Critical care science最新文献

{"title":"Update on the Epimed Monitor Adult ICU Database: 15 years of its use in national registries, quality improvement initiatives and clinical research.","authors":"Marcio Soares, Lunna Perdigão Borges, Leonardo Dos Santos Lourenco Bastos, Fernando Godinho Zampieri, Gabriel Alves Miranda, Pedro Kurtz, Suzana Margareth Lobo, Lucas Rodrigo Garcia de Mello, Gastón Burghi, Ederlon Rezende, Otávio Tavares Ranzani, Jorge Ibrain Figueira Salluh","doi":"10.62675/2965-2774.20240150-en","DOIUrl":"10.62675/2965-2774.20240150-en","url":null,"abstract":"<p><p>In recent decades, several databases of critically ill patients have become available in both low-, middle-, and high-income countries from all continents. These databases are also rich sources of data for the surveillance of emerging diseases, intensive care unit performance evaluation and benchmarking, quality improvement projects and clinical research. The Epimed Monitor database is turning 15 years old in 2024 and has become one of the largest of these databases. In recent years, there has been rapid geographical expansion, an increase in the number of participating intensive care units and hospitals, and the addition of several new variables and scores, allowing a more complete characterization of patients to facilitate multicenter clinical studies. As of December 2023, the database was being used regularly for 23,852 beds in 1,723 intensive care units and 763 hospitals from ten countries, totaling more than 5.6 million admissions. In addition, critical care societies have adopted the system and its database to establish national registries and international collaborations. In the present review, we provide an updated description of the database; report experiences of its use in critical care for quality improvement initiatives, national registries and clinical research; and explore other potential future perspectives and developments.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"36 ","pages":"e20240150en"},"PeriodicalIF":0.0,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11463981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142127550","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":"Fluid management in sepsis: 5 reasons why less fluid might be more rational.","authors":"Thiago Masashi Taniguchi, Leandro Utino Taniguchi","doi":"10.62675/2965-2774.20240111-en","DOIUrl":"10.62675/2965-2774.20240111-en","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"36 ","pages":"e20240111en"},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11463987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142127548","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":"Respiratory mechanics characteristics at the time of barotrauma presentation in patients with critical COVID-19 infection.","authors":"Gabriela Vieira Steckert, Sophia Andreola Borba, Gabriela Meirelles Marchese, Fabrício Schultz Medeiros, Tiago Severo Garcia, Marcio Manozzo Boniatti, Iuri Christmann Wawrzeniak","doi":"10.62675/2965-2774.20240248-en","DOIUrl":"10.62675/2965-2774.20240248-en","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate how ventilatory support, the duration of invasive ventilatory support use and lung mechanics are related to barotrauma development in patients who are severely infected with COVID-19 and who are admitted to the intensive care unit and develop pulmonary barotrauma.</p><p><strong>Methods: </strong>Retrospective cohort study of patients who were severely infected with COVID-19 and who developed pulmonary barotrauma secondary to mechanical ventilation.</p><p><strong>Results: </strong>This study included 60 patients with lung barotrauma who were divided into two groups: 37 with early barotrauma and 23 with late barotrauma. The early barotrauma group included more individuals who needed noninvasive ventilation (62.2% versus 26.1%, p = 0.01). The tidal volume/kg of predicted body weight on the day of barotrauma was measured, and 24 hours later, it was significantly greater in the late barotrauma group than in the early barotrauma group. During the day, barotrauma was accompanied by plateau pressure and driving pressure accompanied by tidal volume, which significantly increased in the late barotrauma group. According to the SAPS 3, patients in the early barotrauma group had more pulmonary thromboembolism and more severe illness. However, the intensive care unit mortality rates did not significantly differ between the two groups (66.7% for early barotrauma versus 76.9% for late barotrauma).</p><p><strong>Conclusion: </strong>We investigated the effect of respiratory mechanics on barotrauma in patients with severe COVID-19 and found that 25% of patients were on nonprotective ventilation parameters when they developed barotrauma. However, 50% of patients were on protective ventilation parameters, suggesting that other nonventilatory factors may contribute to barotrauma.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"36 ","pages":"e20240248en"},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11463995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142127549","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":"VATICAN (Ventilator-Associated Tracheobronchitis Initiative to Conduct Antibiotic Evaluation): protocol for a multicenter randomized open-label trial of watchful waiting versus antimicrobial therapy for ventilator-associated tracheobronchitis.","authors":"Bruno Martins Tomazini, Bruno Adler Maccagnan Pinheiro Besen, Camila Dietrich, Ana Paula Rossi Gandara, Debora Patrícia Silva, Carla Cristina Gomes Pinheiro, Mariane Nascimento Luz, Renata Rodrigues de Mattos, Luiz Fernando Lima Reis, Roberta Muriel Longo Roepke, Carlos Sérgio Luna Gomes Duarte, Antônio Paulo Nassar Júnior, Viviane Cordeiro Veiga, Beatriz Arns, Giovanna Marssola Nascimento, Adriano José Pereira, Alexandre Biasi Cavalcanti, Flávia Ribeiro Machado, Luciano Cesar Pontes Azevedo","doi":"10.62675/2965-2774.20240029-en","DOIUrl":"10.62675/2965-2774.20240029-en","url":null,"abstract":"<p><strong>Background: </strong>Ventilator-associated tracheobronchitis is a common condition among invasively ventilated patients in intensive care units, for which the best treatment strategy is currently unknown. We designed the VATICAN (Ventilator-Associated Tracheobronchitis Initiative to Conduct Antibiotic Evaluation) trial to assess whether a watchful waiting antibiotic treatment strategy is noninferior to routine antibiotic treatment for ventilator-associated tracheobronchitis regarding days free of mechanical ventilation.</p><p><strong>Methods: </strong>VATICAN is a randomized, controlled, open-label, multicenter noninferiority trial. Patients with suspected ventilator-associated tracheobronchitis without evidence of ventilator-associated pneumonia or hemodynamic instability due to probable infection will be assigned to either a watchful waiting strategy, without antimicrobial administration for ventilator-associated tracheobronchitis and prescription of antimicrobials only in cases of ventilator-associated pneumonia, sepsis or septic shock, or another infectious diagnosis, or to a routine antimicrobial treatment strategy for seven days. The primary outcome will be mechanical ventilation-free days at 28 days, and a key secondary outcome will be ventilator-associated pneumonia-free survival. Through an intention-to-treat framework with a per-protocol sensitivity analysis, the primary outcome analysis will address noninferiority with a 20% margin, which translates to a 1.5 difference in ventilator-free days. Other analyses will follow a superiority analysis framework.</p><p><strong>Conclusion: </strong>The VATICAN trial will follow all national and international ethical standards. We aim to publish the trial in a high-visibility general journal and present it at critical care and infectious disease conferences for dissemination. These results will likely be immediately applicable to the bedside upon trial completion and will provide information with a low risk of bias for guideline development.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"36 ","pages":"e20240029en"},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11321716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082794","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":"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}