Critical care science最新文献

{"title":"Venoarterial extracorporeal membrane oxygenation in the treatment of postinfarction cardiogenic shock: is it the end, or do we need to select patients better?","authors":"Livia Maria Garcia Melro, Marcelo Park, Pedro Vitale Mendes","doi":"10.62675/2965-2774.20240041-en","DOIUrl":"10.62675/2965-2774.20240041-en","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"36 ","pages":"e20240041en"},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11321715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082795","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":"Clinical trajectories of critically ill patients discharged directly from a critical unit to a postacute care facility: retrospective cohort.","authors":"João Gabriel Rosa Ramos, Milton José de Souza Neto, Alef Santiago Rezende, Flavia Dos Santos Ferreira, Yanne Danielly Santos Amorim, Flaviane Ribeiro de Souza, Lucas Freire de Andrade","doi":"10.62675/2965-2774.20240015-en","DOIUrl":"10.62675/2965-2774.20240015-en","url":null,"abstract":"<p><strong>Objective: </strong>To describe the clinical trajectories of patients discharged directly from a critical unit to a postacute care facility.</p><p><strong>Methods: </strong>This was a retrospective cohort study of patients who were transferred from an intensive care unit or intermediate care unit to a postacute care facility between July 2017 and April 2023. Functional status was measured by the Functional Independence Measure score.</p><p><strong>Results: </strong>A total of 847 patients were included in the study, and the mean age was 71 years. A total of 692 (82%) patients were admitted for rehabilitation, while 155 (18%) were admitted for palliative care. The mean length of stay in the postacute care facility was 36 days; 389 (45.9%) patients were discharged home, 173 (20.4%) were transferred to an acute hospital, and 285 (33.6%) died during hospitalization, of whom 263 (92%) had a do-not-resuscitate order. Of the patients admitted for rehabilitation purposes, 61 (9.4%) had a worsened functional status, 179 (27.6%) had no change in functional status, and 469 (63%) had an improved functional status during hospitalization. Moreover, 234 (33.8%) patients modified their care goals to palliative care, most of whom were in the group that did not improve functional status. Patients whose functional status improved during hospitalization were younger, had fewer comorbidities, had fewer previous hospitalizations, had lower rates of enteral feeding and tracheostomy, had higher Functional Independence Measure scores at admission to the postacute care facility and were more likely to be discharged home with less complex health care assistance.</p><p><strong>Conclusion: </strong>Postacute care facilities may play a role in the care of patients after discharge from intensive care units, both for those receiving rehabilitation and palliative care, especially for those with more severe illnesses who may not be discharged directly home.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"36 ","pages":"e20240015en"},"PeriodicalIF":0.0,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11463978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082792","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":"From critical care units to postacute care facilities: the sooner, the better?","authors":"Dimitri Gusmao-Flores, Bruna Brandão Barreto, Regis Goulart Rosa","doi":"10.62675/2965-2774.20240145-en","DOIUrl":"10.62675/2965-2774.20240145-en","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"36 ","pages":"e20240145en"},"PeriodicalIF":0.0,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11463977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082793","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":"Adherence to low tidal volume in the transition to spontaneous ventilation in patients with acute respiratory failure in intensive care units in Latin America (SPIRAL): a study protocol.","authors":"Fabia Diniz-Silva, Bruno Valle Pinheiro, Luis Felipe Reyes, Alexandre Biasi Cavalcanti, Belinda Figueredo, Fernando Rios, Flávia Ribeiro Machado, Gabriel Preda, Guillermo Bugedo, Israel Silva Maia, Leda Tomiko Yamada da Silveira, Luis Herrera, Manuel Jibaja, Miguel Ibarra-Estrada, Mino Cestari, Nicolás Nin, Rollin Roldan, Tiago Mendonça Dos Santos, Viviane Cordeiro Veiga, Alejandro Bruhn, Juliana Carvalho Ferreira","doi":"10.62675/2965-2774.20240044-en","DOIUrl":"10.62675/2965-2774.20240044-en","url":null,"abstract":"<p><strong>Objective: </strong>Patients with acute respiratory failure often require mechanical ventilation to reduce the work of breathing and improve gas exchange; however, this may exacerbate lung injury. Protective ventilation strategies, characterized by low tidal volumes (≤ 8mL/kg of predicted body weight) and limited plateau pressure below 30cmH2O, have shown improved outcomes in patients with acute respiratory distress syndrome. However, in the transition to spontaneous ventilation, it can be challenging to maintain tidal volume within protective levels, and it is unclear whether low tidal volumes during spontaneous ventilation impact patient outcomes. We developed a study protocol to estimate the prevalence of low tidal volume ventilation in the first 24 hours of spontaneous ventilation in patients with hypoxemic acute respiratory failure and its association with ventilator-free days and survival.</p><p><strong>Methods: </strong>We designed a multicenter, multinational, cohort study with a 28-day follow-up that will include patients with acute respiratory failure, defined as a partial oxygen pressure/fraction of inspired oxygen ratio < 300mmHg, in transition to spontaneous ventilation in intensive care units in Latin America.</p><p><strong>Results: </strong>We plan to include 422 patients in ten countries. The primary outcomes are the prevalence of low tidal volume in the first 24 hours of spontaneous ventilation and ventilator-free days on day 28. The secondary outcomes are intensive care unit and hospital mortality, incidence of asynchrony and return to controlled ventilation and sedation.</p><p><strong>Conclusion: </strong>In this study, we will assess the prevalence of low tidal volume during spontaneous ventilation and its association with clinical outcomes, which can inform clinical practice and future clinical trials.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"36 ","pages":"e20240044en"},"PeriodicalIF":0.0,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11321717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141977351","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":"Identification of distinct phenotypes and improving prognosis using metabolic biomarkers in COVID-19 patients.","authors":"Andressa Santana, Gabriele da Silveira Prestes, Marinara Dagostin da Silva, Carolina Saibro Girardi, Lucas Dos Santos Silva, José Cláudio Fonseca Moreira, Daniel Pens Gelain, Glauco Adrieno Westphal, Emil Kupek, Roger Walz, Felipe Dal-Pizzol, Cristiane Ritter","doi":"10.62675/2965-2774.20240028-en","DOIUrl":"10.62675/2965-2774.20240028-en","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the relationship between the levels of adipokines and other endocrine biomarkers and patient outcomes in hospitalized patients with COVID-19.</p><p><strong>Methods: </strong>In a prospective study that included 213 subjects with COVID-19 admitted to the intensive care unit, we measured the levels of cortisol, C-peptide, glucagon-like peptide-1, insulin, peptide YY, ghrelin, leptin, and resistin.; their contributions to patient clustering, disease severity, and predicting in-hospital mortality were analyzed.</p><p><strong>Results: </strong>Cortisol, resistin, leptin, insulin, and ghrelin levels significantly differed between severity groups, as defined by the World Health Organization severity scale. Additionally, lower ghrelin and higher cortisol levels were associated with mortality. Adding biomarkers to the clinical predictors of mortality significantly improved accuracy in determining prognosis. Phenotyping of subjects based on plasma biomarker levels yielded two different phenotypes that were associated with disease severity, but not mortality.</p><p><strong>Conclusion: </strong>As a single biomarker, only cortisol was independently associated with mortality; however, metabolic biomarkers could improve mortality prediction when added to clinical parameters. Metabolic biomarker phenotypes were differentially distributed according to COVID-19 severity but were not associated with mortality.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"36 ","pages":"e20240028en"},"PeriodicalIF":0.0,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11321718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141899097","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":"Clinical outcomes of intensive care unit-acquired weakness in critically ill COVID-19 patients. A prospective cohort study.","authors":"Alessandra Preisig Werlang, Viviane Martins Correa Boniatti, Carolina Tarantino Neuenfeldt, Luciana Carcuchinski da Silva, Gabriela Machado Costa, Michelle Carneiro Teixeira, Wagner Luis Nedel","doi":"10.62675/2965-2774.20240003-en","DOIUrl":"https://doi.org/10.62675/2965-2774.20240003-en","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"36 ","pages":"e20240003en"},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141565287","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":"Factors associated with carbon dioxide transfer in an experimental model of severe acute kidney injury and hypoventilation during high bicarbonate continuous renal replacement therapy and oxygenation membrane support.","authors":"Yuri de Albuquerque Pessoa Dos Santos, Luis Carlos Maia Cardozo Junior, Pedro Vitale Mendes, Bruno Adler Maccagnan Pinheiro Besen, Marcelo Park","doi":"10.62675/2965-2774.20240005-en","DOIUrl":"10.62675/2965-2774.20240005-en","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the factors influencing carbon dioxide transfer in a system that integrates an oxygenation membrane in series with high-bicarbonate continuous veno-venous hemodialysis in hypercapnic animals.</p><p><strong>Methods: </strong>In an experimental setting, we induced severe acute kidney injury and hypercapnia in five female Landrace pigs. Subsequently, we initiated high (40mEq/L) bicarbonate continuous veno-venous hemodialysis with an oxygenation membrane in series to maintain a pH above 7.25. At intervals of 1 hour, 6 hours, and 12 hours following the initiation of continuous veno-venous hemodialysis, we performed standardized sweep gas flow titration to quantify carbon dioxide transfer. We evaluated factors associated with carbon dioxide transfer through the membrane lung with a mixed linear model.</p><p><strong>Results: </strong>A total of 20 sweep gas flow titration procedures were conducted, yielding 84 measurements of carbon dioxide transfer. Multivariate analysis revealed associations among the following (coefficients ± standard errors): core temperature (+7.8 ± 1.6 °C, p < 0.001), premembrane partial pressure of carbon dioxide (+0.2 ± 0.1/mmHg, p < 0.001), hemoglobin level (+3.5 ± 0.6/g/dL, p < 0.001), sweep gas flow (+6.2 ± 0.2/L/minute, p < 0.001), and arterial oxygen saturation (-0.5 ± 0.2%, p = 0.019). Among these variables, and within the physiological ranges evaluated, sweep gas flow was the primary modifiable factor influencing the efficacy of low-blood-flow carbon dioxide removal.</p><p><strong>Conclusion: </strong>Sweep gas flow is the main carbon dioxide removal-related variable during continuous veno-venous hemodialysis with a high bicarbonate level coupled with an oxygenator. Other carbon dioxide transfer modulating variables included the hemoglobin level, arterial oxygen saturation, partial pressure of carbon dioxide and core temperature. These results should be interpreted as exploratory to inform other well-designed experimental or clinical studies.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"36 ","pages":"e20240005en"},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11208041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141565288","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":"Influence of obesity on mortality, mechanical ventilation time and mobility of critical patients with COVID-19.","authors":"Luísa Helena Machado Martinato, Débora Schmidt, Taila Cristina Piva, Gracieli Nadalon Deponti, Maricene Colissi Graboski, Rodrigo Della Méa Plentz, Graciele Sbruzzi","doi":"10.62675/2965-2774.20240253-en","DOIUrl":"10.62675/2965-2774.20240253-en","url":null,"abstract":"<p><strong>Objective: </strong>To identify the influence of obesity on mortality, time to weaning from mechanical ventilation and mobility at intensive care unit discharge in patients with COVID-19.</p><p><strong>Methods: </strong>This retrospective cohort study was carried out between March and August 2020. All adult patients admitted to the intensive care unit in need of ventilatory support and confirmed to have COVID-19 were included. The outcomes included mortality, time on mechanical ventilation, and mobility at intensive care unit discharge.</p><p><strong>Results: </strong>Four hundred and twenty-nine patients were included, 36.6% of whom were overweight and 43.8% of whom were obese. Compared with normal body mass index patients, overweight and obese patients had lower mortality (p = 0.002) and longer intensive care unit survival (log-rank p < 0.001). Compared with patients with a normal body mass index, overweight patients had a 36% lower risk of death (p = 0.04), while patients with obesity presented a 23% lower risk (p < 0.001). There was no association between obesity and time on mechanical ventilation. The level of mobility at intensive care unit discharge did not differ between groups and showed a moderate inverse correlation with length of stay in the intensive care unit (r = -0.461; p < 0.001).</p><p><strong>Conclusion: </strong>Overweight and obese patients had lower mortality and higher intensive care unit survival rates. The duration of mechanical ventilation and mobility level at intensive care unit discharge did not differ between the groups.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"36 ","pages":"e20240253en"},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11208042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141565309","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":"To: Neurocritical care management supported by multimodal brain monitoring after acute brain injury","authors":"J. Finsterer, F. Scorza","doi":"10.62675/2965-2774.20240276-en","DOIUrl":"https://doi.org/10.62675/2965-2774.20240276-en","url":null,"abstract":"Editor We read with interest the article by Monteiro et al. on a retrospective single-center study of the outcomes and mortality of 389 patients with traumatic brain injury (TBI) or subarachnoid bleeding (SAB) depending on the level of neuro-monitoring (standard, advanced) in a neuro-critical care unit (NCCU, Group G1) and a general intensive care unit (ICU) (GICU, Group G2). (1) The severity of the disease was assessed at admission to the emergency department using the simplified acute physiology (SAPS) II score. (1) Advanced multimodal brain monitoring, including autoregulation and NCCU management, was associated with better outcomes than standard neuromonitoring in the GICU. (1) The study is impressive, but some points require discussion. The major limitation of the study is that factors other than ICU monitoring and ICU type were not adequately included in the evaluation. The outcomes of TBI and SAB depend not only on the type and quality of neuro-monitoring in the ICU but also on several other influencing factors. These include the type and severity of TBI and SAB, the treatment of TBI and SAB, comorbidities, comedication, family history, and genetic background. In addition, for patients with SAB, it must be clarified whether the bleeding is aneurysmal or non-aneurysmal. In the case of an aneurysm, it is important to know whether the aneurysm is coiled or resected. The outcome of SAB may also depend on the initial Hunt–Hess score and whether there is blood inside the ventricles as well as age, comorbidities,","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"69 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141688398","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":"Science over language: a plea to consider language bias in scientific publishing","authors":"S. González-Dambrauskas, J. Salluh, Flávia Ribeiro Machado, Alexandre T Rotta","doi":"10.62675/2965-2774.20240084-en","DOIUrl":"https://doi.org/10.62675/2965-2774.20240084-en","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"21 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141703860","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}