Critical care science最新文献

{"title":"To: Factors associated with mortality in mechanically ventilated patients with severe acute respiratory syndrome due to COVID-19 evolution.","authors":"Abel Arroyo-Sánchez, Rosa Aguirre-Mejía","doi":"10.62675/2965-2774.20240192-en","DOIUrl":"10.62675/2965-2774.20240192-en","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11152438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141428458","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":"Unmasking the hidden aftermath: postintensive care unit sequelae, discharge preparedness, and long-term follow-up.","authors":"Cassiano Teixeira, Regis Goulart Rosa","doi":"10.62675/2965-2774.20240265-en","DOIUrl":"10.62675/2965-2774.20240265-en","url":null,"abstract":"<p><p>A significant portion of individuals who have experienced critical illness encounter new or exacerbated impairments in their physical, cognitive, or mental health, commonly referred to as postintensive care syndrome. Moreover, those who survive critical illness often face an increased risk of adverse consequences, including infections, major cardiovascular events, readmissions, and elevated mortality rates, during the months following hospitalization. These findings emphasize the critical necessity for effective prevention and management of long-term health deterioration in the critical care environment. Although conclusive evidence from well-designed randomized clinical trials is somewhat limited, potential interventions include strategies such as limiting sedation, early mobilization, maintaining family presence during the intensive care unit stay, implementing multicomponent transition programs (from intensive care unit to ward and from hospital to home), and offering specialized posthospital discharge follow-up. This review seeks to provide a concise summary of recent medical literature concerning long-term outcomes following critical illness and highlight potential approaches for preventing and addressing health decline in critical care survivors.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11152445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141428459","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":"Evaluation of the classifications of severity in acute respiratory distress syndrome in childhood by the Berlin Consensus and the Pediatric Acute Lung Injury Consensus Conference.","authors":"Roberta Costa Capela, Raquel Belmino de Souza, Maria de Fátima Pombo Sant'Anna, Clemax Couto Sant'Anna","doi":"10.62675/2965-2774.20240229-en","DOIUrl":"10.62675/2965-2774.20240229-en","url":null,"abstract":"<p><strong>Objective: </strong>To compare two methods for defining and classifying the severity of pediatric acute respiratory distress syndrome: the Berlin classification, which uses the relationship between the partial pressure of oxygen and the fraction of inspired oxygen, and the classification of the Pediatric Acute Lung Injury Consensus Conference, which uses the oxygenation index.</p><p><strong>Methods: </strong>This was a prospective study of patients aged 0 - 18 years with a diagnosis of acute respiratory distress syndrome who were invasively mechanically ventilated and provided one to three arterial blood gas samples, totaling 140 valid measurements. These measures were evaluated for correlation using the Spearman test and agreement using the kappa coefficient between the two classifications, initially using the general population of the study and then subdividing it into patients with and without bronchospasm and those with and without the use of neuromuscular blockers. The effect of these two factors (bronchospasm and neuromuscular blocking agent) separately and together on both classifications was also assessed using two-way analysis of variance.</p><p><strong>Results: </strong>In the general population, who were 54 patients aged 0 - 18 years a strong negative correlation was found by Spearman's test (ρ -0.91; p < 0.001), and strong agreement was found by the kappa coefficient (0.62; p < 0.001) in the comparison between Berlin and Pediatric Acute Lung Injury Consensus Conference. In the populations with and without bronchospasm and who did and did not use neuromuscular blockers, the correlation coefficients were similar to those of the general population, though among patients not using neuromuscular blockers, there was greater agreement between the classifications than for patients using neuromuscular blockers (kappa 0.67 versus 0.56, p < 0.001 for both). Neuromuscular blockers had a significant effect on the relationship between the partial pressure of oxygen and the fraction of inspired oxygen (analysis of variance; F: 12.9; p < 0.001) and the oxygenation index (analysis of variance; F: 8.3; p = 0.004).</p><p><strong>Conclusion: </strong>There was a strong correlation and agreement between the two classifications in the general population and in the subgroups studied. Use of neuromuscular blockers had a significant effect on the severity of acute respiratory distress syndrome.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11152442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141312418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact on pulmonary, cardiac, and renal function and long-term quality of life after hospitalization for acute respiratory distress syndrome due to COVID-19: Protocol of the Post-COVID Brazil 3 study","authors":"Fernando Luís Scolari, M. Rover, Geraldine Trott, Mariana Motta Dias da Silva, Denise de Souza, Raine Fogliati de Carli Schardosim, Rosa da Rosa Minho dos Santos, Emelyn de Souza Roldão, Duane Mocellin, Jennifer Menna Barreto de Souza, A. Miozzo, G. Rech, Carolina Rothmann Itaqui, Juliana de Mesquita, Gabriel Pozza Muller Estivalete, Hellen Jordan Martins Freitas, Catherine Vitória Pereira dos Santos, L. G. da Luz, Marcelo Kern, M. S. Marcolino, Bruna Brandão Barreto, Paulo R. Schwartzman, A. C. P. Antonio, Maicon Falavigna, C. Robinson, Carisi Anne Polanczy, R. G. Rosa","doi":"10.62675/2965-2774.20240258-en","DOIUrl":"https://doi.org/10.62675/2965-2774.20240258-en","url":null,"abstract":"ABSTRACT Rationale: Evidence about long-term sequelae after hospitalization for acute respiratory distress syndrome due to COVID-19 is still scarce. Purpose: To evaluate changes in pulmonary, cardiac, and renal function and in quality of life after hospitalization for acute respiratory distress syndrome secondary to COVID-19. Methods: This will be a multicenter case–control study of 220 participants. Eligible are patients who are hospitalized for acute respiratory distress syndrome due to COVID-19. In the control group, individuals with no history of hospitalization in the last 12 months or long-term symptoms of COVID-19 will be selected. All individuals will be subjected to pulmonary spirometry with a carbon monoxide diffusion test, chest tomography, cardiac and renal magnetic resonance imaging with gadolinium, ergospirometry, serum and urinary creatinine, total protein, and urinary microalbuminuria, in addition to quality-of-life questionnaires. Patients will be evaluated 12 months after hospital discharge, and controls will be evaluated within 90 days of inclusion in the study. For all the statistical analyses, p < 0.05 is the threshold for significance. Results: The primary outcome of the study will be the pulmonary diffusing capacity for carbon monoxide measured after 12 months. The other parameters of pulmonary, cardiac, and renal function and quality of life are secondary outcomes. Conclusion: This study aims to determine the long-term sequelae of pulmonary, cardiac, and renal function and the quality of life of patients hospitalized for acute respiratory distress syndrome due to COVID-19 in the Brazilian population.","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141382287","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: Biomarkers of neuropsychiatric dysfunction in intensive care unit survivors: a prospective cohort study","authors":"J. Finsterer, F. Scorza","doi":"10.62675/2965-2774.20240260-en","DOIUrl":"https://doi.org/10.62675/2965-2774.20240260-en","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141385763","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":"Waiting for the Pediatric Acute Lung Injury Consensus Conference 3","authors":"José Colleti Junior, Fernanda Lima-Setta","doi":"10.62675/2965-2774.20240114-en","DOIUrl":"https://doi.org/10.62675/2965-2774.20240114-en","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141385042","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":"Prospective, randomized, controlled trial assessing the effects of a driving pressure-limiting strategy for patients with acute respiratory distress syndrome due to community-acquired pneumonia (STAMINA trial): protocol and statistical analysis plan.","authors":"Israel Silva Maia, Fernando Azevedo Medrado, Lucas Tramujas, Bruno Martins Tomazini, Júlia Souza Oliveira, Erica Regina Ribeiro Sady, Letícia Galvão Barbante, Marina Lazzari Nicola, Rodrigo Magalhães Gurgel, Lucas Petri Damiani, Karina Leal Negrelli, Tamiris Abait Miranda, Eliana Santucci, Nanci Valeis, Ligia Nasi Laranjeira, Glauco Adrieno Westphal, Ruthy Perotto Fernandes, Cássio Luis Zandonai, Mariangela Pimentel Pincelli, Rodrigo Cruvinel Figueiredo, Cíntia Loss Sartori Bustamante, Luiz Fernando Norbin, Emerson Boschi, Rafael Lessa, Marcelo Pereira Romano, Mieko Cláudia Miura, Meton Soares de Alencar Filho, Vicente Cés de Souza Dantas, Priscilla Alves Barreto, Mauro Esteves Hernandes, Cintia Magalhães Carvalho Grion, Alexandre Sanches Laranjeira, Ana Luiza Mezzaroba, Marina Bahl, Ana Carolina Starke, Rodrigo Santos Biondi, Felipe Dal-Pizzol, Eliana Bernadete Caser, Marlus Muri Thompson, Andrea Allegrini Padial, Viviane Cordeiro Veiga, Rodrigo Thot Leite, Gustavo Araújo, Mário Guimarães, Priscilla de Aquino Martins, Fábio Holanda Lacerda, Conrado Roberto Hoffmann Filho, Livia Melro, Eduardo Pacheco, Gustavo Adolfo Ospina-Táscon, Juliana Carvalho Ferreira, Fabricio Jocundo Calado Freires, Flávia Ribeiro Machado, Alexandre Biasi Cavalcanti, Fernando Godinho Zampieri","doi":"10.62675/2965-2774.20240210-en","DOIUrl":"10.62675/2965-2774.20240210-en","url":null,"abstract":"<p><strong>Background: </strong>Driving pressure has been suggested to be the main driver of ventilator-induced lung injury and mortality in observational studies of acute respiratory distress syndrome. Whether a driving pressure-limiting strategy can improve clinical outcomes is unclear.</p><p><strong>Objective: </strong>To describe the protocol and statistical analysis plan that will be used to test whether a driving pressure-limiting strategy including positive end-expiratory pressure titration according to the best respiratory compliance and reduction in tidal volume is superior to a standard strategy involving the use of the ARDSNet low-positive end-expiratory pressure table in terms of increasing the number of ventilator-free days in patients with acute respiratory distress syndrome due to community-acquired pneumonia.</p><p><strong>Methods: </strong>The ventilator STrAtegy for coMmunIty acquired pNeumoniA (STAMINA) study is a randomized, multicenter, open-label trial that compares a driving pressure-limiting strategy to the ARDSnet low-positive end-expiratory pressure table in patients with moderate-to-severe acute respiratory distress syndrome due to community-acquired pneumonia admitted to intensive care units. We expect to recruit 500 patients from 20 Brazilian and 2 Colombian intensive care units. They will be randomized to a driving pressure-limiting strategy group or to a standard strategy using the ARDSNet low-positive end-expiratory pressure table. In the driving pressure-limiting strategy group, positive end-expiratory pressure will be titrated according to the best respiratory system compliance.</p><p><strong>Outcomes: </strong>The primary outcome is the number of ventilator-free days within 28 days. The secondary outcomes are in-hospital and intensive care unit mortality and the need for rescue therapies such as extracorporeal life support, recruitment maneuvers and inhaled nitric oxide.</p><p><strong>Conclusion: </strong>STAMINA is designed to provide evidence on whether a driving pressure-limiting strategy is superior to the ARDSNet low-positive end-expiratory pressure table strategy for increasing the number of ventilator-free days within 28 days in patients with moderate-to-severe acute respiratory distress syndrome. Here, we describe the rationale, design and status of the trial.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11098077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141075372","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":"Reply to: Association between rectus femoris cross-sectional area and diaphragmatic excursion with weaning of tracheostomized patients in the intensive care unit.","authors":"Fernando Nataniel Vieira, Raquel Bortoluzzi Bertazzo, Gabriela Carvalho Nascimento, Mariluce Anderle, Ana Cláudia Coelho, Fabiana de Oliveira Chaise, Jaqueline da Silva Fink, Wagner Luis Nedel, Bruna Ziegler","doi":"10.62675/2965-2774.20240012-en","DOIUrl":"10.62675/2965-2774.20240012-en","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11132113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141075700","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":"Delirium and sleep quality in the intensive care unit: the role of melatonin.","authors":"Pedro Henrique Rigotti Soares, Rodrigo Bernardo Serafim","doi":"10.62675/2965-2774.20240083-en","DOIUrl":"10.62675/2965-2774.20240083-en","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11098068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141075150","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":"Goal-directed therapy guided by the FloTrac sensor in major surgery: a systematic review and meta-analysis.","authors":"Márcia Regina Dias Alves, Saulo Fernandes Saturnino, Ana Beatriz Zen, Dayane Gabriele Silveira de Albuquerque, Henrique Diegoli","doi":"10.62675/2965-2774.20240196-en","DOIUrl":"10.62675/2965-2774.20240196-en","url":null,"abstract":"<p><strong>Objective: </strong>To provide insights into the potential benefits of goal-directed therapy guided by FloTrac in reducing postoperative complications and improving outcomes.</p><p><strong>Methods: </strong>We performed a systematic review and meta-analysis of randomized controlled trials to evaluate goal-directed therapy guided by FloTrac in major surgery, comparing goal-directed therapy with usual care or invasive monitoring in cardiac and noncardiac surgery subgroups. The quality of the articles and evidence were evaluated with a risk of bias tool and GRADE.</p><p><strong>Results: </strong>We included 29 randomized controlled trials with 3,468 patients. Goal-directed therapy significantly reduced the duration of hospital stay (mean difference -1.43 days; 95%CI 2.07 to -0.79; I2 81%), intensive care unit stay (mean difference -0.77 days; 95%CI -1.18 to -0.36; I2 93%), and mechanical ventilation (mean difference -2.48 hours, 95%CI -4.10 to -0.86, I2 63%). There was no statistically significant difference in mortality, myocardial infarction, acute kidney injury or hypotension, but goal-directed therapy significantly reduced the risk of heart failure or pulmonary edema (RR 0.46; 95%CI 0.23 - 0.92; I2 0%).</p><p><strong>Conclusion: </strong>Goal-directed therapy guided by the FloTrac sensor improved clinical outcomes and shortened the length of stay in the hospital and intensive care unit in patients undergoing major surgery. Further research can validate these results using specific protocols and better understand the potential benefits of FloTrac beyond these outcomes.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11098079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141075199","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}