Critical care science最新文献

{"title":"Driving pressure, as opposed to tidal volume based on predicted body weight, is associated with mortality: results from a prospective cohort of COVID-19 acute respiratory distress syndrome patients.","authors":"Erich Vidal Carvalho, Maycon Moura Reboredo, Edimar Pedrosa Gomes, Pedro Nascimento Martins, Gabriel Paz Souza Mota, Giovani Bernardo Costa, Fernando Antonio Basile Colugnati, Bruno Valle Pinheiro","doi":"10.62675/2965-2774.20240208-en","DOIUrl":"10.62675/2965-2774.20240208-en","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between driving pressure and tidal volume based on predicted body weight and mortality in a cohort of patients with acute respiratory distress syndrome caused by COVID-19.</p><p><strong>Methods: </strong>This was a prospective, observational study that included patients with acute respiratory distress syndrome due to COVID-19 admitted to two intensive care units. We performed multivariable analyses to determine whether driving pressure and tidal volume/kg predicted body weight on the first day of mechanical ventilation, as independent variables, are associated with hospital mortality.</p><p><strong>Results: </strong>We included 231 patients. The mean age was 64 (53 - 74) years, and the mean Simplified Acute and Physiology Score 3 score was 45 (39 - 54). The hospital mortality rate was 51.9%. Driving pressure was independently associated with hospital mortality (odds ratio 1.21, 95%CI 1.04 - 1.41 for each cm H2O increase in driving pressure, p = 0.01). Based on a double stratification analysis, we found that for the same level of tidal volume/kg predicted body weight, the risk of hospital death increased with increasing driving pressure. However, changes in tidal volume/kg predicted body weight were not associated with mortality when they did not lead to an increase in driving pressure.</p><p><strong>Conclusion: </strong>In patients with acute respiratory distress syndrome caused by COVID-19, exposure to higher driving pressure, as opposed to higher tidal volume/kg predicted body weight, is associated with greater mortality. These results suggest that driving pressure might be a primary target for lung-protective mechanical ventilation in these patients.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11098065/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140922673","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":"Challenges and limitations of using ventilator-free days as an outcome in critical care trials.","authors":"Alejandro Bruhn, Eduardo Kattan, Alexandre Biasi Cavalcanti","doi":"10.62675/2965-2774.20240088-en","DOIUrl":"10.62675/2965-2774.20240088-en","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11098069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140922420","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: Association between rectus femoris cross-sectional area and diaphragmatic excursion with weaning of tracheostomized patients in the intensive care unit","authors":"J. Finsterer, C. Scorza, Antonio-Carlos Guimarães Almeida, F. Scorza","doi":"10.62675/2965-2774.20240131-en","DOIUrl":"https://doi.org/10.62675/2965-2774.20240131-en","url":null,"abstract":"We read an interesting prospective, single-center, observational cohort study on the relationship between the cross-sectional diameter of the rectus femoris muscle, the degree of diaphragmatic excursion, and the outcome of weaning 81 critically ill patients by Vieira et al. (1) Successfully weaning critically ill patients from mechanical ventilation has been found to be associated with a larger cross-sectional area of the rectus femoris and diaphragmatic excursion. (1) The study is compelling but has limitations that should be discussed. The first limitation of the study is that the cross-sectional area of the rectus femoris muscle depends on several nonstandardized factors. The ultrasound measurement of the cross-sectional area of the rectus femoris depends on age, sex, caloric intake, diet, local arterial perfusion, physical condition of the patient before admission to the intensive care unit, innervation of the muscle, previous illness, comorbidities, and current medication. Therefore, few homogeneous cohorts can be generated, which makes the results unreliable. A second limitation of the study is that diaphragmatic deflection can also depend on multiple factors, such as previous lung or bronchial diseases, diseases of the central nervous system or the peripheral nervous system (PNS), status of the neuromuscular junction, premorbid physical activity (training condition), muscle function, and current medications.","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141004390","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":"\"While the wolf is away\": the echo of globalization delaying family decisions in intensive care","authors":"Cassiano Teixeira, Diogo Bolsson de Moraes Rocha, Maria Doroti Sousa da Rosa","doi":"10.62675/2965-2774.20240008-en","DOIUrl":"https://doi.org/10.62675/2965-2774.20240008-en","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141003692","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":"Alternative approaches to analyzing ventilator-free days, mortality and duration of ventilation in critical care research","authors":"Ary Serpa, Michael Bailey, Y. Shehabi, C. Hodgson, Rinaldo Bellomo","doi":"10.62675/2965-2774.20240246-en","DOIUrl":"https://doi.org/10.62675/2965-2774.20240246-en","url":null,"abstract":"ABSTRACT Objective: To discuss the strengths and limitations of ventilator-free days and to provide a comprehensive discussion of the different analytic methods for analyzing and interpreting this outcome. Methods: Using simulations, the power of different analytical methods was assessed, namely: quantile (median) regression, cumulative logistic regression, generalized pairwise comparison, conditional approach and truncated approach. Overall, 3,000 simulations of a two-arm trial with n = 300 per arm were computed using a two-sided alternative hypothesis and a type I error rate of α = 0.05. Results: When considering power, median regression did not perform well in studies where the treatment effect was mainly driven by mortality. Median regression performed better in situations with a weak effect on mortality but a strong effect on duration, duration only, and moderate mortality and duration. Cumulative logistic regression was found to produce similar power to the Wilcoxon rank-sum test across all scenarios, being the best strategy for the scenarios of moderate mortality and duration, weak mortality and strong duration, and duration only. Conclusion: In this study, we describe the relative power of new methods for analyzing ventilator-free days in critical care research. Our data provide validation and guidance for the use of the cumulative logistic model, median regression, generalized pairwise comparisons, and the conditional and truncated approach in specific scenarios.","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141004277","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":"Revolutionizing care: unleashing the power of comprehensive geriatric assessment in tailoring treatment for frail postintensive care patients","authors":"João Gabriel Rosa Ramos, Michele Melo Bautista, Rafael Calazans, Luciulo Melo, Cassiano Teixeira","doi":"10.62675/2965-2774.20240023-en","DOIUrl":"https://doi.org/10.62675/2965-2774.20240023-en","url":null,"abstract":"Frailty represents a condition of vulnerability leading to inadequate recovery following a stressful event, such as an acute illness or injury. This inadequate recovery results from cumulative, multisystem physiological depletion over a lifetime. (1) The frailty state implies that the available functional reserve is insufficient for complete recovery, often leading to a maladaptive response disproportionate to the degree of insult. (2) Frailty syndrome comprises five core components: vulnerability to stressors, multifactorial etiology causing multisystem dysregulation, heterogeneous presentation, clinical measurability, and association with adverse outcomes. (3) These components underscore frailty as a treatable clinical syndrome with a measurable biological basis. (2) Importantly, frailty is separate from but related to older age, multimorbidity or disability. For example, up to 4% of adults less than 65 years of age are frail, and up to 38% are prefrail, with an increasing prevalence in multimorbid patients. (4) Additionally, even though disability and comorbidities overlap with frailty, 8.6% of frail patients have no disabilities or comorbidities. (5) Thus, while conventionally linked to older age and health issues, frailty is now recognized as a dynamic transitional state from robustness to functional decline, potentially preventable or reversible in some cases. (2) The trajectory of critical illness closely aligns with the frailty process. Critical illness affects patients’ functional trajectory, with a substantial proportion of patients facing death or functional decline within a year after intensive care unit (ICU","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141003191","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":"A comprehensive physical functional assessment of survivors of critical care unit stay due to COVID-19.","authors":"Marcia Souza Volpe, Ana Carolina Cardoso Dos Santos, Sílvia Gaspar, Jade Lara de Melo, Gabriela Harada, Patrícia Rocha Alves Ferreira, Karina Ramiceli Soares da Silva, Natália Tiemi Simokomaki Souza, Carlos Toufen Junior, Luciana Dias Chiavegato, Marcelo Britto Passos Amato, Maria Ignez Zanetti Feltrim, Carlos Roberto Ribeiro de Carvalho","doi":"10.62675/2965-2774.20240284-en","DOIUrl":"10.62675/2965-2774.20240284-en","url":null,"abstract":"<p><strong>Objective: </strong>To examine the physical function and respiratory muscle strength of patients - who recovered from critical COVID-19 - after intensive care unit discharge to the ward on Days one (D1) and seven (D7), and to investigate variables associated with functional impairment.</p><p><strong>Methods: </strong>This was a prospective cohort study of adult patients with COVID-19 who needed invasive mechanical ventilation, non-invasive ventilation or high-flow nasal cannula and were discharged from the intensive care unit to the ward. Participants were submitted to Medical Research Council sum-score, handgrip strength, maximal inspiratory pressure, maximal expiratory pressure, and short physical performance battery tests. Participants were grouped into two groups according to their need for invasive ventilation: the Invasive Mechanical Ventilation Group (IMV Group) and the Non-Invasive Mechanical Ventilation Group (Non-IMV Group).</p><p><strong>Results: </strong>Patients in the IMV Group (n = 31) were younger and had higher Sequential Organ Failure Assessment scores than those in the Non-IMV Group (n = 33). The short physical performance battery scores (range 0 - 12) on D1 and D7 were 6.1 ± 4.3 and 7.3 ± 3.8, respectively for the Non-Invasive Mechanical Ventilation Group, and 1.3 ± 2.5 and 2.6 ± 3.7, respectively for the IMV Group. The prevalence of intensive care unit-acquired weakness on D7 was 13% for the Non-IMV Group and 72% for the IMV Group. The maximal inspiratory pressure, maximal expiratory pressure, and handgrip strength increased on D7 in both groups, but the maximal expiratory pressure and handgrip strength were still weak. Only maximal inspiratory pressure was recovered (i.e., > 80% of the predicted value) in the Non-IMV Group. Female sex, and the need and duration of invasive mechanical were independently and negatively associated with the short physical performance battery score and handgrip strength.</p><p><strong>Conclusion: </strong>Patients who recovered from critical COVID-19 and who received invasive mechanical ventilation presented greater disability than those who were not invasively ventilated. However, they both showed marginal functional improvement during early recovery, regardless of the need for invasive mechanical ventilation. This might highlight the severity of disability caused by SARS-CoV-2.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11098067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140878073","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":"Generalizing the application of machine learning predictive models across different populations: does a model to predict the use of renal replacement therapy in critically ill COVID-19 patients apply to general intensive care unit patients?","authors":"Allan Rodrigo Murrieta França, Julia Nunes Cantarino, Jorge Ibrain Figueira Salluh, Leonardo Dos Santos Lourenço Bastos","doi":"10.62675/2965-2774.20240285-en","DOIUrl":"10.62675/2965-2774.20240285-en","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11098073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140873804","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":"Efficacy of melatonin in decreasing the incidence of delirium in critically ill adults: a randomized controlled trial.","authors":"Anjishnujit Bandyopadhyay, Lakshmi Narayana Yaddanapudi, Vikas Saini, Neeru Sahni, Sandeep Grover, Sunaakshi Puri, Vighnesh Ashok","doi":"10.62675/2965-2774.20240144-en","DOIUrl":"10.62675/2965-2774.20240144-en","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether enteral melatonin decreases the incidence of delirium in critically ill adults.</p><p><strong>Methods: </strong>In this randomized controlled trial, adults were admitted to the intensive care unit and received either usual standard care alone (Control Group) or in combination with 3mg of enteral melatonin once a day at 9 PM (Melatonin Group). Concealment of allocation was done by serially numbered opaque sealed envelopes. The intensivist assessing delirium and the investigator performing the data analysis were blinded to the group allocation. The primary outcome was the incidence of delirium within 24 hours of the intensive care unit stay. The secondary outcomes were the incidence of delirium on Days 3 and 7, intensive care unit mortality, length of intensive care unit stay, duration of mechanical ventilation and Glasgow outcome score (at discharge).</p><p><strong>Results: </strong>We included 108 patients in the final analysis, with 54 patients in each group. At 24 hours of intensive care unit stay, there was no difference in the incidence of delirium between Melatonin and Control Groups (29.6 versus 46.2%; RR = 0.6; 95%CI 0.38 - 1.05; p = 0.11). No secondary outcome showed a statistically significant difference.</p><p><strong>Conclusion: </strong>Enteral melatonin 3mg is not more effective at decreasing the incidence of delirium than standard care is in critically ill adults.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11098074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140872477","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":"Why the Sequential Organ Failure Assessment score needs updating?","authors":"Rui Moreno, Mervyn Singer, Andrew Rhodes","doi":"10.62675/2965-2774.20240296-en","DOIUrl":"10.62675/2965-2774.20240296-en","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11098070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140873311","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}