Critical Care and Resuscitation最新文献

{"title":"Corrigendum to “Statistical analysis plan for the BLING III study: a phase 3 multicentre randomised controlled trial of continuous versus intermittent β-lactam antibiotic infusion in critically ill patients with sepsis” [Crit Care Resusc 23(3) (2021) 273–284]","authors":"Laurent Billot , Jeffrey Lipman , Stephen J. Brett , Jan J. De Waele , Menino Osbert Cotta , Joshua S. Davis , Simon Finfer , Naomi Hammond , Serena Knowles , Shay McGuinness , John Myburgh , David L. Paterson , Sandra Peake , Dorrilyn Rajbhandari , Andrew Rhodes , Jason A. Roberts , Claire Roger , Charudatt Shirwadkar , Therese Starr , Colman Taylor , Joel M. Dulhunty","doi":"10.1016/j.ccrj.2023.04.012","DOIUrl":"10.1016/j.ccrj.2023.04.012","url":null,"abstract":"","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42176687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous electroencephalography in the intensive care unit: A critical review and position statement from an Australian and New Zealand perspective","authors":"Michaela Waak MBBS FRACP, FCICM, MD ,&nbsp;Joshua Laing MBBS FRACP BBiomedSci(hons) PhD ,&nbsp;Lakshmi Nagarajan MBBS FRACP, MD ,&nbsp;Nicholas Lawn MBChB, FRACP ,&nbsp;A. Simon Harvey MBBS FRACP, MD","doi":"10.1016/j.ccrj.2023.04.004","DOIUrl":"10.1016/j.ccrj.2023.04.004","url":null,"abstract":"<div><h3>Objectives</h3><p>This article aims to critically review the literature on continuous electroencephalography (cEEG) monitoring in the intensive care unit (ICU) from an Australian and New Zealand perspective and provide recommendations for clinicians.</p></div><div><h3>Design and review methods</h3><p>A taskforce of adult and paediatric neurologists, selected by the Epilepsy Society of Australia, reviewed the literature on cEEG for seizure detection in critically ill neonates, children, and adults in the ICU. The literature on routine EEG and cEEG for other indications was not reviewed. Following an evaluation of the evidence and discussion of controversial issues, consensus was reached, and a document that highlighted important clinical, practical, and economic considerations regarding cEEG in Australia and New Zealand was drafted.</p></div><div><h3>Results</h3><p>This review represents a summary of the literature and consensus opinion regarding the use of cEEG in the ICU for detection of seizures, highlighting gaps in evidence, practical problems with implementation, funding shortfalls, and areas for future research.</p></div><div><h3>Conclusion</h3><p>While cEEG detects electrographic seizures in a significant proportion of at-risk neonates, children, and adults in the ICU, conferring poorer neurological outcomes and guiding treatment in many settings, the health economic benefits of treating such seizures remain to be proven. Presently, cEEG in Australian and New Zealand ICUs is a largely unfunded clinical resource that is subsequently reserved for the highest-impact patient groups. Wider adoption of cEEG requires further research into impact on functional and health economic outcomes, education and training of the neurology and ICU teams involved, and securement of the necessary resources and funding to support the service.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48519413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tiered escalation response systems in practice: A post hoc analysis examining the workload implications","authors":"Alice O'Connell MBBS ,&nbsp;Arthas Flabouris MBBS MD ,&nbsp;Suzanne Edwards BN ,&nbsp;Campbell H. Thompson DPhil","doi":"10.1016/j.ccrj.2023.04.010","DOIUrl":"10.1016/j.ccrj.2023.04.010","url":null,"abstract":"<div><h3>Objective</h3><p>Many rapid response systems now have multiple tiers of escalation in addition to the traditional single tier of a medical emergency team. Given that the benefit to patient outcomes of this change is unclear, we sought to investigate the workload implications of a multitiered system, including the impact of trigger modification.</p></div><div><h3>Design</h3><p>The study design incorporated a post hoc analysis using a matched case–control dataset.</p></div><div><h3>Setting</h3><p>The study setting was an acute, adult tertiary referral hospital.</p></div><div><h3>Participants</h3><p>Cases that had an adverse event (cardiac arrest or unanticipated intensive care unit admission) or a rapid response team (RRT) call participated in the study. Controls were matched by age, gender, ward and time of year, and no adverse event or RRT call. Participants were admitted between May 2014 and April 2015.</p></div><div><h3>Main outcome measures</h3><p>The main outcome measure were the number of reviews, triggers, and modifications across three tiers of escalation; a nurse review, a multidisciplinary review (MDT—admitting medical team review), and an RRT call.</p></div><div><h3>Results</h3><p>There were 321 cases and 321 controls. Overall, there were 1948 nurse triggers, of which 1431 (73.5%) were in cases and 517 (26.5%) in controls, 798 MDT triggers (660 [82.7%] in cases and 138 [17.3%] in controls), and 379 RRT triggers (351 [92.6%] in cases and 28 [7.4%] in controls). Per patient per 24 h, there were 3.03 nurse, 1.24 MDT, and 0.59 RRT triggers. Accounting for modifications, this reduced to 2.17, 0.88, and 0.42, respectively. The proportion of triggers that were modified, so as not to trigger a review, was similar across all the tiers, being 28.6% of nurse, 29.6% of MDT, and 28.2% of RRT triggers. Per patient per 24 h, there were 0.61 nurse reviews, 0.52 MDT reviews, and 0.08 RRT reviews.</p></div><div><h3>Conclusions</h3><p>Lower-tier triggers were more prevalent, and modifications were common. Modifications significantly mitigated the escalation workload across all tiers of a multitiered system.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47380543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Midodrine use in critically ill patients: a narrative review","authors":"Rahul Costa-Pinto ,&nbsp;Daryl A. Jones ,&nbsp;Andrew A. Udy ,&nbsp;Stephen J. Warrillow ,&nbsp;Rinaldo Bellomo","doi":"10.51893/2022.4.R","DOIUrl":"10.51893/2022.4.R","url":null,"abstract":"<div><p>Midodrine is a peripherally acting, oral α-agonist that is increasingly used in intensive care units despite conflicting evidence for its effectiveness. It has pharmacological effects on blood vessels as well as pupillary, cardiac, renal, gastrointestinal, genitourinary, lymphatic and skin tissue. It has approval for use as a treatment for orthostatic hypotension, but a surge in interest over the past decade has prompted its use for a growing number of off-label indications. In critically ill patients, midodrine has been used as either an adjunctive oral therapy to wean vasoplegic patients off low dose intravenous vasopressor infusions, or as an oral vasopressor agent to prevent or minimise the need for intravenous infusion. Clinical trials have mostly focused on midodrine as an intravenous vasopressor weaning agent. Early retrospective studies supported its use for this indication, but more recent randomised controlled trials have largely refuted this practice. Key questions remain on its role in managing critically ill patients before intensive care admission, during intensive care stay, and following discharge. This narrative review presents a comprehensive overview of midodrine use for the critical care physician and highlights why lingering questions around ideal patient selection, dosing, timing of initiation, and efficacy of midodrine for critically ill patients remain unanswered.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223000364/pdfft?md5=d4bd99aa68644473322d0771ad632dbb&pid=1-s2.0-S1441277223000364-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47810358","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":"Early sedation in traumatic brain injury: a multicentre international observational study","authors":"Giovanni Russo ,&nbsp;Anatole Harrois ,&nbsp;James Anstey ,&nbsp;Mathieu Van Der Jagt ,&nbsp;Fabio Taccone ,&nbsp;Andrew Udy ,&nbsp;Giuseppe Citerio ,&nbsp;Jacques Duranteau ,&nbsp;Carole Ichai ,&nbsp;Rafael Badenes ,&nbsp;John Prowle ,&nbsp;Ari Ercole ,&nbsp;Mauro Oddo ,&nbsp;Antoine Schneider ,&nbsp;Stefan Wolf ,&nbsp;Raimund Helbok ,&nbsp;David Nelson ,&nbsp;Jamie Cooper ,&nbsp;For the TBI Collaborative Investigators","doi":"10.51893/2022.4.OA2","DOIUrl":"10.51893/2022.4.OA2","url":null,"abstract":"<div><p><strong>Objectives:</strong> We aimed to investigate the use of sedation in patients with severe traumatic brain injury (TBI), focusing on the choice of sedative agent, dose, duration, and their association with clinical outcomes.</p><p><strong>Design:</strong> Multinational, multicentre, retrospective observational study.</p><p><strong>Settings:</strong> 14 trauma centres in Europe, Australia and the United Kingdom.</p><p><strong>Participants:</strong> A total of 262 adult patients with severe TBI and intracranial pressure monitoring.</p><p><strong>Main outcome measures:</strong> We described how sedative agents were used in this population. The primary outcome was 60-day mortality according to the use of different sedative agents. Secondary outcomes included intensive care unit and hospital length of stay, and the Extended Glasgow Outcome Scale at hospital discharge.</p><p><strong>Results:</strong> Propofol and midazolam were the most commonly used sedatives. Propofol was more common than midazolam as first line therapy (35.4% <em>v</em> 25.6% respectively). Patients treated with propofol had similar Acute Physiology and Chronic Health Evaluation (APACHE) II and International Mission for Prognosis and Analysis of Clinical Trials in Traumatic Brain Injury (IMPACT) scores to patients treated with midazolam, but lower Injury Severity Score (ISS) (median, 26 [IQR, 22–38] <em>v</em> 34 [IQR, 26–44]; <em>P</em> = 0.001). The use of propofol was more common in heavier patients, and midazolam use was strongly associated with opioid co-administration (OR, 12.9; 95% CI, 3.47–47.95; <em>P</em> &lt; 0.001). Sixty-day mortality and hospital mortality were predicted by a higher IMPACT score (<em>P</em> &lt; 0.001) and a higher ISS (<em>P</em> &lt; 0.001), but, after adjustment, were not related to the choice of sedative agent.</p><p><strong>Conclusions:</strong> Propofol was used more often than midazolam, and large doses were common for both sedatives. The first choice was highly variable, was affected by injury severity, and was not independently associated with 60-day mortality.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223000388/pdfft?md5=6185b21053f5cf95ad12fe48b5b91d14&pid=1-s2.0-S1441277223000388-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43294450","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":"The association between vital signs abnormalities during postanaesthesia care unit stay and deterioration in the general ward following major abdominal cancer surgery assessed by continuous wireless monitoring","authors":"Magnus Skovbye ,&nbsp;Jesper Mølgaard ,&nbsp;Søren M. Rasmussen ,&nbsp;Helge B.D. Sørensen ,&nbsp;Christian S. Meyhoff ,&nbsp;Eske K. Aasvang","doi":"10.51893/2022.4.OA3","DOIUrl":"10.51893/2022.4.OA3","url":null,"abstract":"<div><p><strong>Objective:</strong> Vital signs abnormalities in the post-anaesthesia care unit (PACU) may identify patients at risk of severe postoperative complications in the general ward, but are sparsely investigated by continuous monitoring. We aimed to assess if the severity of vital signs abnormalities in the PACU was correlated to the duration of severe vital signs abnormalities and serious adverse events (SAEs) in the general ward.</p><p><strong>Design:</strong> Prospective cohort study. Primary exposure was PACU vital signs abnormalities assessed by a standardised PACU recovery score.</p><p><strong>Participants:</strong> Adult patients, aged ≥ 60 years, who underwent major abdominal cancer surgery.</p><p><strong>Main outcome measures:</strong> The duration of severe vital signs abnormalities were assessed by continuous wireless vital signs monitoring and, secondly, by any SAE within the first 96 hours in the general ward.</p><p><strong>Results:</strong> One-hundred patients were included, and 92 patients with a median of 91 hours (interquartile range, 71–95 hours) of vital signs recording were analysed. The maximum vital signs abnormalities in the PACU were not significantly correlated to overall vital signs abnormalities in the general ward <em>(R</em> = 0.13; <em>P</em> = 0.22). Severe circulatory abnormalities in the overall PACU stay and at discharge were significantly correlated to the duration of circulatory vital signs abnormalities on the ward (<em>R</em> = 0.32 [<em>P</em> = 0.00021] and <em>R</em> = 0.26 [<em>P</em> = 0.014], respectively). Seventeen patients (18%) experienced SAEs, without significant association to the PACU stay (area under the receiver operating characteristic [AUROC], 0.59; 95% CI, 0.46–0.73).</p><p><strong>Conclusion:</strong> Vital signs abnormalities in the PACU did not show a tendency towards predicting overall severe vital signs abnormalities or SAEs during the first days in the general ward. Circulatory abnormalities in the PACU showed a tendency towards predicting circulatory complications in the ward.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S144127722300039X/pdfft?md5=368e51b742dc90a11a64a3d63acfd2e8&pid=1-s2.0-S144127722300039X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42519610","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":"Study protocol and statistical analysis plan for the 20% Human Albumin Solution Fluid Bolus Administration Therapy in Patients after Cardiac Surgery-ll (HAS FLAIR-II) trial","authors":"Geoffrey Wigmore ,&nbsp;Adam M. Deane ,&nbsp;James Anstey ,&nbsp;Michael Bailey ,&nbsp;Shailesh Bihari ,&nbsp;Glenn Eastwood ,&nbsp;Rashmi Ghanpur ,&nbsp;Matthew J. Maiden ,&nbsp;Jeffrey J. Presneill ,&nbsp;Jaishankar Raman ,&nbsp;Rinaldo Bellomo ,&nbsp;For the HAS FLAIR-II trial investigators","doi":"10.51893/2022.4.OA1","DOIUrl":"https://doi.org/10.51893/2022.4.OA1","url":null,"abstract":"<div><p><strong>Background:</strong> Fluid bolus therapy with 20% albumin may shorten the duration of vasopressor therapy in patients after cardiac surgery.</p><p><strong>Objective:</strong> To describe the study protocol and statistical analysis plan for the 20% Human Albumin Solution Fluid Bolus Administration Therapy in Patients after Cardiac Surgery-II (HAS FLAIR-II) trial.</p><p><strong>Design, setting, participants and intervention:</strong> HAS FLAIR-II is a phase 2b, multicentre, parallel group, openlabel, randomised controlled trial that will be conducted at six Australian intensive care units. Patients requiring fluid bolus therapy after cardiac surgery will be randomly assigned in a 1:1 ratio to the intervention of fluid bolus therapy with 20% albumin or a comparator of fluid bolus therapy with a crystalloid solution.</p><p><strong>Main outcome measures:</strong> The primary outcome measure is the cumulative duration of vasopressor therapy. Secondary outcomes include vasopressor use, service utilisation, and mortality. All analyses will be conducted on an intention-to-treat basis.</p><p><strong>Results and conclusion:</strong> The study protocol and statistical analysis plan will guide the conduct and analysis of the HAS FLAIR-II trial, such that analytical and reporting biases are minimised.</p><p><strong>Trial registration:</strong> This trial has been registered with the Australian New Zealand Clinical Trials Registry (ACTRN No. 12620000137998).</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223000376/pdfft?md5=28ced19a4b550c12c95af92533e5af0c&pid=1-s2.0-S1441277223000376-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90025218","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":"AntiPORT: adaptation of a transfusion prediction score to an Australian cardiac surgery population","authors":"James Yeates ,&nbsp;Lachlan Miles ,&nbsp;Kate Blatchford ,&nbsp;Michael Bailey ,&nbsp;Jenni Williams-Spence ,&nbsp;Christopher Reid ,&nbsp;Tim Coulson","doi":"10.51893/2022.4.OA6","DOIUrl":"10.51893/2022.4.OA6","url":null,"abstract":"<div><p><strong>Introduction:</strong> Risk scoring systems exist to predict perioperative blood transfusion risk in cardiac surgery, but none have been validated in the Australian or New Zealand population. The ACTA-PORT score was developed in the United Kingdom for this purpose. In this study, we validate and recalibrate the ACTA-PORT score in a large national database.</p><p><strong>Methods:</strong> We performed a retrospective validation study using data from the Australian and New Zealand Society of Cardiac and Thoracic Surgeons Database between 1 September 2016 and 31 December 2018. The ACTA-PORT score was calculated using an equivalent of EuroSCORE I. Discrimination and calibration was assessed using area under the receiver operating characteristic (AUROC) curves, Brier scores, and calibration plots. ACTA-PORT was then recalibrated in a development set using logistic regression and the outcome of transfusion to develop new predicted transfusion rates, termed \"AntiPORT”, using AusSCORE \"all procedures\" as the regional equivalent of EuroSCORE I. The accuracy of these new predictions was assessed as for ACTA-PORT.</p><p><strong>Results:</strong> 30 388 patients were included in the study at 37 Australian centres. The rate of red blood cell transfusion was 33%. Discrimination of ACTA-PORT was good but calibration was poor, with overprediction of transfusion (AUROC curve, 0.76; 95% CI, 0.75-0.76; Brier score, 0.19). The recalibrated AntiPORT showed significantly improved calibration in both development and validation sets without compromising discrimination (AUROC curve, 0.76; 95% CI, 0.75-0.76; Brier score, 0.18).</p><p><strong>Conclusions:</strong> The AntiPORT is the first red cell transfusion risk scoring system for cardiac surgery patients to be validated using Australian data. It is accurate and simple to calculate. The demonstrated accuracy of AntiPORT may help facilitate benchmarking and future research in patient blood management, as well as providing a useful tool to help clinicians target these resource-saving strategies.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S144127722300042X/pdfft?md5=91e61d6de89e07e6bfb9e4c700cba573&pid=1-s2.0-S144127722300042X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43965765","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":"The prevalence of post-extubation dysphagia in critically ill adults: an Australian data linkage study","authors":"Melanie L. McIntyre ,&nbsp;Timothy Chimunda ,&nbsp;Joanne Murray ,&nbsp;Trent W. Lewis ,&nbsp;Sebastian H. Doeltgen","doi":"10.51893/2022.4.OA5","DOIUrl":"10.51893/2022.4.OA5","url":null,"abstract":"<div><p><strong>Objective:</strong> To define the prevalence of dysphagia after endotracheal intubation in critically ill adult patients.</p><p><strong>Design:</strong> A retrospective observational data linkage cohort study using the Australian and New Zealand Intensive Care Society Adult Patient Database and a mandatory government statewide health care administration database.</p><p><strong>Setting:</strong> Private and public intensive care units (ICUs) within Victoria, Australia.</p><p><strong>Participants:</strong> Adult patients who required endotracheal intubation for the purpose of mechanical ventilation within a Victorian ICU between July 2013 and June 2018.</p><p><strong>Main outcome measures:</strong> Presence of dysphagia, aspiration pneumonia, ICU length of stay, hospital length of stay, and cost per episode of care.</p><p><strong>Results:</strong> Endotracheal intubation in the ICU was required for 71 124 patient episodes across the study period. Dysphagia was coded in 7.3% <em>(n</em> = 5203) of those episodes. Patients with dysphagia required longer ICU (median, 154 [interquartile range (IQR), 78–259] <em>v</em> 53 [IQR, 27–107] hours; <em>P</em> &lt; 0.001) and hospital admissions (median, 20 [IQR, 13–30] <em>v</em> 8 [IQR, 5–15] days; <em>P</em> &lt; 0.001), were more likely to develop aspiration pneumonia (17.2% <em>v</em> 5.6%; odds ratio, 3.0; 95% CI, 2.8–3.2; <em>P</em> &lt; 0.001), and the median health care expenditure increased by 93% per episode of care ($73 586 <em>v</em> $38 108; <em>P</em> &lt; 0.001) compared with patients without dysphagia.</p><p><strong>Conclusions:</strong> Post-extubation dysphagia is associated with adverse patient and health care outcomes. Consideration should be given to strategies that support early identification of patients with dysphagia in the ICU to determine if these adverse outcomes can be reduced.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223000418/pdfft?md5=2cfe30b276e2a7d89774c2d3ccca35db&pid=1-s2.0-S1441277223000418-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49093825","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":"Midodrine — why don't you just work better?","authors":"Matthew Anstey ,&nbsp;Shahzad Shaefi ,&nbsp;Bradley Wibrow","doi":"10.51893/2022.4.E","DOIUrl":"10.51893/2022.4.E","url":null,"abstract":"Successful identification and characterisation of a titratable and safe oral agent that consistently increases blood pressure carries a great deal of appeal and the promise of negating physician and patient frustration and morbidity in a significant tranche of intensive care unit (ICU) patients. Universally, ICUs often house patients with mild hypotension rate limiting them from going to the ward, be that in the postoperative period, during recovery from critical illness, or in patients with decompensation of a chronic condition where augmented blood pressure for a period may be beneficial. These groups of patients are not traditionally “shocked” and perhaps do not require the full gamut of intensive management that we are used to providing to critically ill patients but are unable to be cared for on the ward. An oral vasopressor could provide this treatment and conceivably relieve some of the capacity constraints that units are facing.","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223000352/pdfft?md5=e162390983b7d558526bfd5d5cad451e&pid=1-s2.0-S1441277223000352-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49141871","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}