Critical Care Research and Practice最新文献

{"title":"Caffeine Treatment for Prostaglandin E1-Induced Apnea Prevention in Congenital Heart Disease Neonates: A Randomized Clinical Trial.","authors":"Ladan Salamati, Bahar Dehghan, Mohammad Reza Sabri, Alireza Ahmadi, Mehdi Ghaderian, Chehreh Mahdavi, Davood Ramezani Nezhad, Atefeh Karbasi, Mohsen Sedighi","doi":"10.1155/ccrp/4923280","DOIUrl":"10.1155/ccrp/4923280","url":null,"abstract":"<p><p><b>Background:</b> Congenital heart diseases (CHDs) are structural abnormalities of the heart or great vessels. Prostaglandin E1 (PGE1) is used to maintain the ductus arteriosus open in neonates with ductal-dependent heart lesions but is associated with apnea. We aimed to investigate the effects of caffeine therapy on the occurrence of apnea in neonates with CHD. <b>Methods:</b> This single-blinded randomized clinical trial was performed on 51 CHD neonates who were treated with PGE1 or PGE1 + caffeine. PGE1 dose ranged from 0.01 to 0.1 mcg/kg/min, and caffeine was administered initially at 20 mg/kg, followed by a daily bolus dose of 10 mg/kg. Demographic and clinical data, prevalence of apnea, and PGE1 side effects were recorded and analyzed. <b>Results:</b> A total of 51 CHD neonates receiving PGE1 + caffeine (<i>n</i> = 25) and PGE1 (<i>n</i> = 26) were included. The median age of total neonates was 2 (1-7) days, and 57% were female. There was no statistically significant difference between the baseline characteristics of participants, but neonates in the caffeine group received a higher mean dose of PGE1 (0.03 ± 0.17 vs. 0.02 ± 0.02, <i>p</i>=0.049) over the course of the treatment. The prevalence of apnea was 20% in the PGE1 + caffeine group and 42% in the PGE1 group (<i>p</i>=0.086). In the Cox regression model, the age of neonates had a significant effect on time to apnea in patients receiving caffeine (HR = 0.87, <i>p</i>=0.04). <b>Conclusion:</b> Our findings fail to demonstrate that caffeine therapy reduces PGE1-induced apnea. A larger randomized controlled trial is required to confirm or refute the efficacy of caffeine in reducing the incidence of apnea associated with PGE1 infusion. <b>Trial Registration:</b> Iranian Registry of Clinical Trials: IRCT20220503054729N1.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2025 ","pages":"4923280"},"PeriodicalIF":1.8,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12086028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102988","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":"Acute Ischemic and Hemorrhagic Cerebrovascular Strokes After Cardiac Surgery: Incidence, Predictors, and Outcomes.","authors":"Mohamed Laimoud, Mosleh Nazzal Alanazi, Patricia Machado, Mary Jane Maghirang, Suha Althibait, Shatha Al-Mutlaq, Munirah Alomran, Imad Bou-Saad, Lamees Subhi, Reem Almutairi, Renad Nadhreen, Hamza Busaleh, Sreedevi Pillai, Saranya Sidharthan, Tareq Almazeedi, Zohair Al-Halees","doi":"10.1155/ccrp/6645363","DOIUrl":"https://doi.org/10.1155/ccrp/6645363","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background:&lt;/b&gt; Many studies have attempted to determine the incidence, predictors, and outcomes of cerebrovascular stroke after cardiac surgery, with different, sometimes contradictory, results because of differences in population risk profiles, study design, and surgical details. &lt;b&gt;Methods:&lt;/b&gt; We retrospectively reviewed the records of all adult patients who underwent cardiac surgery between January 2018 and January 2023. Univariate, multivariable, and survival analyses were performed to identify the outcomes and predictors of ischemic and hemorrhagic strokes. &lt;b&gt;Results:&lt;/b&gt; Of the 1334 patients studied, 70 (5.2%) patients had ischemic stroke, 23 (1.7%) had intracranial hemorrhage (ICH), and 9 (0.7%) had combined ischemic and hemorrhagic strokes. The patients who developed strokes had longer cardiopulmonary bypass (CPB) time (165.5 [126, 234] versus 136 [104, 171] min, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and aortic cross-clamping time (112 [79, 163] versus 89 [75, 121.5] min, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), with higher rates of intra-aortic balloon pump (IABP) use (13.3% vs. 4.4%, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), veno-arterial extracorporeal membrane oxygenation use (24.8% vs. 12.37%, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), and mediastinal exploration for bleeding (22.9% vs. 8.9%, &lt;i&gt;p&lt;/i&gt; &lt; 0.0011). The patients who developed strokes showed increased hospital mortality (37.1% vs. 5.6%, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), new need for dialysis (29.5% vs. 10.7%, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), higher rate of tracheostomy (13.3% vs. 1.2%, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), and longer intensive care unit (ICU) stay (12 [7, 28] versus 3 [2, 8] days, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and post-ICU stay (16 [7, 39] versus 5 [3, 10] days, &lt;i&gt;p&lt;/i&gt; &lt; 0.001). Follow-up for 36.4 (21.67, 50.7) months revealed an insignificant mortality difference, but there was an increased risk of recurrent cerebrovascular strokes. Cox-proportional hazards regression showed an increased risk of hospital mortality after cardiac surgery in patients who developed acute ischemic stroke (HR: 5.075, 95% CI: 3.28-7.851, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and ICH (HR: 12.288, 95% CI: 7.576-19.93, &lt;i&gt;p&lt;/i&gt; &lt; 0.001). Logistic multivariable regression showed that increased age, hyperlactatemia, redo cardiotomy, history of old stroke, CPB time, and perioperative IABP use were the predictors of ischemic stroke. Young age, old ICH, hyperlactatemia, and hypoalbuminemia were the predictors of postoperative ICH. Postoperative ICH, ischemic stroke, atrial fibrillation, chronic kidney disease, blood lactate level 24 h after surgery, and increased age were the independent predictors of mortality. &lt;b&gt;Conclusions:&lt;/b&gt; Ischemic and hemorrhagic cerebrovascular strokes are serious complications that increase postoperative mortality and prolong hospitalization after cardiac surgery. Atrial fibrillation was not a significant predictor of postoperative stroke but was a predictor of hospital mortality. Careful attention should be given to maintaining hemodynamic stability and minimizing CPB time, especially in patients with a hist","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2025 ","pages":"6645363"},"PeriodicalIF":1.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12058317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015289","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":"Reassessing the Risk: A Retrospective Analysis of CLABSI Risk in Femoral, Internal Jugular, and Subclavian Central Venous Catheters.","authors":"Alexandra Vaughan-Masamitsu, Wesley Paulson, Robert Hodes, Cain Dudek","doi":"10.1155/ccrp/8193419","DOIUrl":"https://doi.org/10.1155/ccrp/8193419","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background:&lt;/b&gt; Central line-associated bloodstream infections (CLABSIs) represent a significant healthcare challenge due to their association with increased morbidity, mortality, and financial burden. Current guidelines discourage the use of the femoral vein (FV) for central venous catheter (CVC) placement due to a perceived higher infection risk compared to the internal jugular vein (IJV) or subclavian (SCV) sites. However, recent evidence questions this assumption and suggests that femoral CVCs may carry similar risks to other sites, emphasizing the need for updated analyses. &lt;b&gt;Objective:&lt;/b&gt; The goal of this study was to address the misconception that femoral CVCs have a higher associated risk for developing CLABSI compared to other central line sites. This study evaluates risk for CLABSI across FV, IJV, and SCV sites. &lt;b&gt;Methods:&lt;/b&gt; Using the TriNetX Research Network to conduct a retrospective cohort analysis, initial queries identified 99,216 patients who were encountered between 2014 and 2025 for CVC placement. Following propensity score matching, 65,265 of these patients were retained for statistical analysis. Patients were categorized based on anatomic CVC placement sites into IJV, SCV, and FV cohorts. CLABSI incidence was determined using ICD-10-CM codes within 1 day to 1 month post-CVC insertion. Sensitivity analyses were conducted for the 2014-2025 period, as well as for the 2014-2019 and 2019-2025 periods to assess overall risk and evaluate for changes in CLABSI risk by anatomic site over time. Outcomes were compared using risk percentages, risk ratios, and odds ratios with 95% confidence intervals to compare differences in risk for CLABSI across different sites. &lt;b&gt;Results:&lt;/b&gt; Overall, femoral CVCs were not associated with a statistically significant higher risk of CLABSI compared to IJV or FV CVCs from the overall period of 2014-2025. Only the risk difference between IJV and SCV CVCs over 2014-2025 showed a statistically significant difference. IJV CVCs were associated with a higher risk of CLABSI compared with SCV CVCs, with a risk difference of 0.089% (95% CI: 0.006%, 0.171%, &lt;i&gt;Z&lt;/i&gt; = 2.11, &lt;i&gt;p&lt;/i&gt;=0.0348), a risk ratio of 1.708 (95% CI: 1.033, 2.826), and an odds ratio of 1.71 (95% CI:1.033, 2.831). Over the 2014-2019 period, there was no statistically significant risk difference between the IJV and FV cohorts (risk difference 0.09%, 95% CI: -0.035%, 0.215%, &lt;i&gt;Z&lt;/i&gt; = 1.415, &lt;i&gt;p&lt;/i&gt;=0.1569). Comparing the IJV to SCV CLABSI rates for the 2014-2019 period, the risk difference was 0.112% (95% CI: -0.009%, 0.234%, &lt;i&gt;Z&lt;/i&gt; = 1.81, &lt;i&gt;p&lt;/i&gt;=0.07). For the 2019-2025 period between the IJV and FV cohorts, the risk difference was -0.077% (higher risk in the FV cohort), which was not a statistically significant difference (95% CI: -0.193%, 0.04%, &lt;i&gt;Z&lt;/i&gt; = -1.289, &lt;i&gt;p&lt;/i&gt;=0.1974). Comparing the IJV to SCV CLABSI rates for the 2019-2025 period, the risk difference was 0.117% (95% CI: = -0.006%, 0.24%, &lt;i&gt;Z&lt;/i&gt; = 1.861, ","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2025 ","pages":"8193419"},"PeriodicalIF":1.8,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054352","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":"Incidence and Risk Factors of Ventilator-Associated Pneumonia in Cardiac Arrest in Patients With Selective Digestive Decontamination.","authors":"Erik Roman-Pognuz, Stefano Di Bella, Alberto Enrico Maraolo, Mauro Giuffrè, Chiara Robba, Giuseppe Ristagno, Clifton W Callaway, Umberto Lucangelo","doi":"10.1155/ccrp/7669466","DOIUrl":"10.1155/ccrp/7669466","url":null,"abstract":"<p><p><b>Background:</b> Out-of-hospital cardiac arrest (OHCA) is a leading cause of morbidity and mortality. Temperature management (TM) is recommended since hyperthermia is associated with worse outcomes. Pneumonia is a frequent occurrence following OHCA, and some studies suggest that TM may have a negative impact on its development. Selective digestive decontamination (SDD) is used in some centers to reduce the incidence of pneumonia in intensive care unit (ICU), but its use remains controversial. This study aims to assess the incidence, risk factors and clinical course of VAP after OHCA. <b>Methods:</b> We conducted a retrospective cohort study on 169 consecutive OHCA patients after their admission in ICU. All patients were treated with TM and SDD. Pharyngeal swabs were analyzed twice weekly. The primary outcome was the incidence of VAP and non-VAP. Secondary aim was to identify the risk factors associated with VAP and its effect on patients' outcome. <b>Results:</b> Incidence of VAP was 5.3%, while incidence of non-VAP was 9.5%. In multivariate analysis, male gender (sHR 3.01; CI 1.1-7.9), increase of white blood cells (WBC) count > 30% over 5 days (sHR 2.32; CI 1.23-3.9), heart disease (sHR 2.4; CI 1.36-4.59), and bacterial colonization of the pharynx (sHR 2.79; CI 1.13-4.39) were significantly associated with VAP. <b>Conclusions:</b> Pharyngeal colonization could be useful to identify patients at higher risk of VAP development. The low rate of VAP in this cohort suggests that SDD can prevent VAP after OHCA. Further studies are needed to explore the potential of SDD in OHCA patients.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2025 ","pages":"7669466"},"PeriodicalIF":1.8,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11964724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774596","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":"Significance of Right Ventricular Dysfunction in Predicting Short-Term Survival Among Patients With Sepsis and Septic Shock: A Prognostic Analysis.","authors":"Sukrisd Koowattanatianchai, Patchara Kochaiyapatana, Narueporn Eungsuwat, Vimonsri Rangsrisaeneepitak, Katkanit Thammakumpee, Kiraphol Kaladee","doi":"10.1155/ccrp/5511135","DOIUrl":"10.1155/ccrp/5511135","url":null,"abstract":"<p><p><b>Objective:</b> This study sought to evaluate the association between right ventricular (RV) dysfunction and short-term in-hospital mortality among patients with sepsis and septic shock. <b>Methods:</b> A prospective cohort study was conducted on adult patients admitted at Burapha University Hospital for sepsis and septic shock from October 1, 2022, through June 30, 2023, who underwent echocardiography within 72 h after admission. RV dysfunction and other echocardiographic findings were analyzed and defined using the American Society of Echocardiography criteria. The primary outcome examined in this study was 28-day in-hospital mortality. Secondary outcomes included maximal blood lactate levels, length of intensive care unit (ICU) stay, and duration of mechanical ventilation. <b>Results:</b> A total of 104 patients (mean age: 69.54 ± 14.88 years) were enrolled in this study. Among the included patients, 32 (30.8%) developed septic shock whereas 20 (19.2%) exhibited RV dysfunction. Cox regression analysis showed that patients with RV dysfunction had a 28-day in-hospital mortality rate 5.53 times higher than that of patients with normal RV function (95% confidence intervals: 1.98-15.42; <i>p</i>=0.001). Regarding the secondary outcomes, patients with RV dysfunction exhibited a significantly higher mean serum lactate level (5.72 ± 4.96 vs. 3.74 ± 3.29 mmol/L; <i>p</i>=0.034) and length of ICU stay (6.50 ± 2.86 vs. 2.84 ± 1.56 days; <i>p</i>=0.020) than did those with normal RV function. <b>Conclusions:</b> RV dysfunction was associated with increased short-term mortality among patients with sepsis and septic shock. Assessing RV function among these patients facilitates precise prognostication and aids in guiding treatment strategies aimed at reducing mortality. <b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT06193109.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2025 ","pages":"5511135"},"PeriodicalIF":1.8,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11928220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693958","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":"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}