Critical Care and Resuscitation最新文献

{"title":"ICU-acquired hypernatremia: Prevalence, patient characteristics, trajectory, risk factors, and outcomes","authors":"Ahmad Nasser MBChB, FCICM, ICU Consultant, Senior Lecturer ,&nbsp;Anis Chaba MD ,&nbsp;Kevin B. Laupland Prof UQ, MD, PhD ,&nbsp;Mahesh Ramanan Ass Prof QUT, MBBS, FCICM ,&nbsp;Alexis Tabah Ass Prof QUT, MD, FCICM ,&nbsp;Antony G. Attokaran MBBS, FRACP ,&nbsp;Aashish Kumar MBBS, FCICM ,&nbsp;James McCullough Mmed, FCICM ,&nbsp;Kiran Shekar Prof UQ, MBBS, FCICM, PhD ,&nbsp;Peter Garrett MBBS, FCICM ,&nbsp;Philippa McIlroy MBBS, FCICM ,&nbsp;Stephen Luke Prof JCU, MBBS, FCICM ,&nbsp;Siva Senthuran Prof JCU, MBBS, FCICM ,&nbsp;Rinaldo Bellomo Prof Monash Uni, MD, PhD ,&nbsp;Kyle C. White Senior Lect, UQ, MBBS, FCICM","doi":"10.1016/j.ccrj.2024.09.003","DOIUrl":"10.1016/j.ccrj.2024.09.003","url":null,"abstract":"<div><h3>Objective</h3><div>Knowledge of intensive care unit (ICU) acquired hypernatremia (ICU-AH) has been hampered by the absence of granular data and confounded by variable definitions and inclusion criteria.</div></div><div><h3>Design</h3><div>Multicentre retrospective cohort study.</div></div><div><h3>Setting</h3><div>Twelve ICUs in Queensland (QLD), Australia.</div></div><div><h3>Participants</h3><div>Adult patients admitted to ICU from 2015 to 2021. Only the first ICU admission was considered, and we categorised patients into mild (146–150 mmol·L⁻¹), moderate (151–155 mmol·L⁻¹) and severe (&gt;155 mmol·L⁻¹) ICU-acquired hypernatremia.</div></div><div><h3>Main outcome measure</h3><div>We aimed to study the prevalence of ICU-AH, patient characteristics, trajectory, risk factors, and outcomes.</div></div><div><h3>Results</h3><div>Data from 55,255 ICU admissions were included in the analysis, of which 4146 (7.5 %) patients had ICU-AH. These were subcategorised into mild (n = 2,670, 4.8 %), moderate (n = 1,073, 1.9 %) and severe (n = 403, 0.73 %) forms. Median time to diagnosis was 4 (2–6) d after ICU admission, while median time to peak serum sodium level was 5 (3–8) d. The median maximum sodium level across the cohort was 149 (147–152) mmol·L⁻¹. The sodium correction rate was 1 mmol·L⁻¹ per day, taking a median of 3 d (1–5) for sodium levels to return below 145 mmol·L⁻¹. APACHE III score, invasive ventilation, fever, and diuretic use on the day before hypernatremia were independent risk factors for moderate or severe ICU-AH. After adjusting for confounders, all levels of hypernatremia were independently associated with an increased risk of 30-d in-hospital mortality.</div></div><div><h3>Conclusions</h3><div>In a large multicentric study of critically ill patients, ICU-acquired hypernatremia occurred in one in eight admissions after a median of four days in the ICU and was preceded by identifiable and modifiable risk factors. If severe, its correction was slow, and normalisation was delayed. After adjusting for other factors, all levels of hypernatremia were an independent risk factor for 30-d in-hospital mortality.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 4","pages":"Pages 303-310"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous frusemide infusion versus intermittent bolus therapy in paediatric intensive care: A single centre retrospective study","authors":"Nutnicha Preeprem MD ,&nbsp;Emily See MBBS BMedSci MSc PhD FRACP FCICM ,&nbsp;Siva P. Namachivayam FCICM ,&nbsp;Ben Gelbart MBBS PhD FRACP FCICM","doi":"10.1016/j.ccrj.2024.10.001","DOIUrl":"10.1016/j.ccrj.2024.10.001","url":null,"abstract":"<div><h3>Objective</h3><div>Frusemide is a common diuretic administered to critically ill children intravenously, by either continuous infusion (CI) or intermittent bolus (IB). We aim to describe the characteristics of children who receive intravenous frusemide, patterns of use, and incidence of acute kidney injury (AKI), and to investigate factors associated with commencing CI.</div></div><div><h3>Design</h3><div>Retrospective observational study.</div></div><div><h3>Setting</h3><div>Paediatric intensive care unit (PICU), the Royal Children’s Hospital Melbourne.</div></div><div><h3>Participants</h3><div>Children who received intravenous frusemide during PICU admission lasting ≥24 h between 2017 and 2022.</div></div><div><h3>Main outcome measures</h3><div>The primary outcome was the daily dose of frusemide. Secondary outcomes included timing of therapy from PICU admission, fluid balance at frusemide initiation, additional diuretic therapy, and the incidence of AKI at admission and frusemide initiation. Children who received CI were compared with those who received IB only using multivariable logistic regression analyses.</div></div><div><h3>Results</h3><div>Nine thousand three ninety-four children were admitted during the study period. A total of 1387 children (15 %) received intravenous frusemide, including 220 children (16 %) by CI. The CI group were younger (132 vs 202 days, <em>p</em> = 0.01), had higher PIM-3 scores (2.2 vs 1.5, <em>p</em>-value &lt;0.001), more congenital heart disease (CHD) (72.3 % vs 60.6 %, <em>p</em> &lt;0.01), and higher incidence and severity of AKI at frusemide initiation than the IB group (65.7 % vs 40.1 %, <em>p</em>-value &lt;0.001). CI were commenced later than IB (46 vs 19 h into admission, <em>p</em> &lt;0.001) and at higher doses (4.3 vs 1.5 mg/kg/day, <em>p</em>-value &lt;0.001). In multivariable analyses, CHD (aOR 1.67, 95 % CI 1.16-2.40, <em>p</em> &lt;0.01) was associated with CI.</div></div><div><h3>Conclusion</h3><div>Frusemide infusions are administered more commonly to children with CHD, later in PICU admission, and at higher daily doses compared to IB. Children who receive CI have a higher incidence and severity of AKI at initiation.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 4","pages":"Pages 319-325"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital-level volume in extracorporeal membrane oxygenation cases and death or disability at 6 months","authors":"Atacan D. Ertugrul MD ,&nbsp;Ary Serpa Neto PhD ,&nbsp;Bentley J. Fulcher BPharmSci (Hons) ,&nbsp;Anaïs Charles-Nelson PhD ,&nbsp;Michael Bailey PhD ,&nbsp;Aidan J.C. Burrell PhD ,&nbsp;Shannah Anderson BS ,&nbsp;Stephen Bernard MD ,&nbsp;Jasmin V. Board MPH ,&nbsp;Daniel Brodie MD ,&nbsp;Heidi Buhr MScMed ClinEpid ,&nbsp;D. James Cooper MD ,&nbsp;Craig Dicker ,&nbsp;Eddy Fan PhD ,&nbsp;John F. Fraser PhD ,&nbsp;David J. Gattas MMed ClinEpi ,&nbsp;Ingrid K. Hopper PhD ,&nbsp;Sue Huckson BappSc ,&nbsp;Natalie J. Linke BN ,&nbsp;Edward Litton PhD ,&nbsp;Jing Kong","doi":"10.1016/j.ccrj.2024.08.006","DOIUrl":"10.1016/j.ccrj.2024.08.006","url":null,"abstract":"<div><h3>Objective</h3><div>Extracorporeal membrane oxygenation (ECMO) is a high-risk procedure with significant morbidity and mortality and there is an uncertain volume-outcome relationship, especially regarding long-term functional outcomes. The aim of this study was to examine the association between ECMO centre volume and long-term death and disability outcomes.</div></div><div><h3>Design, setting, and participants</h3><div>This is a registry-embedded observational cohort study. Patients were included if they were enrolled in the binational ECMO registry (EXCEL). The exclusion criteria included patients on ECMO for heart/lung transplants. Data included demographics, clinical information on their first ECMO run, and six-month outcomes obtained by telephone interview. The primary outcome was death or new disability at six months. A multivariable analysis was conducted using hospitals' annual ECMO volume. High-volume centres were defined as having &gt;30 ECMO cases annually, and analyses were run on ECMO subgroups of veno-venous (VV), veno-arterial (VA), and extracorporeal cardiopulmonary resuscitation (ECPR).</div></div><div><h3>Results</h3><div>Of 1232 patients, 663 patients were cared for on ECMO at high-volume centres and 569 patients at low-volume centres. There was no difference in six-month death or new disability between high- and low-volume ECMO centres in VV-ECMO [OR: 1.09 (0.65–1.83), p = 0.744], VA-ECMO [OR: 1.10 (0.66–1.84), p = 0.708], and ECPR-ECMO [OR: 1.38 (0.37–5.08), p = 0.629]. This finding was persistent in all sensitivity analyses, including exclusion of patients who were transferred between high- and low-volume centres.</div></div><div><h3>Conclusion</h3><div>There was no difference in death or disability at six months between high- and low-volume centres in Australia and New Zealand, possibly due to the current model of coordinated care that includes patient transfers and training between high- and low-volume ECMO centres in our region.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 4","pages":"Pages 262-270"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timing of adjunctive vasopressin initiation for septic shock patients and hospital mortality: A multicentre observational study","authors":"Kyle C. White MBBS MPH ,&nbsp;Rahul Costa-Pinto FCICM ,&nbsp;Anis Chaba MD ,&nbsp;Philippa McIlroy MBBS FCICM ,&nbsp;Siva Senthuran MBBS FCICM ,&nbsp;Stephen Luke MBBS FCICM ,&nbsp;Antony G. Attokaran MBBS FCICM ,&nbsp;Peter Garrett MBBS FCICM ,&nbsp;Mahesh Ramanan MBBS FCICM ,&nbsp;Alexis Tabah MD FCICM ,&nbsp;Kiran Shekar MBBS PhD ,&nbsp;Kevin B. Laupland MS PhD ,&nbsp;Hayden White FCICM PhD ,&nbsp;James McCullough CFCICM MMed ,&nbsp;Andrew Udy FCICM PhD ,&nbsp;Glenn Eastwood MD PhD ,&nbsp;Rinaldo Bellomo MD PhD","doi":"10.1016/j.ccrj.2024.09.002","DOIUrl":"10.1016/j.ccrj.2024.09.002","url":null,"abstract":"<div><h3>Objective</h3><div>The optimal timing of vasopressin initiation as an adjunctive vasopressor remains unclear. We aimed to study the association between the timing of vasopressin commencement, pre-specified physiological parameters, and hospital mortality.</div></div><div><h3>Design</h3><div>We conducted a multicentre, retrospective, observational study.</div></div><div><h3>Setting</h3><div>Twelve ICUs in Queensland, Australia between January 2015 and December 2021.</div></div><div><h3>Participants</h3><div>Adult patients with septic shock who received vasopressin as an adjunctive vasopressor within 72 hours of ICU admission.</div></div><div><h3>Main Outcome</h3><div>Hospital mortality.</div></div><div><h3>Results</h3><div>Overall, 2747 patients fulfilled the inclusion criteria. Of these, 1850 (67%) started vasopressin within six hours of vasopressor therapy start, while 897 (33%) started vasopressin between six hours and 72 hours. APACHE III score, peak lactate, and creatinine were higher in the early start group. Early vasopressin start was independently associated with decreased hospital mortality (aOR = 0.69, 95% CI = 0.57-0.83). Vasopressin infusion start was also associated with an immediate decrease in the noradrenaline-equivalent dose regardless of timing. There was a statistically significant favourable breakpoint at vasopressin start for the course of arterial pH, lactate, heart rate and crystalloid infusion rate (p&lt;0.001).</div></div><div><h3>Conclusions</h3><div>In patients with septic shock, early adjunctive vasopressin initiation was independently associated with lower hospital mortality. Vasopressin starting at any time was also associated with reduced tachycardia, acidosis, and hyperlactatemia.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 4","pages":"Pages 295-302"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Olanzapine versus quetiapine in critically ill patients with hyperactive delirium: Protocol for a multicentre, cluster-randomised, double-crossover, pragmatic clinical trial (CALM-ICU)","authors":"Melissa J. Ankravs BPharm MClinPharm ,&nbsp;Andrew Udy FCICM PhD ,&nbsp;Rinaldo Bellomo MD PhD ,&nbsp;Jeffrey J. Presneill MBBS PhD ,&nbsp;Laura Adams RN ,&nbsp;Yasmine Ali Abdelhamid MBBS PhD FRACP FCICM ,&nbsp;Michael Bailey PhD ,&nbsp;Jasmin Board RN PostGradDipNurs (ICU) MPH ,&nbsp;Kathleen Byrne RN MNSc ,&nbsp;Glenn Eastwood RN PhD ,&nbsp;Maurice Le Guen MBBS MPH ,&nbsp;Emma-Leah Martin BPharmSc MPH ,&nbsp;Mark P. Plummer MBBS PhD ,&nbsp;Megan Richardson BPharm GradDipClinPharm ,&nbsp;Lucy Sharrock BPharm MHA ,&nbsp;Meredith Young RN MPH ,&nbsp;Adam M. Deane MBBS PhD","doi":"10.1016/j.ccrj.2024.08.003","DOIUrl":"10.1016/j.ccrj.2024.08.003","url":null,"abstract":"<div><h3>Background</h3><div>Patients in the intensive care unit (ICU) frequently develop hyperactive delirium, which may be accompanied by behaviour that increases clinical risks to themselves as well as other patients and staff. There is a paucity of evidence to inform the urgent enteral administration of antipsychotic drugs to treat such hyperactive delirium and behavioural disturbances.</div></div><div><h3>Objective</h3><div>The aim of this study is to test the efficacy and safety of administering enteral olanzapine when compared to quetiapine in critically ill patients with hyperactive delirium.</div></div><div><h3>Design, setting, participants, and interventions</h3><div>This is a cluster-randomised, double-crossover, clinical trial. Critically ill adult patients admitted to three tertiary Australian intensive care units over a 12-month period will be eligible. Randomisation will occur at the site level, with allocation to open-label olanzapine or quetiapine use over four treatment periods of 3-month duration.</div></div><div><h3>Main outcome measure</h3><div>The primary outcome and days alive and delirium-/coma-free (censored at 14 days post enrolment) will be analysed using median quantile regression accounting for clustering at sites' level and time period and treatment order.</div></div><div><h3>Results and conclusion</h3><div>This trial will compare the effect of enteral olanzapine to quetiapine in critically ill adults with hyperactive delirium on an important indicator of patient outcome.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 4","pages":"Pages 249-254"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anticoagulation and associated complications in veno-arterial extracorporeal membrane oxygenation in adult patients: A systematic review and meta-analysis","authors":"Ruan Vlok MBBS ,&nbsp;Hergen Buscher FCICM ,&nbsp;Anthony Delaney FCICM, PhD ,&nbsp;Tessa Garside FCICM, PhD ,&nbsp;Gabrielle McDonald MD ,&nbsp;Richard Chatoor MD ,&nbsp;John Myburgh FCICM, PhD ,&nbsp;Priya Nair FCICM, PhD","doi":"10.1016/j.ccrj.2024.10.003","DOIUrl":"10.1016/j.ccrj.2024.10.003","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the incidence of bleeding and thrombotic complications in VA-ECMO according to anticoagulation strategy.</div></div><div><h3>Design</h3><div>This systematic review and meta-analysis included randomised controlled trials (RCTs) and observational studies reporting bleeding and thrombotic complications in VA-ECMO. The incidence of primary outcomes according to anticoagulation drug and monitoring test was described.</div></div><div><h3>Data sources</h3><div>CENTRAL, MEDLINE, Embase and CINAHL (2010–January 2024).</div></div><div><h3>Review methods</h3><div>Data was extracted using Covidence. A meta-analysis of proportions was performed using STATA MP v18.1 metaprop.</div></div><div><h3>Results</h3><div>We included 159 studies with 21,942 patients. No studies were at low risk of bias. The incidence of major bleeding or thrombotic events was similar among heparin-, bivalirudin- and anticoagulation-free cohorts. The pooled incidence of major bleeding and thrombotic complications were 40% (95%CI 36–44, I² = 97.12) and 17% (95%CI 14–19, <em>I</em>^<em>2</em> = 92.60%), respectively. The most common bleeding site was thoracic. The most common ischaemic complication was limb ischaemia. The incidences of major bleeding or thrombotic events, intracranial haemorrhage and ischaemic stroke were similar among all monitoring tests. Mechanical unloading was associated with a high incidence of major bleeding events (60%, 95%CI 43–77, I² = 93.32), and ischaemic strokes (13%, 95%CI 7–19, I² = 81.80).</div></div><div><h3>Conclusions</h3><div>Available literature assessing the association between anticoagulation strategies in VA-ECMO, and bleeding and thrombosis is of limited quality. We identified a substantially higher incidence of major bleeding events than a previous meta-analysis. Limited numbers of patients anticoagulated with alternatives to heparin were reported. Patients with additional mechanical LV unloading represent a cohort at particular risk of bleeding and thrombotic complications.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 4","pages":"Pages 332-363"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of guanfacine in hospitalized patients with delirium: A scoping review","authors":"Nuttapol Pattamin MD ,&nbsp;Atthaphong Phongphithakchai MD ,&nbsp;Sofia Spano MD ,&nbsp;Akinori Maeda MD ,&nbsp;Anis Chaba MD ,&nbsp;Yukiko Hikasa MD ,&nbsp;Rinaldo Bellomo MD, PhD, FRACP, FCICM","doi":"10.1016/j.ccrj.2024.08.009","DOIUrl":"10.1016/j.ccrj.2024.08.009","url":null,"abstract":"<div><h3>Objective</h3><div>To assess current evidence regarding guanfacine use in hospitalized patients with delirium.</div></div><div><h3>Introduction</h3><div>Delirium is a common and important complication of critical illness. Central alpha-2 agonists are often used for symptomatic management. Guanfacine is an enteral central alpha-2 agonist approved for the treatment of attention deficit hyperactivity disorders. However, its use for delirium treatment has not been systematically assessed.</div></div><div><h3>Inclusion criteria</h3><div>All studies of guanfacine to treat patients with delirium during hospitalization. We excluded reviews, letters, commentaries, correspondence, conference abstracts, expert opinions or editorials.</div></div><div><h3>Methods</h3><div>We performed a systematic search of the literature using: MEDLINE (Ovid), Embase (Ovid), CENTRAL and SCOPUS (Elsevier) from inception until 29 February, 2024. Two independent reviewers assessed the identified citations and abstracts. Data on study and patient characteristics, as well as efficacy and safety outcomes, were extracted. Efficacy was defined by guanfacine's ability to relieve delirium and improve clinical outcomes, including intensive care unit (ICU) length of stay (LOS), hospital LOS, and mortality. Safety was assessed for hemodynamic stability or other reported side effects.</div></div><div><h3>Results</h3><div>We screened 908 articles and included two case reports, one case series, two retrospective descriptive cohorts, and one retrospective analytic cohort. Guanfacine therapy was associated with delirium attenuation and a reduction in the use of sedative agents. Median dosage was 1.5 mg daily, with a median time to delirium improvement of 3 days. However, guanfacine therapy was not associated with decreased ICU or hospital LOS. The most frequently reported adverse events were mild hypotension and bradycardia.</div></div><div><h3>Conclusion</h3><div>There is limited data on the efficacy of guanfacine for the treatment of delirium. However, given its pharmacologic properties and its available safety data, controlled investigations may be justified.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 4","pages":"Pages 286-294"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe intensive care unit–acquired hypernatraemia: Prevalence, risk factors, trajectory, management, and outcome","authors":"Anis Chaba MD ,&nbsp;Atthaphong Phongphithakchai MD ,&nbsp;Oscar Pope MD ,&nbsp;Sam Rajapaksha MD ,&nbsp;Pratibha Ranjan MD ,&nbsp;Akinori Maeda MD, PhD ,&nbsp;Sofia Spano MD ,&nbsp;Yukiko Hikasa MD ,&nbsp;Glenn Eastwood RN, PhD ,&nbsp;Nuttapol Pattamin MD ,&nbsp;Nuanprae Kitisin MD ,&nbsp;Ahmad Nasser MD ,&nbsp;Kyle C. White MD, PhD ,&nbsp;Rinaldo Bellomo MD, PhD ,&nbsp;Severe Hypernatremia Assessment, Resolution, and Eradication (SHARE) Investigators","doi":"10.1016/j.ccrj.2024.09.004","DOIUrl":"10.1016/j.ccrj.2024.09.004","url":null,"abstract":"<div><h3>Background</h3><div>Severe intensive care unit–acquired hypernatraemia (ICU-AH) is a serious complication of critical illness. However, there is no detailed information on how this condition develops.</div></div><div><h3>Objectives</h3><div>The objective of this study was to study the prevalence, risk factors, trajectory, management, and outcome of severe ICU-AH (≥155 mmol·L⁻¹).</div></div><div><h3>Methods</h3><div>A retrospective study was conducted in a 40-bed ICU in a university-affiliated hospital. Assessment of sodium levels, factors associated with severe ICU-AH, urinary electrolyte measurements, water therapy, fluid balance, correction rate, and delirium was made.</div></div><div><h3>Results</h3><div>We screened 11,642 ICU admissions and identified 109 patients with severe ICU-AH. The median age was 57 years, 63% were male, and the median Acute Physiology and Chronic Health Evaluation III score was 64 (52; 80). On the day of ICU admission, 64% of patients were ventilated; 71% received vasopressors, and 22% had acute kidney injury. The median peak sodium level was 158 (156; 161) mmolL⁻¹ at a median of 4 (1; 11) days after ICU admission. Only eight patients (7%) had urine sodium measurement (median concentration: 17 mmol·L⁻¹). On the day of peak hypernatraemia, 80% of patients were unable to drink due to invasive ventilation; 34% were on diuretics; 25% had fever, and 50% did not receive hypotonic fluids. When available, the median electrolyte-free water clearance was −1.1 L (−1.7; −0.5), representing half of the urine output. After peak hypernatraemia, the correction rate was −2.8 mmol·L⁻¹ per day (95% confidence interval: [-2.9 to −2.6]) during the first 3 d.</div></div><div><h3>Conclusions</h3><div>Severe hypernatraemia occurred in the setting of inability to drink, near-absent measurement of urinary free water losses, diuretic therapy, fever, renal impairment, and near-absent or limited or delayed water administration. Correction was slow.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 4","pages":"Pages 311-318"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Natural language processing in the intensive care unit: A scoping review","authors":"Julia K. Pilowsky RN, PhD ,&nbsp;Jae-Won Choi MBiomedE, BE (Comp), BE-Health (HI) (ProfHons) ,&nbsp;Aldo Saavedra PhD ,&nbsp;Maysaa Daher BPsych, MAppStats ,&nbsp;Nhi Nguyen MBBS, FCICM ,&nbsp;Linda Williams RN, MHealthManagement ,&nbsp;Sarah L. Jones RN, Grad Dip Ed (Nursing), Grad Cert (ICU)","doi":"10.1016/j.ccrj.2024.06.008","DOIUrl":"10.1016/j.ccrj.2024.06.008","url":null,"abstract":"<div><h3>Objectives</h3><p>Natural language processing (NLP) is a branch of artificial intelligence focused on enabling computers to interpret and analyse text-based data. The intensive care specialty is known to generate large volumes of data, including free-text, however, NLP applications are not commonly used either in critical care clinical research or quality improvement projects. This review aims to provide an overview of how NLP has been used in the intensive care specialty and promote an understanding of NLP's potential future clinical applications.</p></div><div><h3>Design</h3><p>Scoping review.</p></div><div><h3>Data sources</h3><p>A systematic search was developed with an information specialist and deployed on the PubMed electronic journal database. Results were restricted to the last 10 years to ensure currency.</p></div><div><h3>Review methods</h3><p>Screening and data extraction were undertaken by two independent reviewers, with any disagreements resolved by a third. Given the heterogeneity of the eligible articles, a narrative synthesis was conducted.</p></div><div><h3>Results</h3><p>Eighty-seven eligible articles were included in the review. The most common type (n = 24) were studies that used NLP-derived features to predict clinical outcomes, most commonly mortality (n = 16). Next were articles that used NLP to identify a specific concept (n = 23), including sepsis, family visitation and mental health disorders. Most studies only described the development and internal validation of their algorithm (n = 79), and only one reported the implementation of an algorithm in a clinical setting.</p></div><div><h3>Conclusions</h3><p>Natural language processing has been used for a variety of purposes in the ICU context. Increasing awareness of these techniques amongst clinicians may lead to more clinically relevant algorithms being developed and implemented.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 3","pages":"Pages 210-216"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277224000243/pdfft?md5=baca71f4ef8b264efa157f45c9f3f932&pid=1-s2.0-S1441277224000243-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to: “More than one pathway: ECMO training and credentialing”","authors":"Stuart C. Duffin BMedSci, MBBS, FCICM, DESA, EDIC,&nbsp;Judith H. Askew BAppSci, MBBS, FCICM,&nbsp;Timothy J. Southwood MBBS, MSc, FCICM,&nbsp;Paul Forrest MBCHB, FANZCA,&nbsp;Brian Plunkett MBChB, FRACS,&nbsp;Richard J. Totaro MBBS, FRACP, FCICM","doi":"10.1016/j.ccrj.2024.07.001","DOIUrl":"10.1016/j.ccrj.2024.07.001","url":null,"abstract":"","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 3","pages":"Page 219"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277224000267/pdfft?md5=b7e7d7886f372d75e1216e260de71fe2&pid=1-s2.0-S1441277224000267-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}