Critical Care Research and Practice最新文献

{"title":"Comfort and Coordination among Interprofessional Care Providers Involved in Intubations in the Pediatric Intensive Care Unit.","authors":"Chetna K Pande,&nbsp;Kelsey Stayer,&nbsp;Thomas Rappold,&nbsp;Madeleine Alvin,&nbsp;Keri Koszela,&nbsp;Sapna R Kudchadkar","doi":"10.1155/2023/4504934","DOIUrl":"10.1155/2023/4504934","url":null,"abstract":"Background Successful execution of invasive procedures in acute care settings, including tracheal intubation, requires careful coordination of an interprofessional team. The stress inherent to the intensive care unit (ICU) environment may threaten the optimal communication and planning necessary for the safe execution of this complex procedure. The objective of this study is to characterize the perceptions of interprofessional team members surrounding tracheal intubations in the pediatric ICU (PICU). Methods This is a single-center survey-based study of staff involved in the intubation of pediatric patients admitted to a tertiary level academic PICU. Physicians, nurses, and respiratory therapists (RT) involved in tracheal intubations were queried via standardized, discipline-specific electronic surveys regarding their involvement in procedural planning and overall awareness of and comfort with the intubation plan. Qualitative variables were assessed by both Likert scales and free-text comments that were grouped and analyzed thematically. Results One hundred and eleven intubation encounters were included during the study time period, of which 93 (84%) had survey responses from at least 2 professional teams. Among those included in the analysis, the survey was completed 244 times by members of the PICU teams including 86 responses from physicians, 76 from nurses, and 82 from RTs. Survey response rates were >80% from each provider team. There were significant differences in interprofessional team comfort with nurses feeling less well informed and comfortable with the intubation plan and process compared to physicians and RTs (p < 0.001 for both). Qualitative themes including clear communication, adequate planning and preparation prior to procedure initiation, and clear definition of roles emerged among both affirmative and constructive comments. Conclusions Exploration of provider perceptions and emergence of constructive themes expose opportunities for teamwork improvement strategies involving intubations in the PICU. The use of a preintubation checklist may improve organization and communication amongst team members, increase provider morale, decrease team stress levels, and, ultimately, may improve patient outcomes during this high stakes, coordinated event.","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2023 ","pages":"4504934"},"PeriodicalIF":1.7,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10567513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41215805","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 Impact of Positive Fluid Balance on Sepsis Subtypes: A Causal Inference Study.","authors":"Sharad Patel,&nbsp;Adam Green,&nbsp;Yanika Wolfe,&nbsp;Gregory Felock,&nbsp;Samantha Epstein,&nbsp;Nitin Puri","doi":"10.1155/2023/2081588","DOIUrl":"10.1155/2023/2081588","url":null,"abstract":"<p><strong>Introduction: </strong>Sepsis, the leading cause of death in hospitalized patients globally, was investigated in this study, examining the varying effects of positive fluid balance on sepsis subtypes through causal inference.</p><p><strong>Methods: </strong>In this study, data from the eICU database were utilized, extracting 35 features from sepsis patients. Fluid balance during ICU stay was the treatment, and ICU mortality was the primary outcome. Data preprocessing ensured linear assumptions for logistic regression. Binarized positive fluid balance with mortality was examined using DoWhy's logistic regression, while continuous data were analyzed with random forest T-learner. ATE served as the primary metric.</p><p><strong>Results: </strong>Results revealed that septic patients with higher fluid balance had worse mortality outcomes, with an ATE of 0.042 (95% CI: (0.034, 0.047)) using logistic regression and an ATE of 0.0340 (95% CI: (0.028-0.040)) using T-learner. In the pulmonary sepsis subtype, higher mortality was associated with increased fluid balance, showing an ATE of 0.047 (95% CI: (0.037, 0.055)) using logistic regression and an ATE of 0.28 (95% CI: (0.22, 0.34)) with T-learner. Conversely, urinary sepsis patients had improved mortality with higher fluid balance, presenting an ATE of -0.135 (95% CI: (-0.024, -0.0035)) using logistic regression and an ATE of -0.28 (95% CI: (-0.34, -0.22)) with T-learner.</p><p><strong>Conclusion: </strong>Our research implies that fluid balance impact on ICU mortality differs among sepsis subtypes. Positive fluid balance raises mortality in sepsis and pulmonary sepsis but may protect against urinary sepsis. Further trials are needed to confirm these findings.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2023 ","pages":"2081588"},"PeriodicalIF":1.7,"publicationDate":"2023-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10564571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41215806","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":"Rate of Change of Rapid Shallow Breathing Index and Extubation Outcome in Mechanically Ventilated Patients.","authors":"Manjush Karthika,&nbsp;Farhan A Al Enezi,&nbsp;Lalitha V Pillai,&nbsp;Yaseen M Arabi","doi":"10.1155/2023/9141441","DOIUrl":"10.1155/2023/9141441","url":null,"abstract":"<p><strong>Background: </strong>Rapid shallow breathing index (RSBI) has been widely used as a predictor of extubation outcome in mechanically ventilated patients. We hypothesize that the rate of change of RSBI between the beginning and end of a 120-minute spontaneous breathing trial (SBT) could be a better predictor of extubation outcome than a single RSBI measured at the end of SBT in mechanically ventilated patients. <i>Methodology</i>. In this prospective observational study, we enrolled 193 patients who met the inclusion criteria, of whom 33 patients were unable to tolerate a 120-minute SBT and were excluded from the study. The study population consisted of 160 patients, categorized into three subgroups: patients with normal lung (no reported history of respiratory diseases), patients with airway disease, and patients with parenchymal disease who completed 120 minutes of SBT on low levels of pressure support ventilation. RSBI was obtained from the ventilator display at the 5^th and the 120^th minutes of SBT. The rate of change of RSBI (RSBI 5-120) was calculated as (RSBI 2-RSBI 1)/RSBI 1 × 100. Receiver-operating characteristic (ROC) curves were plotted for RSBI 5-120 and RSBI 120 in all patients and among the three subgroups (normal group, airway group, and parenchymal group) to compare the superiority of their best thresholds in predicting extubation failure.</p><p><strong>Results: </strong>The RSBI 5-120 threshold for extubation failure in the entire patient group was 23% with an overall accuracy of 88% (AUC = 0.933, sensitivity = 91%, and specificity = 86%) and the threshold of RSBI 120 for extubation failure in the entire patient group was 70 breaths/min/L with an overall accuracy of 82% (AUC = 0.899, sensitivity = 85%, and specificity = 81%). In patients in the normal lung group, the threshold of RSBI 5-120 was 22%, with an overall accuracy of 89% (AUC = 0.892, sensitivity = 87.5%, and specificity = 90%), and the RSBI 120 threshold was 70 breaths/min/L, with an overall accuracy of 89% (AUC = 0.956, sensitivity = 88%, and specificity = 90%). The RSBI 5-120 threshold in patients with airway disease was 25% with an accuracy of 86% (AUC = 0.892, sensitivity = 85%, and specificity = 86%) and the threshold of RSBI 120 was 73 breaths/min/L with an accuracy of 83% (AUC = 0.874, sensitivity = 85%, and specificity = 82%). In patients in the parenchymal disease group, the threshold of RSBI 5-120 was 24%, with an accuracy of 90% (AUC = 0.966, sensitivity = 92%, and specificity = 89%) and RSBI 120 threshold was 71 breaths/min/L, which was 88% accurate (AUC = 0.893, sensitivity = 85%, and specificity = 89%).</p><p><strong>Conclusion: </strong>The rate of change of RSBI between the 5^th and 120^th minutes was moderately more accurate than the single value of RSBI measured at the 120^th minute in predicting extubation outcome.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2023 ","pages":"9141441"},"PeriodicalIF":1.7,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10547562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41165953","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":"Impact of Chronic Kidney Disease on Clinical Outcomes during Hospitalization and Five-Year Follow-Up after Coronary Artery Bypass Grafting.","authors":"Mohamed Laimoud,&nbsp;Mosleh Nazzel Alanazi,&nbsp;Mary Jane Maghirang,&nbsp;Shatha Mohamed Al-Mutlaq,&nbsp;Suha Althibait,&nbsp;Rasha Ghamry,&nbsp;Rehan Qureshi,&nbsp;Boshra Alanazi,&nbsp;Munirah Alomran,&nbsp;Zeina Bakheet,&nbsp;Zohair Al-Halees","doi":"10.1155/2023/9364913","DOIUrl":"10.1155/2023/9364913","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) is often associated with multiple comorbidities including diabetes mellitus, and each has its own complications and impact after cardiac surgery including coronary revascularization. The objective of this work was to study the impact of CKD on clinical outcomes after coronary artery bypass grafting (CABG) and to compare outcomes in patients with different grades of renal functions. We retrospectively reviewed all patients who underwent CABG from January 2016 to August 2020 at our tertiary care hospital using electronic medical records.</p><p><strong>Results: </strong>The study included 410 patients with a median age of 60 years, and 28.6% of them had CKD and hospital mortality of 2.7%. About 71.4% of the patients had GFR > 60 mL/min per 1.73 m², 18.1% had early CKD (GFR 30-60), 2.7% had late CKD (GFR < 30), and 7.8% of them had end-stage renal disease (ESRD) requiring dialysis. The CKD group had significantly more frequent hospital mortality (<i>p</i> = 0.04), acute cerebrovascular stroke (<i>p</i> = 0.03), acute kidney injury (AKI) (<i>p</i> < 0.001), longer ICU stay (<i>p</i> = 0.002), post-ICU stay (<i>p</i> = 0.001), and sternotomy wound debridement (<i>p</i> = 0.03) compared to the non-CKD group. The frequencies of new need for dialysis were 2.4% vs. 14.9% vs. 45.5% (<i>p</i> < 0.001) in the patients with GFR > 60 mL/min per 1.73 m², early CKD, and late CKD, respectively. Acute cerebral stroke (OR: 10.29, 95% CI: 1.82-58.08, and <i>p</i> = 0.008), new need for dialysis (OR: 25.617, 95% CI: 13.78-85.47, and <i>p</i> < 0.001), and emergency surgery (OR: 3.1, 95% CI: 1.82-12.37, and <i>p</i> = 0.036) were the independent predictors of hospital mortality after CABG. The patients with CKD had an increased risk of strokes (HR: 2.14, 95% CI: 1.20-3.81, and <i>p</i> = 0.01) but insignificant mortality increase (HR: 1.44, 95% CI: 0.42-4.92, and <i>p</i> = 0.56) during follow-up.</p><p><strong>Conclusion: </strong>The patients with CKD, especially the late grade, had worse postoperative early and late outcomes compared to non-CKD patients after CABG. Patients with dialysis-independent CKD had increased risks of needing dialysis, hospital mortality, and permanent dialysis after CABG.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2023 ","pages":"9364913"},"PeriodicalIF":1.7,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10547561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41165952","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":"Value of Diaphragm Ultrasonography for Extubation: A Single-Blinded Randomized Clinical Trial.","authors":"T G Toledo,&nbsp;M R Bacci","doi":"10.1155/2023/8403971","DOIUrl":"https://doi.org/10.1155/2023/8403971","url":null,"abstract":"<p><strong>Introduction: </strong>Daily evaluation of mechanically ventilated (MV) patients is essential for successful extubation. Proper withdrawal prevents complications and reduces the cost of hospitalization in the intensive care unit (ICU). Diaphragm ultrasonography (DUS) has emerged as a potential instrument for determining whether a patient is ready to be extubated. This study compared the efficacy rate of extubation using a standard withdrawal protocol and DUS in patients with MV.</p><p><strong>Methods: </strong>A randomized, parallel, single-blind, controlled study was conducted on ICU patients undergoing MV. Patients were randomly assigned to either the control (conventional weaning protocol) group or intervention (DUS-guided weaning) group in a 1 : 1 ratio. The primary outcome measure was the rate of reintubation and hospital mortality.</p><p><strong>Results: </strong>Forty patients were randomized to the trial. The mean age of the sample was 70 years, representing an older population. The extubation success rate was 90% in both groups. There was no reintubation in the first 48 hours and only two reintubations in both groups between the second and seventh days. The hospital mortality risk in patients with acute kidney injury was positively correlated with age and the need for hemodialysis. <i>Discussion</i>. This study demonstrates the usefulness of DUS measurement protocols for withdrawing MV. The rate of reintubation was low for both cessation methods. As a parameter, the diaphragm thickness fraction comprehensively evaluates the diaphragm function. The results demonstrate that DUS has the potential to serve as a noninvasive tool for guiding extubation decisions. In conclusion, using DUS in patients with respiratory failure revealed no difference in reintubation rates or mortality compared with the conventional method. Future research should concentrate on larger, multicentered, randomized trials employing a multimodal strategy that combines diaphragmatic parameters with traditional clinical withdrawal indices.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2023 ","pages":"8403971"},"PeriodicalIF":1.7,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10522420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41162759","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":"Fungal Infections Are Not Associated with Increased Mortality in COVID-19 Patients Admitted to Intensive Care Unit (ICU).","authors":"James Ainsworth,&nbsp;Peter Sewell,&nbsp;Sabine Eggert,&nbsp;Keith Morris,&nbsp;Suresh Pillai","doi":"10.1155/2023/4037915","DOIUrl":"10.1155/2023/4037915","url":null,"abstract":"<p><strong>Introduction: </strong>Fungal infection is a cause of increased morbidity and mortality in intensive care patients. Critically unwell patients are at increased risk of developing invasive fungal infections. COVID-19 patients in the intensive care unit (ICU) may be at a particularly high risk. The primary aim of this study was to establish the incidence of secondary fungal infections in patients admitted to the ICU with COVID-19. Secondary aims were to investigate factors that may contribute to an increased risk of fungal infections and to calculate the mortality between fungal and nonfungal groups.</p><p><strong>Methods: </strong>We undertook a retrospective observational study in a tertiary ICU in Wales, United Kingdom. 174 patients admitted with COVID-19 infection from March 2020 until May 2021 were included. Data were collected through a retrospective review of patient's clinical notes and microbiology investigation results obtained from the online clinical portal.</p><p><strong>Results: </strong>81/174 (47%) COVID-19 patients developed fungal infections, 93% of which were Candida species, including <i>Candida albicans</i> (88%), and 6% had an Aspergillus infection. Age and smoking history did not appear to be contributing factors. The nonfungal group had a significantly higher body mass index (33 ± 8 vs. 31 ± 7, <i>p</i>=0.01). The ICU length of stay (23 (1-116) vs. 8 (1-60), <i>p</i> < 0.001), hospital length of stay (30 (3-183) vs. 15 (1-174) ± 7, <i>p</i> < 0.001), steroid days (10 (1-116) vs. 4 (0-28), <i>p</i>=0.02), and ventilation days (18 (0-120) vs. 2 (0-55), <i>p</i> < 0.001) were significantly higher in the fungal group. The mortality rate in both groups was similar (51% vs. 52%). The Kaplan-Meier survival analysis showed that the fungal group survived more than the nonfungal group (log rank (Mantel-Cox), <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Secondary fungal infections are common in COVID-19 patients admitted to the ICU. Longer treatment with corticosteroids, increased length of hospital and ICU stay, and greater length of mechanical ventilation significantly increase the risk of fungal infections. Fungal infection, however, was not associated with an increase in mortality.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2023 ","pages":"4037915"},"PeriodicalIF":1.7,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10505078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10290851","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":"Impact of Quality Improvement Bundle on Compliance with Resuscitation Guidelines during In-Hospital Cardiac Arrest in Children.","authors":"Pranali Awadhare, Karma Barot, Ingrid Frydson, Niveditha Balakumar, Donna Doerr, Utpal Bhalala","doi":"10.1155/2023/6875754","DOIUrl":"10.1155/2023/6875754","url":null,"abstract":"<p><strong>Introduction: </strong>Various quality improvement (QI) interventions have been individually assessed for the quality of cardiopulmonary resuscitation (CPR). We aimed to assess the QI bundle (hands-on training and debriefing) for the quality of CPR in our children's hospital. We hypothesized that the QI bundle improves the quality of CPR in hospitalized children.</p><p><strong>Methods: </strong>We initiated a QI bundle (hands-on training and debriefing) in August 2017. We conducted a before-after analysis comparing the CPR quality during July 2013-May 2017 (before) and January 2018-December 2020 (after). We collected data from the critical events logbook on CPR duration, chest compressions (CC) rate, ventilation rate (VR), the timing of first dose of epinephrine, blood pressure (BP), end-tidal CO₂ (EtCO₂), and vital signs monitoring during CPR. We performed univariate analysis and presented data as the median interquartile range (IQR) and in percentage as appropriate.</p><p><strong>Results: </strong>We compared data from 58 CPR events versus 41 CPR events before and after QI bundle implementation, respectively. The median (IQR) CPR duration for the pre- and post-QI bundle was 5 (1-13) minutes and 3 minutes (1.25-10), and the timing of the first dose of epinephrine was 2 (1-2) minutes and 2 minutes (1-5), respectively. We observed an improvement in compliance with the CC rate (100-120 per minute) from 72% events before versus 100% events after QI bundle implementation (<i>p</i>=0.0009). Similarly, there was a decrease in CC interruptions and hyperventilation rates from 100% to 50% (<i>p</i>=0.016) and 100% vs. 63% (<i>p</i>=<0.0001) events before vs. after QI bundle implementation, respectively. We also observed improvement in BP monitoring from 36% before versus 60% after QI bundle (<i>p</i>=0.014).</p><p><strong>Conclusion: </strong>Our QI bundle (hands-on training and debriefing) was associated with improved compliance with high-quality CPR in children.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2023 ","pages":"6875754"},"PeriodicalIF":1.8,"publicationDate":"2023-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10019965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9140575","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":"Early Tracheostomy May Reduce the Length of Hospital Stay.","authors":"Fernanda Kazmierski Morakami,&nbsp;Ana Luiza Mezzaroba,&nbsp;Alexandre Sanches Larangeira,&nbsp;Lucienne Tibery Queiroz Cardoso,&nbsp;Carlos Augusto Marçal Camillo,&nbsp;Cintia Magalhães Carvalho Grion","doi":"10.1155/2023/8456673","DOIUrl":"https://doi.org/10.1155/2023/8456673","url":null,"abstract":"<p><strong>Introduction: </strong>There is evidence that prolonged invasive mechanical ventilation has negative consequences for critically ill patients and that performing tracheostomy (TQT) could help to reduce these consequences. The ideal period for performing TQT is still not clear in the literature since few studies have compared clinical aspects between patients undergoing early or late TQT.</p><p><strong>Objective: </strong>To compare the mortality rate, length of stay in the intensive care unit, length of hospital stay, and number of days free of mechanical ventilation in patients undergoing TQT before or after ten days of orotracheal intubation.</p><p><strong>Methods: </strong>A retrospective cohort study carried out by collecting data from patients admitted to an intensive care unit between January 2008 and December 2017. Patients who underwent TQT were divided into an early TQT group (i.e., time to TQT ≤ 10 days) or late TQT (i.e., time to TQT > 10 days) and the clinical outcomes of the two groups were compared.</p><p><strong>Results: </strong>Patients in the early TQT group had a shorter ICU stay than the late TQT group (19 ± 16 vs. 32 ± 22 days, <i>p</i> < 0.001), a shorter stay in the hospital (42 ± 32 vs. 52 ± 50 days, <i>p</i> < 0.001), a shorter duration of mechanical ventilation (17 ± 14 vs. 30 ± 18 days, <i>p</i> < 0.001), and a higher proportion of survivors in the ICU outcome (57% vs. 46%, <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Tracheostomy performed within 10 days of mechanical ventilation provides several benefits to the patient and should be considered by the multidisciplinary team as a part of their clinical practice.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2023 ","pages":"8456673"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10457168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10101251","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":"Developing a Preliminary Clinical Prediction Model for Prognosis of Pneumonia Complicated with Heart Failure Based on Metagenomic Sequencing.","authors":"Rongyuan Yang,&nbsp;Yong Duan,&nbsp;Dawei Wang,&nbsp;Qing Liu","doi":"10.1155/2023/5930742","DOIUrl":"https://doi.org/10.1155/2023/5930742","url":null,"abstract":"<p><strong>Background: </strong>The predictive factors of prognosis in patients with pneumonia complicated with heart failure (HF) have not been fully investigated yet, especially with the use of next-generation sequencing (NGS) of metagenome.</p><p><strong>Methods: </strong>Patients diagnosed with pneumonia complicated with HF were collected and divided into control group and NGS group. Univariate and multivariate logistic regression and LASSO regression analysis were conducted to screen the predictive factors for the prognosis, followed by nomogram construction, ROC curve plot, and internal validation. Data analysis was conducted in SPSS and R software.</p><p><strong>Results: </strong>The NGS of metagenome detected more microbial species. Univariate and multivariate logistic regression and LASSO regression analysis revealed that Enterococcus (<i>χ</i>² = 7.449, <i>P</i> = 0.006), Hb (Wals = 6.289, <i>P</i> = 0.012), and ProBNP (Wals = 4.037, <i>P</i> = 0.045) were screened out as potential predictive factors for the prognosis. Nomogram was constructed with these 3 parameters, and the performance of nomogram was checked in ROC curves (AUC = 0.772). The specificity and sensitivity of this model were calculated as 0.579 and 0.851, respectively, with the threshold of 0.630 in ROC curve. Further internal verification indicated that the predictive value of our constructed model was efficient.</p><p><strong>Conclusion: </strong>This study developed a preliminary clinical prediction model for the prognosis of pneumonia complicated with HF based on NGS of metagenome. More objects will be collected and tested to improve the predictive model in the near future.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2023 ","pages":"5930742"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10368513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10258877","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":"Occurrence, Risk Factors, and Outcomes of Pulmonary Barotrauma in Critically Ill COVID-19 Patients: A Retrospective Cohort Study.","authors":"Hasan M Al-Dorzi,&nbsp;Haifa Al Mejedea,&nbsp;Reema Nazer,&nbsp;Yara Alhusaini,&nbsp;Aminah Alhamdan,&nbsp;Ajyad Al Jawad","doi":"10.1155/2023/4675910","DOIUrl":"https://doi.org/10.1155/2023/4675910","url":null,"abstract":"<p><strong>Objective: </strong>Pulmonary barotrauma has been frequently observed in patients with COVID-19 who present with acute hypoxemic respiratory failure. This study evaluated the prevalence, risk factors, and outcomes of barotrauma in patients with COVID-19 requiring ICU admission.</p><p><strong>Methods: </strong>This retrospective cohort study included patients with confirmed COVID-19 who were admitted to an adult ICU between March and December 2020. We compared patients who had barotrauma with those who did not. A multivariable logistic regression analysis was performed to determine the predictors of barotrauma and hospital mortality.</p><p><strong>Results: </strong>Of 481 patients in the study cohort, 49 (10.2%, 95% confidence interval: 7.6-13.2%) developed barotrauma on a median of 4 days after ICU admission. Barotrauma manifested as pneumothorax (<i>N</i> = 21), pneumomediastinum (<i>N</i> = 25), and subcutaneous emphysema (<i>N</i> = 25) with frequent overlap. Chronic comorbidities and inflammatory markers were similar in both patient groups. Barotrauma occurred in 4/132 patients (3.0%) who received noninvasive ventilation without intubation, and in 43/280 patients (15.4%) who received invasive mechanical ventilation. Invasive mechanical ventilation was the only risk factor for barotrauma (odds ratio: 14.558, 95% confidence interval: 1.833-115.601). Patients with barotrauma had higher hospital mortality (69.4% versus 37.0%; <i>p</i> < 0.0001) and longer duration of mechanical ventilation and ICU stay. Barotrauma was an independent predictor of hospital mortality (odds ratio: 2.784, 95% confidence interval: 1.310-5.918).</p><p><strong>Conclusion: </strong>s. Barotrauma was common in critical COVID-19, with invasive mechanical ventilation being the most prominent risk factor. Barotrauma was associated with poorer clinical outcomes and was an independent predictor of hospital mortality.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2023 ","pages":"4675910"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9977517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10849455","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}