of COVID-19 Vaccinated and Nonvaccinated Patients Admitted to an Intensive Care Unit in a Low-Middle-Income Country.","authors":"Waleed Bin Ghaffar, Muhammad Faisal Khan, Moeed Bin Abdul Ghaffar, Muhammad Sohaib, Asma Rayani, Muhammad Mehmood Alam, Syed Talha Sibtain, Zahra Cheema, Asad Latif","doi":"10.1155/2024/9571132","DOIUrl":"https://doi.org/10.1155/2024/9571132","url":null,"abstract":"<p><p>Patients critically afflicted with coronavirus disease 2019 (COVID-19) often need intensive care unit (ICU) admission, despite comprehensive vaccination campaigns. The challenges faced by healthcare systems in low-middle-income countries, including limited infrastructure and resources, play a pivotal role in shaping the outcomes for these patients. This study aimed to meticulously compare outcomes between COVID-19 vaccinated and nonvaccinated patients admitted to the ICU. In addition, demographic factors and the ICU course influencing mortality were also assessed. A retrospective review of records from the COVID-ICU of Aga Khan University Hospital spanning July 2021-March 2022 included 133 patients. Statistical analyses, encompassing the Mann-Whitney U-test and chi-square/Fisher exact test, discerned quantitative and qualitative differences. Stepwise multivariable logistic regression models with forward selection identified factors associated with hospital mortality. Results revealed comparable cohorts: vaccinated (48.13%) and nonvaccinated (51.87%). Vaccinated individuals, characterized by advanced age and higher Charlson Comorbidity Index, exhibited more critical disease (89.1%; <i>p</i> value: 0.06), acute respiratory distress syndrome (96.9%; <i>p</i> value: 0.013) and elevated inflammatory markers. Despite these differences, both cohorts exhibited similar overall outcomes. Factors such as decreased PaO2/FiO2 ratio on admission and complications during ICU stay were significantly associated with in-hospital mortality. In conclusion, despite advanced age and increased frailty among vaccinated patients, their mortality rate remained comparable to nonvaccinated counterparts. These findings underscore the pivotal role of vaccination in mitigating severe outcomes within this vulnerable population.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2024 ","pages":"9571132"},"PeriodicalIF":1.8,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dyschloremia and Renal Outcomes in Critically Ill Patients With Sepsis: A Prospective Cohort Study: Dyschloremia and Renal Outcomes in Sepsis.","authors":"Saurabh M Thanekar, Vishal Shanbhag, Attur Ravindra Prabhu, Shankar Prasad Nagaraju, Dharshan Rangaswamy, Srinivas Vinayak Shenoy, Mohan Varadarayanahalli Bhojaraja, Indu Ramachandra Rao","doi":"10.1155/2024/8848405","DOIUrl":"https://doi.org/10.1155/2024/8848405","url":null,"abstract":"<p><p><b>Introduction:</b> Chloride is the most abundant extracellular anion; however, abnormalities of serum chloride (dyschloremia) are often overlooked. This study aimed to study the association of dyschloremia with AKI and major adverse kidney events at Day 30 (MAKE30) in critically ill patients with sepsis. <b>Materials and Methods:</b> This prospective single-center cohort study included adult patients with sepsis admitted in a tertiary care hospital in India. Patients with advanced chronic kidney disease, requiring dialysis at admission, or with hospital stay of less than 72 h were excluded. Hyperchloremia and hypochloremia were defined as chloride levels of > 110 mEq/L and < 95 mEq/L, respectively. The primary outcome measure was MAKE30-a composite of death, need for dialysis, or sustained loss of kidney function at Day 30. <b>Results:</b> In a cohort of 400 patients with a mean age of 60 (±15) years, AKI was seen in 301 (75.2%) and MAKE30 in 171 (42.8%). Hyperchloremia and hypochloremia were seen in 19.3% (<i>n</i> = 77) and 32.3% (<i>n</i> = 129), respectively, in the first 72 h of ICU stay. Hypochloremia, but not hyperchloremia, was independently associated with both MAKE30 (OR: 2.56, 95% CI: 1.13-5.79; <i>p</i>=0.024) and new-onset or worsening AKI (OR: 2.52, 95% CI: 1.17-5.41; <i>p</i>=0.019). There was no association between hyperchloremia and either MAKE30 (OR: 1.07, 95% CI: 0.43-2.69; <i>p</i>=0.882) or new-onset/worsening AKI (OR: 0.89, 95% CI: 0.38-2.09; <i>p</i>=0.781). <b>Conclusion:</b> Hypochloremia, but not hyperchloremia, was associated with MAKE30 in this cohort of critically ill patients with sepsis. <b>Trial Registration:</b> Clinical Trial Registry identifier: CTRI//2022/02/040519.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2024 ","pages":"8848405"},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11519073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consensus for the Development of a New Early Warning Score for Predicting Patients' Clinical Deterioration in Angola: A Delphi Study.","authors":"Esmael Tomás, Ana Escoval, Maria Lina Antunes","doi":"10.1155/2024/9070807","DOIUrl":"10.1155/2024/9070807","url":null,"abstract":"<p><p><b>Background:</b> Nearly 30 years since its inception, the early warning scores (EWSs) remain pivotal, yet variations have emerged for hospital and prehospital use. Aggregated scores, reflecting multiple physiological parameters, outperform single-parameter systems in assessing acute illness severity, though consensus on optimal approaches is lacking. Resource-limited countries, including Angola, lack adapted EWSs, emphasizing the need for cost-effective and adaptable solutions to enhance patient care. <b>Objective:</b> To explore the perspectives of Angolan experts to identify physiological parameters suitable for incorporation into existing EWSs, allowing the development of a new tool adjusted to the healthcare context in Angola. <b>Methods:</b> We conducted a three-round Delphi survey, engaging a national expert panel comprising twenty-five physicians and nurses with expertise in internal medicine, surgery, emergency rooms, intensive care units, and/or teachers at universities or at teaching courses in these fields. Participants were asked to rate items using a five-point Likert scale. Consensus was achieved if the items received a rating ≥ 80% from the panel. <b>Results:</b> Consensus was evident for the inclusion of standard physiological parameters, such as systolic blood pressure, heart rate, respiratory rate, temperature, oxygen saturation, neurological status, and the presence or absence of supplemental oxygen. Furthermore, there was consensus for the consideration of specific items, namely, seizures, jaundice, cyanosis, capillary refill time, and pain-typically not included in the current EWSs. Consensus was reached regarding the exclusion of both oxygen saturation and temperature measurements in healthcare settings where oximeters and thermometers might not be readily available. <b>Conclusion:</b> Angolan experts were able to identify the physiological parameters suitable for incorporation into the basic EWSs. Further study must be conducted to test and validate the impact of the newly suggested vital parameters on the discriminant and predictive capability of a new aggregated model specifically adjusted to the Angolan healthcare setting.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2024 ","pages":"9070807"},"PeriodicalIF":1.8,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11442038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}