Critical care science最新文献

{"title":"Effects of atelectatic areas on the surrounding lung tissue during mechanical ventilation in an experimental model of acute lung injury induced by lipopolysaccharide.","authors":"Lídia Maria Carneiro Fonseca, Maycon Moura Reboredo, Leda Marília Fonseca Lucinda, Thaís Fernanda Fazza, Bruno Curty Bergamini, Mateus Pinto Botelho, Gabriele Moura Lopes, Juliana Dias Nascimento Ferreira, Erich Vidal Carvalho, Bruno Valle Pinheiro","doi":"10.5935/2965-2774.20230190-en","DOIUrl":"10.5935/2965-2774.20230190-en","url":null,"abstract":"<p><strong>Objective: </strong>To assess the effect of atelectasis during mechanical ventilation on the periatelectatic and normal lung regions in a model of atelectasis in rats with acute lung injury induced by lipopolysaccharide.</p><p><strong>Methods: </strong>Twenty-four rats were randomized into the following four groups, each with 6 animals: the Saline-Control Group, Lipopolysaccharide Control Group, Saline-Atelectasis Group, and Lipopolysaccharide Atelectasis Group. Acute lung injury was induced by intraperitoneal injection of lipopolysaccharide. After 24 hours, atelectasis was induced by bronchial blocking. The animals underwent mechanical ventilation for two hours with protective parameters, and respiratory mechanics were monitored during this period. Thereafter, histologic analyses of two regions of interest, periatelectatic areas and the normally-aerated lung contralateral to the atelectatic areas, were performed.</p><p><strong>Results: </strong>The lung injury score was significantly higher in the Lipopolysaccharide Control Group (0.41 ± 0.13) than in the Saline Control Group (0.15 ± 0.51), p < 0.05. Periatelectatic regions showed higher lung injury scores than normally-aerated regions in both the Saline-Atelectasis (0.44 ± 0.06 x 0.27 ± 0.74 p < 0.05) and Lipopolysaccharide Atelectasis (0.56 ± 0.09 x 0.35 ± 0.04 p < 0.05) Groups. The lung injury score in the periatelectatic regions was higher in the Lipopolysaccharide Atelectasis Group (0.56 ± 0.09) than in the periatelectatic region of the Saline-Atelectasis Group (0.44 ± 0.06), p < 0.05.</p><p><strong>Conclusion: </strong>Atelectasis may cause injury to the surrounding tissue after a period of mechanical ventilation with protective parameters. Its effect was more significant in previously injured lungs.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10802780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139543719","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 glucose control in critically ill adults: a protocol for a systematic review and individual patient data meta-analysis.","authors":"Derick Adigbli, Li Yang, Naomi Hammond, Djillali Annane, Yaseen Arabi, Federico Bilotta, Julien Bohé, Frank Martin Brunkhorst, Alexandre Biasi Cavalcanti, Deborah Cook, Christoph Engel, Deborah Green-LaRoche, Wei He, William Henderson, Cornelia Hoedemaekers, Gaetano Iapichino, Pierre Kalfon, Gisela de La Rosa, Iain MacKenzie, Christian Mélot, Imogen Mitchell, Tuomas Oksanen, Federico Polli, Jean-Charles Preiser, Francisco Garcia Soriano, Ling-Cong Wang, Jiaxiang Yuan, Anthony Delaney, Gian Luca Di Tanna, Simon Finfer","doi":"10.5935/2965-2774.20230162-en","DOIUrl":"10.5935/2965-2774.20230162-en","url":null,"abstract":"<p><strong>Objective: </strong>The optimal target for blood glucose concentration in critically ill patients is unclear. We will perform a systematic review and meta-analysis with aggregated and individual patient data from randomized controlled trials, comparing intensive glucose control with liberal glucose control in critically ill adults.</p><p><strong>Data sources: </strong>MEDLINE®, Embase, the Cochrane Central Register of Clinical Trials, and clinical trials registries (World Health Organization, clinical trials.gov). The authors of eligible trials will be invited to provide individual patient data. Published trial-level data from eligible trials that are not at high risk of bias will be included in an aggregated data meta-analysis if individual patient data are not available.</p><p><strong>Methods: </strong>Inclusion criteria: randomized controlled trials that recruited adult patients, targeting a blood glucose of ≤ 120mg/dL (≤ 6.6mmol/L) compared to a higher blood glucose concentration target using intravenous insulin in both groups. Excluded studies: those with an upper limit blood glucose target in the intervention group of > 120mg/dL (> 6.6mmol/L), or where intensive glucose control was only performed in the intraoperative period, and those where loss to follow-up exceeded 10% by hospital discharge.</p><p><strong>Primary endpoint: </strong>In-hospital mortality during index hospital admission. Secondary endpoints: mortality and survival at other timepoints, duration of invasive mechanical ventilation, vasoactive agents, and renal replacement therapy. A random effect Bayesian meta-analysis and hierarchical Bayesian models for individual patient data will be used.</p><p><strong>Discussion: </strong>This systematic review with aggregate and individual patient data will address the clinical question, 'what is the best blood glucose target for critically ill patients overall?'Protocol version 0.4 - 06/26/2023PROSPERO registration:CRD42021278869.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10802778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139543723","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":"Adverse events in the postoperative period of cardiac surgery in a pediatric intensive care unit: the contribution of the VIS score and the RACHS-1.","authors":"Ana Beatriz Ramos Wasniewski, Claudia Pires Ricachinevsky, Raíssa Queiroz Rezende, Bruna Tomasi Lorentz, Edinara da Silva Silveira, Viviane Helena Rampon Angeli, Mariana González de Oliveira, Themis Reverbel da Silveira","doi":"10.5935/2965-2774.20230215-en","DOIUrl":"10.5935/2965-2774.20230215-en","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the occurrence of adverse events in the postoperative period of cardiac surgery in a pediatric intensive care unit and to find any patient characteristics that can predict such events.</p><p><strong>Methods: </strong>This was a historical cohort study of patients recovering in the pediatric intensive care unit for the first 7 days after cardiac surgery between April and December 2019, by reviewing the medical records. The following were reviewed: demographic, clinical, and laboratory characteristics; patient severity scores; and selected adverse events, grouped into device-related, surgical, and nonsurgical.</p><p><strong>Results: </strong>A total of 238 medical records were included. At least one adverse event occurred in 110 postoperative patients (46.2%). The total number of adverse events was 193 (81%). Vascular catheters were the most common cause, followed by cardiac arrest, bleeding, and surgical reexploration. In the univariate analysis, the vasoactive-inotropic score (VIS), Risk Adjustment in Congenital Heart Surgery (RACHS-1) score, age, Pediatric Index of Mortality (PIM-2), cardiopulmonary bypass and aortic clamping duration were significantly associated with adverse events. In the multivariate analysis, VIS ≥ 20 (OR 2.90; p = 0.004) and RACHS-1 ≥ 3 (OR 2.11; p = 0.019) were significant predictors, while age and delayed sternal closure showed only trends toward significance. To predict the occurrence of adverse events from VIS and RACHS-1, the area under the curve was 0.73 (95%CI 0.66 - 0.79).</p><p><strong>Conclusion: </strong>Adverse events were quite frequent in children after cardiac surgery, especially those related to devices. The VIS and RACHS-1, used together, predicted the occurrence of adverse events well in this pediatric sample.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10802767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139543707","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":"Capillary leak syndrome during continuous renal replacement therapy after renal hilum ligation in a hypercapnic landrace pig.","authors":"Yuri de Albuquerque Pessoa Dos Santos, Luis Carlos Maia Cardozo Júnior, Pedro Vitale Mendes, Bruno Adler Maccagnan Pinheiro Besen, Marcelo Park","doi":"10.5935/2965-2774.20230139-en","DOIUrl":"10.5935/2965-2774.20230139-en","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10802781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139543708","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 severity and outcomes of critically ill COVID-19 patients.","authors":"Luciana Leal do Rego, Jorge Ibrain Figueira Salluh, Vicente Cés de Souza-Dantas, José Roberto Lapa E Silva, Pedro Póvoa, Rodrigo Bernardo Serafim","doi":"10.5935/2965-2774.20230170-en","DOIUrl":"10.5935/2965-2774.20230170-en","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the impact of delirium severity in critically ill COVID-19 patients and its association with outcomes.</p><p><strong>Methods: </strong>This prospective cohort study was performed in two tertiary intensive care units in Rio de Janeiro, Brazil. COVID-19 patients were evaluated daily during the first 7 days of intensive care unit stay using the Richmond Agitation Sedation Scale, Confusion Assessment Method for Intensive Care Unit (CAM-ICU) and Confusion Method Assessment for Intensive Care Unit-7 (CAM-ICU-7). Delirium severity was correlated with outcomes and one-year mortality.</p><p><strong>Results: </strong>Among the 277 COVID-19 patients included, delirium occurred in 101 (36.5%) during the first 7 days of intensive care unit stay, and it was associated with a higher length of intensive care unit stay in days (IQR 13 [7 - 25] versus 6 [4 - 12]; p < 0.001), higher hospital mortality (25.74% versus 5.11%; p < 0.001) and additional higher one-year mortality (5.3% versus 0.6%, p < 0.001). Delirium was classified by CAM-ICU-7 in terms of severity, and higher scores were associated with higher in-hospital mortality (17.86% versus 34.38% versus 38.46%, 95%CI, p value < 0.001). Severe delirium was associated with a higher risk of progression to coma (OR 7.1; 95%CI 1.9 - 31.0; p = 0.005) and to mechanical ventilation (OR 11.09; 95%CI 2.8 - 58.5; p = 0.002) in the multivariate analysis, adjusted by severity and frailty.</p><p><strong>Conclusion: </strong>In patients admitted with COVID-19 in the intensive care unit, delirium was an independent risk factor for the worst prognosis, including mortality. The delirium severity assessed by the CAM-ICU-7 during the first week in the intensive care unit was associated with poor outcomes, including progression to coma and to mechanical ventilation.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10802771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139543714","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":"Intensivist-led ultrasound-guided percutaneous tracheostomy: a phase IV cohort study.","authors":"Pedro Fortes Osório Bustamante, Bruno Adler Maccagnan Pinheiro Besen, Amanda Pinto Botêga, Filipe Matheus Cadamuro, Marcelo Park, Pedro Vitale Mendes, Roberta Muriel Longo Roepke","doi":"10.5935/2965-2774.20230174-en","DOIUrl":"10.5935/2965-2774.20230174-en","url":null,"abstract":"<p><strong>Objective: </strong>To describe, with a larger number of patients in a real-world scenario following routine implementation, intensivist-led ultrasound-guided percutaneous dilational tracheostomy and the possible risks and complications of the procedure not identified in clinical trials.</p><p><strong>Methods: </strong>This was a phase IV cohort study of patients admitted to three intensive care units of a quaternary academic hospital who underwent intensivist-led ultrasound-guided percutaneous tracheostomy in Brazil from September 2017 to December 2021.</p><p><strong>Results: </strong>There were 4,810 intensive care unit admissions during the study period; 2,084 patients received mechanical ventilation, and 287 underwent tracheostomy, 227 of which were performed at bedside by the intensive care team. The main reason for intensive care unit admission was trauma, and for perform a tracheostomy it was a neurological impairment or an inability to protect the airways. The median time from intubation to tracheostomy was 14 days. Intensive care residents performed 76% of the procedures. At least one complication occurred in 29.5% of the procedures, the most common being hemodynamic instability and extubation during the procedure, with only 3 serious complications. The intensive care unit mortality was 29.1%, and the hospital mortality was 43.6%.</p><p><strong>Conclusion: </strong>Intensivist-led ultrasound-guided percutaneous tracheostomy is feasible out of a clinical trial context with outcomes and complications comparable to those in the literature. Intensivists can acquire this competence during their training but should be aware of potential complications to enhance procedural safety.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10802775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139543725","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":"Open-access publications: a double-edged sword for critical care researchers in lowand middle-income countries.","authors":"Antonio Paulo Nassar, Flávia Ribeiro Machado, Felipe Dal-Pizzol, Jorge Ibrain Figueira Salluh","doi":"10.5935/2965-2774.20230263-en","DOIUrl":"10.5935/2965-2774.20230263-en","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10802774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139543727","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":"Outcomes of critically ill pregnant COVID-19 patients: a cohort study.","authors":"Pedro Henrique Rigotti Soares, Cesar Antônio Sebben Filho, Rafaela Doebber Escobar, Leonardo Bianchet Botega, Laura Rodolpho Petry, Wagner Luís Nedel","doi":"10.5935/2965-2774.20230222-en","DOIUrl":"10.5935/2965-2774.20230222-en","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10802777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139543728","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: Posterior reversible encephalopathy syndrome in a child with severe multisystem inflammatory syndrome due to COVID-19.","authors":"Carla Alessandra Scorza, Ana Claudia Fiorini, Fulvio Alexandre Scorza, Josef Finsterer","doi":"10.5935/2965-2774.20230283-en","DOIUrl":"10.5935/2965-2774.20230283-en","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10802772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139543733","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":"Acute kidney injury in hospitalized patients with COVID-19: a retrospective cohort.","authors":"Fernando Godinho Zampieri,&nbsp;Henrique Palomba,&nbsp;Fernando Augusto Bozza,&nbsp;Daniel C Cubos,&nbsp;Thiago G Romano","doi":"10.5935/2965-2774.20230428-en","DOIUrl":"10.5935/2965-2774.20230428-en","url":null,"abstract":"Coronavirus disease 2019 (COVID-19) has been reported to cause acute kidney injury (AKI).(1-4) Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may directly harm the kidneys through endothelial and coagulation dysfunction,(1) AKI in COVID-19 may also be related to additional organ dysfunctions and other host factors, including mechanical ventilation. The incidence of AKI in hospitalized COVID-19 patients has been suggested to be close to 10.6%, with AKI being strongly associated with increased mortality.(2) We sought to describe the occurrence of AKI in a cohort of hospitalized patients in a private network of hospitals in Brazil during the first COVID wave (March to August 2020). Second, we assessed the interplay between the time of initiation of mechanical ventilation and the occurrence of AKI. Our initial hypothesis was that AKI would predominantly occur after the initiation of mechanical ventilation. The study was approved by the centralized ethics committee with a waiver for consent due to the retrospective nature of its analysis based on anonymized data. We initially selected all 1,602 patients admitted to 45 hospitals in the first wave who had creatinine levels obtained at admission, who did not have a diagnosis of chronic kidney disease, who were older than 18 years old, who had at least one additional creatinine measurement, and who had known hospital outcomes (not transferred to another facility), as shown in figure 1. AKI was defined using two different definitions based on daily information collected up to Fernando Godinho Zampieri1 , Henrique Palomba1 , Fernando Augusto Bozza2 , Daniel C. Cubos1, Thiago G Romano1","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10406411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10321441","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}