Critical care science最新文献

{"title":"Caffeine-clarithromycin coadministration and hyperlactatemia in a young infant: a case report.","authors":"Leila Costa Volpon, Flavia Maria Costa, Ana Paula de Carvalho Panzeri Carlotti","doi":"10.62675/2965-2774.20250159","DOIUrl":"10.62675/2965-2774.20250159","url":null,"abstract":"<p><p>Apnea is a major complication of acute respiratory tract infection in young infants and may lead to the need for ventilatory support. Caffeine is methylxanthine, which is considered the mainstay of pharmacologic treatment for apnea of prematurity. On the basis of neonatal guidelines, caffeine has been used as a respiratory stimulant for the treatment of acute respiratory tract infection-related apnea, despite low evidence of its ability to improve clinical outcomes. Hyperlactatemia has been reported in adults with caffeine poisoning. Clarithromycin acts as an inhibitor of human cytochrome P450 and may impair drug metabolism. However, there are no published data concerning lactic acidosis associated with caffeine-clarithromycin coadministration. We report a case of hyperlactatemia in a young infant born prematurely who presented to the emergency department with acute respiratory tract infection-associated apnea and who required noninvasive ventilatory support. Because respiratory viruses were not detected in the nasopharyngeal aspirates and the chest radiography revealed interstitial opacities, clarithromycin (15mg/kg/day) was started via a nasoduodenal tube. In polysomnography, dysmaturity and immaturity of the central nervous system were evident. Hence, caffeine treatment was initiated at a loading dose of 10mg/kg followed by a maintenance dose of 5mg/kg/day. After treatment initiation, the child experienced ventilatory improvement and apnea control. However, a progressive increase in the serum lactate concentration and high anion gap metabolic acidosis were observed, despite hemodynamic stability. Following discontinuation of both drugs, the serum concentrations of lactate gradually returned to normal values. Thus, clarithromycin-caffeine coadministration may cause a sharp increase in lactate concentrations and should be avoided in young infants with acute respiratory tract infection-associated apnea.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"37 ","pages":"e20250159"},"PeriodicalIF":0.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617868","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":"Best practices for guideline development in Critical Care.","authors":"Leticia Kawano-Dourado, Tyler Pitre, Dena Zeraatkar, Gordon Guyatt","doi":"10.62675/2965-2774.20250372","DOIUrl":"10.62675/2965-2774.20250372","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"37 ","pages":"e20250372"},"PeriodicalIF":0.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574746","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":"Thank you, Professor Gattinoni†, and have a good trip to eternity!","authors":"Guillermo Bugedo, Nicolas Nin, Elisa Estenssoro, Flavia Ribeiro Machado","doi":"10.62675/2965-2774.20250002","DOIUrl":"10.62675/2965-2774.20250002","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"37 ","pages":"e20250002"},"PeriodicalIF":0.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574750","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":"Care of the chronic dialysis patient in the intensive care unit: a state-of-the-art review.","authors":"Julian Yaxley, Alexander Lesser, Victoria Campbell","doi":"10.62675/2965-2774.20250130","DOIUrl":"10.62675/2965-2774.20250130","url":null,"abstract":"<p><p>Chronic dialysis patients account for a high proportion of intensive care unit admissions. The prevalent dialysis population is growing worldwide, accompanied by increasing medical complexity and comorbidities. Critical care physicians must be familiar with the unique clinical characteristics of this patient group. There is relatively little evidence specifically concerning the assessment and treatment of critically unwell individuals on long-term dialysis. This narrative review explores the approach to the management of chronic dialysis patients in the intensive care unit.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"37 ","pages":"e20250130"},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506489","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":"Predictive factors for high-flow nasal cannula failure in patients with acute viral bronchiolitis admitted to the pediatric intensive care unit.","authors":"Patrick Jacobsen Westphal, Cassiano Teixeira, João Ronaldo Mafalda Krauzer, Mirelle Hugo Bueno, Priscilla Alves Pereira, Sandro V Hostyn, Marcela Doebber Vieira, Camila Durante, Cristiane Bündchen","doi":"10.62675/2965-2774.20250161","DOIUrl":"10.62675/2965-2774.20250161","url":null,"abstract":"<p><strong>Objective: </strong>To identify predictive factors for failure in the installation of high-flow nasal cannulas in children diagnosed with acute viral bronchiolitis under 24 months of age admitted to the pediatric intensive care unit.</p><p><strong>Methods: </strong>This work was a retrospective single-center cohort study conducted from March 2018 to July 2023 involving infants under 24 months of age who were diagnosed with acute viral bronchiolitis and who received high-flow nasal cannulas upon admission to the pediatric intensive care unit. Patients were categorized into two groups, the Success Group and Failure Group, on the basis of high-flow nasal cannula therapy efficacy. The primary outcome was treatment failure, which was defined as the transition to invasive or noninvasive ventilation. The analyzed variables included age, sex, weight, high-flow nasal cannula parameters, vital signs, risk factors, comorbidities, and imaging. Acute viral bronchiolitis severity was assessed using the Wood-Downes Scale, and functional status was assessed via the Functional Status Scale, both of which were administered by trained physiotherapists.</p><p><strong>Results: </strong>In total, 162 infants with acute viral bronchiolitis used high-flow nasal cannulas, with 17.28% experiencing treatment failure. The significant differences between the Failure and Success Groups included age (p = 0.001), weight (p = 0.002), bronchiolitis severity (p = 0.004), initial high-flow nasal cannula flow (p = 0.001), and duration of use (p = 0.000). The cutoff values for initial flow (≤ 12L/min), weight (≤ 5kg), and Wood-Downes score (≥ 9 points) were determined from the ROC curves. Initial flow ≤ 12L/min was the most predictive for failure (AUC = 0.71; 95%CI: 0.61 - 0.84; p = 0.001). Multivariate analysis indicated that weight was a protective factor (RR = 0.87; 95%CI: 0.78 - 0.98), duration of use reduced the risk of failure (RR = 0.49; 95%CI: 0.38 - 0.64; p = 0.000), and Wood-Downes score was not significant (RR = 1.04; 95%CI: 0.95 - 1.14; p = 0.427). Weight explained 84.7% of the variation in initial flow.</p><p><strong>Conclusion: </strong>Risk factors for high-flow nasal cannula therapy failure in bronchiolitis patients include younger age, consequently lower weight, and a lower initial flow rate.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"37 ","pages":"e20250161"},"PeriodicalIF":0.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451151","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":"Intensive Care Medicine in Portugal.","authors":"Rui Moreno, Andrew Rhodes, Ederlon Rezende","doi":"10.62675/2965-2774.20250344","DOIUrl":"10.62675/2965-2774.20250344","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"37 ","pages":"e20250344"},"PeriodicalIF":0.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451150","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":"Analysis of the Functional Status Score for the Intensive Care Unit and its correlation with measures of muscle strength in critically ill patients during hospitalization in the intensive care unit.","authors":"Gabriela de Sousa Martins, Katryne Holanda Silva, William Rafael Almeida Moraes, Eduardo Yoshio Nakano, Joanlise Marco de Leon Andrade, Laura Maria Tomazi Neves, Graziella França Bernardelli Cipriano","doi":"10.62675/2965-2774.20250197","DOIUrl":"10.62675/2965-2774.20250197","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"37 ","pages":"e20250197"},"PeriodicalIF":0.0,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11805452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400832","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":"Ultrasonographic assessment of the muscle mass of the rectus femoris in mechanically ventilated patients at intensive care unit discharge is associated with deterioration of functional status at hospital discharge: a prospective cohort study.","authors":"Thiele Cabral Coelho Quadros, Thaline Lima Horn, Marina Santos de Moraes, Luisa da Cunha Selmo, Alexandre Ribas, Clarissa Netto Blattner, Márcio Manozzo Boniatti","doi":"10.62675/2965-2774.20250050","DOIUrl":"10.62675/2965-2774.20250050","url":null,"abstract":"<p><strong>Objective: </strong>To verify whether the rectus femoris muscle mass in mechanically ventilated patients assessed by ultrasonography at intensive care unit discharge is associated with functional status at hospital discharge.</p><p><strong>Methods: </strong>This cohort study was conducted at a tertiary hospital in Brazil between August 2019 and November 2020. We included patients over 18 years who were previously independent (Barthel index > 60) and underwent mechanical ventilation for at least 48 hours within 96 hours of admission. Ultrasonographic measurements of the rectus femoris cross-sectional area and right quadriceps thickness were performed upon enrollment, five days after enrollment, and at intensive care unit discharge. The primary outcome was assessing functional capacity via the Barthel index at hospital discharge.</p><p><strong>Results: </strong>Of the 78 patients included, 35 had assessable primary outcomes. Twenty (57.1%) patients were considered functionally dependent (Barthel index < 60). The Barthel index at hospital discharge was correlated with the cross-sectional area (r = 0.53; p = 0.001) and quadriceps thickness (r = 0.43; p = 0.01) at intensive care unit discharge. Multiple linear regression analysis revealed that the cross-sectional area at intensive care unit discharge was independently associated with the Barthel index.</p><p><strong>Conclusion: </strong>We found that muscle mass assessed by cross-sectional area ultrasonography at intensive care unit discharge was significantly correlated with functional capacity at hospital discharge.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"37 ","pages":"e20250050"},"PeriodicalIF":0.0,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11805460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400835","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":"Protocolized strategies to encourage early mobilization of critical care patients: challenges and success.","authors":"Patrick Sepúlveda, Adrián Gallardo, Ricardo Arriagada, Eduardo González, Patricia Rieken Macedo Rocco, Denise Battaglini","doi":"10.62675/2965-2774.20250128","DOIUrl":"10.62675/2965-2774.20250128","url":null,"abstract":"<p><p>Technological advances and interprofessional teamwork have significantly improved survival rates of critically ill patients. However, this progress has also introduced new challenges, such as intensive care unit-acquired weakness, which can contribute to postintensive care syndrome. Both conditions are associated with increased morbidity and mortality, prolonged length of hospital stay, higher social and health care costs, and reduced quality of life for patients and their families. Timely physical therapy plays a crucial role in mitigating intensive care unit-acquired weakness and postintensive care syndrome. Key recommendations for the effective rehabilitation of patients in the intensive care unit include education and training, communication and collaboration, patient screening, planning of activities, distribution of functions focused on teamwork, patient cooperation, safety assessments, patient positioning, functional mobilization, and documentation of outcomes. This narrative review aims to update the current understanding of the influence of physical therapy and critical care teamwork on intensive care unit patients and to provide evidence-based recommendations for promoting early mobilization in the intensive care unit setting.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"37 ","pages":"e20250128"},"PeriodicalIF":0.0,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11805459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400834","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":"A national survey of Intensive Care Medicine Services in Portugal: where we are and the road ahead.","authors":"José-Artur Osório de Carvalho Paiva, Rui Alberto Lomelino Araújo, Paulo Jorge Coimbra Martins, António Jose Pereira Pais-Martins, Fernando Manuel Ferreira Araújo","doi":"10.62675/2965-2774.20250302","DOIUrl":"10.62675/2965-2774.20250302","url":null,"abstract":"<p><strong>Objective: </strong>The goal of this study was to assess the Portuguese Intensive Care Referral Network, namely the mission and organization of the Portuguese National Health Service Intensive Care Medicine Services and patient flows between them.</p><p><strong>Methods: </strong>The study was based on the responses to a semi-structured questionnaire by the directors of the forty-one Intensive Care Medicine Services, characterizing four domains: a) number, type, and management of beds; b) human resources and their consumption; c) outreach, including activities in the resuscitation room, intra-hospital emergency team and follow-up clinics; and d) referral network.</p><p><strong>Results: </strong>The number of active Intensive Care Medicine Services beds in Portugal markedly increased in the last 12 years, but the beds/habitant ratio is still below the Organization for Economic Cooperation and Development average. The activation of all installed beds would likely allow for the reduction of the hospital care gap perceived by many of the Intensive Care Medicine Services directors. There is significant geographic heterogeneity in the beds/habitant ratio and in the performance of outreach activities. The number of intensivists is rapidly growing, but nursing staff should be augmented, especially rehabilitation nurses. The referral network is globally complied, but the secondary transport of critical patients needs improvement and an electronic information system, which can be constantly updated, is seen as a relevant decision aid.</p><p><strong>Conclusion: </strong>Although intensive care medicine has significantly strengthened in the last 12 years, both in number of beds and in role and mission, there is still relevant heterogeneity in the beds/habitant ratio and in the performance of outreach activities among different Intensive Care Medicine Services.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"37 ","pages":"e20250302"},"PeriodicalIF":0.0,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11805461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400831","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}