Critical care science最新文献

{"title":"A clinical guide to assess the immune response to sepsis: from bench to bedside.","authors":"José Pedro Cidade, Gonçalo Guerreiro, Pedro Póvoa","doi":"10.62675/2965-2774.20240179-en","DOIUrl":"https://doi.org/10.62675/2965-2774.20240179-en","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"36 ","pages":"e20240179en"},"PeriodicalIF":0.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959467","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":"Long-term mortality of Dutch COVID-19 patients admitted to the intensive care medicine: a retrospective analysis from a national quality registry.","authors":"Safira A Wortel, Ferishta Bakhshi-Raiez, Ameen Abu-Hanna, Dave A Dongelmans, Nicolette F de Keizer, Aletta Houwink, Allard Dijkhuizen, Annelies Draisma, Annemiek Rijkeboer, Arjan Cloïn, Arthur de Meijer, Auke Reidinga, Barbara Festen-Spanjer, Bas van Bussel, Bob Eikemans, Cretièn Jacobs, David Moolenaar, Dharmanand Ramnarain, Dick Koning, Dirk Boer, Dirk Verbiest, Eline van Slobbe-Bijlsma, Ellen van Koppen, Els Rengers, Erik van Driel, Eva Verweij, Freya van Iersel, Gert Brunnekreef, Hans Kieft, Herman Kreeftenberg, Ilanit Hené, Inge Janssen, Ionana Drogt, Iwan van der Horst, Jan Jaap Spijkstra, Jan Rozendaal, Jannet Mehagnoul-Schipper, Jelle Epker Erasmus, Jessica Holtkamp, Johan Lutisan, Jos van Oers, Judith Lens, Laura van Gulik, Lettie van den Berg, Louise Urlings-Strop, Lyuba Georgieva, Maarten van Lieshout, Marga Hoogendoorn, Marissa Vrolijk-de Mos, Mart de Graaff, Martha de Bruin, Martijn Hoeksema, Martijn van Tellingen, Michel Barnas, Michiel Erkamp, Niels Gritters, Nuray Kusadasi, Paul Elbers, Peter Koetsier, Peter Spronk, Peter van der Voort, Ralph Pruijsten, Remko de Jong, Robert-Jan Bosman, Ronald Wesselink, Ronny Schnabel, Roy van den Berg, Ruud de Waal, Sesmu Arbous, Silvia Knape, Stefaan Hendriks, Tim Frenzel, Tom Dormans, Tom Rijpstra, Vera Silderhuis, Wouter de Ruijter","doi":"10.62675/2965-2774.20240251-en","DOIUrl":"https://doi.org/10.62675/2965-2774.20240251-en","url":null,"abstract":"<p><strong>Objective: </strong>To describe the 12-month mortality of Dutch COVID-19 intensive care unit patients, the total COVID-19 population and various subgroups on the basis of the number of comorbidities, age, sex, mechanical ventilation, and vasoactive medication use.</p><p><strong>Methods: </strong>We included all patients admitted with COVID-19 between March 1, 2020, and March 29, 2022, from the Dutch National Intensive Care (NICE) database. The crude 12-month mortality rate is presented via Kaplan-Meier survival curves for each patient subgroup. We used Cox regression models to analyze the effects of patient characteristics on 12-month mortality after hospital discharge.</p><p><strong>Results: </strong>We included 16,605 COVID-19 patients. The in-hospital mortality rate was 28.1%, and the 12-month mortality rate after intensive care unit admission was 29.8%. Among hospital survivors, 12-month mortality after hospital discharge was 2.5% (300/11,931). The hazard of death at 12 months after hospital discharge was greater in patients between 60 and 79 years (HR 4.74; 95%CI 2.23 - 10.06) and ≥ 80 years (HR 22.77; 95%CI 9.91 - 52.28) than in patients < 40 years of age; in male patients than in female patients (HR 1.38; 95%CI 1.07 - 1.78); and in patients with one (adjusted HR 1.95; 95%CI 1.5 - 2.53), two (adjusted HR 4.49; 95%CI 3.27 - 6.16) or more than two comorbidities (adjusted HR 4.99; 95%CI 2.62 - 9.5) than in patients with no comorbidities. Neither vasoactive medication use nor mechanical ventilation resulted in statistically significant results.</p><p><strong>Conclusion: </strong>For Dutch COVID-19 intensive care unit patients, most deaths occurred during their hospital stay. For hospital survivors, the crude 12-month mortality rate was low. Patient age (older than 60), sex and the number of comorbidities were associated with a greater hazard of death at 12 months after hospital discharge, whereas mechanical ventilation and vasoactive medication were not.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"36 ","pages":"e202400251en"},"PeriodicalIF":0.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11463994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959600","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":"Comparison of the effectiveness of awake-prone positioning and high-flow nasal oxygen in patients with COVID-19-related acute respiratory failure between different waves.","authors":"Mariano Esperatti, Matías Olmos, Marina Busico, Adrian Gallardo, Alejandra Vitali, Jorgelina Quintana, Hiromi Kakisu, Bruno Leonel Ferreyro, Nora Angélica Fuentes, Javier Osatnik, Santiago Nicolas Saavedra, Agustin Matarrese, Greta Dennise Rebaza Niquin, Elizabeth Gisele Wasinger, Giuliana Mast, Facundo Juan Andrada, Ana Inés Lagazio, Nahuel Esteban Romano, Marisol Mariela Laiz, Jose Garcia Urrutia, Mariela Adriana Mogaadouro, Micaela Ruiz Seifert, Emilce Mastroberti, Claudia Navarro Moreno, Anabel Miranda Tirado, María Constanza Viñas, Juan Manuel Pintos, Maria Eugenia Gonzalez, Maite Mateos, Verónica Barbaresi, Ana Elizabeth Grimbeek, Leonel Stein, Ariel Juan Latronico, Silvia Laura Menéndez, Alejandra Dominga Basualdo, Romina Castrillo","doi":"10.62675/2965-2774.20240065-en","DOIUrl":"10.62675/2965-2774.20240065-en","url":null,"abstract":"<p><strong>Objective: </strong>To compare the effectiveness of the awake-prone position on relevant clinical outcomes in patients with COVID-19-related acute respiratory failure requiring high-flow nasal oxygen between different waves in Argentina.</p><p><strong>Methods: </strong>This multicenter, prospective cohort study included adult patients with COVID-19-related acute respiratory failure requiring high-flow nasal oxygen. The main exposure position was the awake-prone position (≥ 6 hours/day) compared to the non-prone position. The primary outcome was endotracheal intubation, and the secondary outcome was in-hospital mortality. The inverse probability weighting-propensity score was used to adjust the conditional probability of treatment assignment. We then adjusted for contextual variables that varied over time and compared the effectiveness between the first and second waves.</p><p><strong>Results: </strong>A total of 728 patients were included: 360 during the first wave and 368 during the second wave, of whom 195 (54%) and 227 (62%) remained awake-prone for a median (p25 - 75) of 12 (10 - 16) and 14 (8 - 17) hours/day, respectively (Awake-Prone Position Group). The ORs (95%CIs) for endotracheal intubation in the Awake-Prone Position Group were 0.25 (0.13 - 0.46) and 0.19 (0.09 - 0.31) for the first and second waves, respectively (p = 0.41 for comparison between waves). The ORs for in-hospital mortality in the awake-prone position were 0.35 (0.17 - 0.65) and 0.22 (0.12 - 0.43), respectively (p = 0.44 for comparison between waves).</p><p><strong>Conclusion: </strong>The awake-prone position was associated with a reduction in the risk of endotracheal intubation and in-hospital mortality. These effects were independent of the context in which the intervention was applied, and no differences were observed between the different waves.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"36 ","pages":"e20240065en"},"PeriodicalIF":0.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic indicators in intensive care unit oncology patients: bridging short-term and long-term survival.","authors":"Fernanda Chohfi Atallah, Regis Goulart Rosa, Kathryn Puxty","doi":"10.62675/2965-2774.20240262-en","DOIUrl":"10.62675/2965-2774.20240262-en","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"36 ","pages":"e20240262en"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856944","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":"Andexanet alfa for the management of severe bleeding: what should critical care physicians know about it?","authors":"Felicio Savioli, Julyana Maiolino, Leonardo Rocha","doi":"10.62675/2965-2774.20240178-en","DOIUrl":"10.62675/2965-2774.20240178-en","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"36 ","pages":"e20240178en"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"To: Goal-directed therapy guided by the FloTrac sensor in major surgery: a systematic review and meta-analysis.","authors":"Luigi La Via, Giacomo Cusumano, Christian Zanza, Carmelo Calvagna, Antonino Maniaci","doi":"10.62675/2965-2774.20240168-en","DOIUrl":"10.62675/2965-2774.20240168-en","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"36 ","pages":"e20240168en"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11464003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856903","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":"Sepsis survivors readmitted within 30 days: outcomes of a single-center retrospective study.","authors":"Abdelrahman Nanah, Fatima Abdeljaleel, Marcos Vinícius Fernandes Garcia, Kelly Pannikodu, Mohannad Seif, Amy Flowers-Surovi, Naveen Gopal, Divyajot Sadana","doi":"10.62675/2965-2774.20240116-en","DOIUrl":"https://doi.org/10.62675/2965-2774.20240116-en","url":null,"abstract":"<p><strong>Objective: </strong>To investigate a cohort of sepsis survivors readmitted within 30 days postdischarge, explore the one-year mortality rate based on different causes of readmission and identify factors associated with increased one-year mortality risk among all sepsis survivors readmitted within this timeframe.</p><p><strong>Methods: </strong>This was a single-center retrospective cohort study involving adult sepsis survivors who were readmitted within 30 days of discharge. Patients were categorized into 3 groups based on the cause of readmission: same-source infectious readmission, different-source infectious readmission, and noninfectious readmission. The outcome of interest was all-cause one-year mortality. Cox proportional hazard analysis was performed to compare factors associated with one-year mortality.</p><p><strong>Results: </strong>Of the 1,666 patients admitted with sepsis, 243 (14.5%) were readmitted within 30 days. Readmissions were due to same-source infections (40.7%), different-source infections (21.4%), or noninfectious causes (37.9%). All-cause one-year mortality was 46.9%, with no difference between the groups. Age (HR 1.02; 95%CI: 1.003 - 1.04; p = 0.01), Sequential Organ Failure Assessment score (HR 1.1; 95%CI: 1.02 - 1.18; p = 0.01), discharge to a care facility during index admission (HR 1.6; 95%CI: 1.04 - 2.40; p = 0.03), and malignancy (HR 2.3; 95%CI: 1.5 - 3.7; p < 0.001) were associated with one-year mortality.</p><p><strong>Conclusion: </strong>Thirty-day readmission in sepsis survivors was common and was associated with a 46.9% one-year mortality rate regardless of readmission cause. Quality improvement patient safety initiatives based on local institutional factors may allow for targeted interventions to improve sepsis survivor outcomes.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"36 ","pages":"e20240116en"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in central venous pressure during a fluid challenge have limited value for guiding fluid therapy.","authors":"Priscilla Souza de Oliveira, Fernando José da Silva Ramos, Daniere Yurie Vieira Tomotani, Flávia Ribeiro Machado, Flávio Geraldo Rezende de Freitas","doi":"10.62675/2965-2774.20240073-en","DOIUrl":"10.62675/2965-2774.20240073-en","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether changes in central venous pressure during fluid expansion and baseline cyclic respiratory variation in the central venous pressure amplitude (RespCVP) curve could be used to discriminate between fluid responders and nonresponders.</p><p><strong>Methods: </strong>This prospective observational study included critically ill adult patients who underwent fluid expansion in the form of a fluid bolus or fluid challenge with crystalloids. All patients were under mechanical ventilation and adequately sedated. We determined the central venous pressure at baseline (CVPT0) and the changes at 5 (ΔCVPT5), 10 (ΔCVPT10) and 15 (ΔCVPT15) minutes during fluid infusion. We also measured the RespCVP at baseline. Fluid responsiveness was defined as a cardiac index increase of ≥ 15%.</p><p><strong>Results: </strong>The study included 30 patients (11 responders and 19 nonresponders). The CVPT0 and the changes after a fluid challenge at all three time points did not adequately predict fluid responsiveness, as determined by their area under the curve values (CVPT0: 0.70, (95%CI: 0.49 - 0.90; ΔCVPT5: 0.78, (95%CI: 0.57 - 0.99; ΔCVPT10: 0.63, (95%CI: 0.39 - 0.88; ΔCVPT15: 0.68, ((95%CI: 0.45 - 0.92). The RespCVP at baseline also had a poor performance (area under the curve: 0.70; 95%CI: 0.50 - 0.91).</p><p><strong>Conclusion: </strong>Changes in central venous pressure have limited value in predicting fluid responsiveness.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"36 ","pages":"e20240073en"},"PeriodicalIF":0.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781870","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":"Differences in the relative importance of predictors of short- and long-term mortality among critically ill patients with cancer.","authors":"Carla Marchini Dias da Silva, Bárbara Beltrame Bettim, Bruno Adler Maccagnan Pinheiro Besen, Antônio Paulo Nassar Junior","doi":"10.62675/2965-2774.20240149-en","DOIUrl":"10.62675/2965-2774.20240149-en","url":null,"abstract":"<p><strong>Objective: </strong>To identify the relative importance of several clinical variables present at intensive care unit admission on the short- and long-term mortality of critically ill patients with cancer after unplanned intensive care unit admission.</p><p><strong>Methods: </strong>This was a retrospective cohort study of patients with cancer with unplanned intensive care unit admission from January 2017 to December 2018. We developed models to analyze the relative importance of well-known predictors of mortality in patients with cancer admitted to the intensive care unit compared with mortality at 28, 90, and 360 days after intensive care unit admission, both in the full cohort and stratified by the type of cancer when the patient was admitted to the intensive care unit.</p><p><strong>Results: </strong>Among 3,592 patients, 3,136 (87.3%) had solid tumors, and metastatic disease was observed in 60.8% of those patients. A total of 1,196 (33.3%), 1,738 (48.4%), and 2,435 patients (67.8%) died at 28, 90, and 360 days, respectively. An impaired functional status was the greatest contribution to mortality in the short term for all patients and in the short and long term for the subgroups of patients with solid tumors. For patients with hematologic malignancies, the use of mechanical ventilation was the most important variable associated with mortality in all study periods. The SOFA score at admission was important for mortality prediction only for patients with solid metastatic tumors and hematological malignancies. The use of vasopressors and renal replacement therapy had a small importance in predicting mortality at every time point analyzed after the SOFA score was accounted for.</p><p><strong>Conclusion: </strong>Healthcare providers must consider performance status, the use of mechanical ventilation, and the severity of illness when discussing prognosis, preferences for care, and end-of-life care planning with patients or their families during intensive care unit stays.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"36 ","pages":"e20240149en"},"PeriodicalIF":0.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781886","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":"Scientific output and organizational characteristics in Brazilian intensive care units: a multicenter cross-sectional study.","authors":"Thiago Tavares Dos Santos, Luciano César Pontes de Azevedo, Antonio Paulo Nassar Junior, Jorge Ibrain Figueira Salluh","doi":"10.62675/2965-2774.20240006-en","DOIUrl":"10.62675/2965-2774.20240006-en","url":null,"abstract":"<p><strong>Objective: </strong>To examine the associations between the scientific output of Brazilian intensive care units and their organizational characteristics.</p><p><strong>Methods: </strong>This study is a re-analysis of a previous retrospective cohort that evaluated organizational intensive care unit characteristics and their associations with outcomes. We analyzed data from 93 intensive care units across Brazil. Intensive care units were assessed for scientific productivity and the effects of their research activities, using indicators of care for comparison. We defined the most scientifically productive intensive care units as those with numerous publications and a SCImago Journal Rank score or an H-index above the median values of the participating intensive care units.</p><p><strong>Results: </strong>Intensive care units with more publications, higher SCImago Journal Rank scores and higher H-index scores had a greater number of certified intensivists (median of 7; IQR 5 - 10 versus 4; IQR 2 - 8; with p < 0.01 for the comparison between intensive care units with more versus fewer publications). Intensive care units with higher SCImago Journal Rank scores and H-index scores also had a greater number of fully implemented protocols (median of 8; IQR 6 - 8 versus 5; IQR 3.75 - 7.25; p < 0.01 for the comparison between intensive care units with higher versus lower SCImago Journal Rank scores).</p><p><strong>Conclusions: </strong>Scientific engagement was associated with better staffing patterns and greater protocol implementation, suggesting that research activity may be an indicator of better intensive care unit organization and care delivery.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"36 ","pages":"e20240006en"},"PeriodicalIF":0.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781924","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}