Critical care science最新文献

{"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}

{"title":"To: Death by community-based methicillin-resistant Staphylococcus aureus: case report.","authors":"Fulvio Alexandre Scorza, Carla Alessandra Scorza, Josef Finsterer","doi":"10.62675/2965-2774.20240040-en","DOIUrl":"10.62675/2965-2774.20240040-en","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"36 ","pages":"e20240040en"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11208040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141494450","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":"New Phoenix criteria for pediatric sepsis and septic shock: the strengths and the future of a comprehensive perspective","authors":"Vanessa Soares Lanziotti, Andrea Ventura, S. Kache, Jaime Fernández-Sarmiento","doi":"10.62675/2965-2774.20240058-en","DOIUrl":"https://doi.org/10.62675/2965-2774.20240058-en","url":null,"abstract":"In Greek mythology, the phoenix bird symbolizes life that overcomes death and the strength that accompanies transformation. Therefore, Phoenix is an appropriate name for the new Pediatric Sepsis Score owing to both the mythological reference and the location where it was first presented (Society of Critical Care Medicine – SCCM - Conference in Phoenix, Arizona). (1) The Phoenix Pediatric Sepsis (PPS) criteria for sepsis and septic shock are intended to identify children (1 month to <18 years) with life-threatening organ dysfunction due to infection, and the score was developed based on more than three million pediatric electronic health encounters, (2) which is a remarkable achievement considering pediatric and adult sepsis studies. The previous pediatric sepsis criteria were published in 2005 by the International Pediatric Sepsis Consensus Conference (IPSCC), and sepsis was defined as a suspected or confirmed infection in the presence of systemic inflammatory response syndrome (SIRS) (Figure 1). (3) Although these criteria are broadly used in daily practice, limitations to this definition have been identified since its inception. (4) Specific limitations of concern include a lack of consideration of a global context, leading to challenges in the applicabiblity of these criteria in limited-resource settings where the highest sepsis burden lies; variability in application at the bedside, which leads to delay in patient diagnosis; and the inability to","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"92 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141695738","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":"Analysis of factors associated with admission to the intensive care unit of children and adolescents with COVID-19: application of a multilevel model","authors":"L. C. L. Damascena, Aline Roseane Queiroz de Paiva Faria, Nyellisonn Nando Nóbrega de Lucena, Ana Hermínia Andrade e Silva, Talita Tavares Alves de Almeida, Diana de Fátima Alves Pinto, H. F. Coêlho, Ana Maria Gondim Valença","doi":"10.62675/2965-2774.20240068-en","DOIUrl":"https://doi.org/10.62675/2965-2774.20240068-en","url":null,"abstract":"ABSTRACT Objective To identify factors associated with hospitalization in the intensive care unit in children and adolescents with COVID-19. Methods This was a retrospective cohort study using secondary data of hospitalized children and adolescents (zero to 18 years old) with COVID-19 reported in Paraíba from April 2020 to July 2021, totaling 486 records. Descriptive analysis, logistic regression and multilevel regression were performed, utilizing a significance level of 5%. Results According to logistic regression without hierarchical levels, there was an increased chance of admission to the intensive care unit for male patients (OR = 1.98; 95%CI 1.18 - 3.32), patients with respiratory distress (OR = 2.43; 95%CI 1.29 - 4.56), patients with dyspnea (OR = 3.57; 95%CI 1.77 - 7.18) and patients living in large cities (OR = 2.70; 95%CI 1.07 - 6.77). The likelihood of requiring intensive care was observed to decrease with increasing age (OR = 0.94; 95%CI = 0.90 - 0.97), the presence of cough (OR = 0.32; 95%CI 0.18 - 0.59) or fever (OR = 0.42; 95%CI 0.23 - 0.74) and increasing Gini index (OR = 0.003; 95%CI 0.000 - 0.243). According to the multilevel analysis, the odds of admission to the intensive care unit increased in male patients (OR = 1.70; 95%CI = 1.68-1.71) and with increasing population size of the municipality per 100,000 inhabitants (OR = 1.01; 95%CI 1.01-1.03); additionally, the odds of admission to the intensive care unit decreased for mixed-race versus non-brown-skinned patients (OR = 0.981; 95%CI 0.97 - 0.99) and increasing Gini index (OR = 0.02; 95%CI 0.02 - 0.02). Conclusion The effects of patient characteristics and social context on the need for intensive care in children and adolescents with SARS-CoV-2 infection were better estimated with the inclusion of a multilevel regression model.","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"202 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141692665","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 decade of the ORCHESTRA study: organizational characteristics, patient outcomes, performance and efficiency in critical care","authors":"Marcio Soares, J. Salluh, Fernando G Zampieri, F. A. Bozza, Pedro Martins Pereira Kurtz","doi":"10.62675/2965-2774.20240118-en","DOIUrl":"https://doi.org/10.62675/2965-2774.20240118-en","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"94 S3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141695818","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":"The respiratory oxygenation index for identifying the risk of orotracheal intubation in COVID-19 patients receiving high-flow nasal cannula oxygen.","authors":"Aline Braz Pereira, Felipe Dal Pizzol, Viviane Cordeiro Veiga, Leandro Utino Taniguchi, Aline Finoti Misquita, Gustavo Augusto Couto Carvalho, Ligia Maria Coscrato Junqueira Silva, Michelli Marcela Dadam, Ruthy Perotto Fernandes, Israel Silva Maia, Cassio Luis Zandonai, Alexandre Biasi Cavalcanti, Marcelo Luz Pereira Romano, Glauco Adrieno Westphal","doi":"10.62675/2965-2774.20240203-en","DOIUrl":"10.62675/2965-2774.20240203-en","url":null,"abstract":"<p><strong>Objective: </strong>To assess whether the respiratory oxygenation index (ROX index) measured after the start of high-flow nasal cannula oxygen therapy can help identify the need for intubation in patients with acute respiratory failure due to coronavirus disease 2019.</p><p><strong>Methods: </strong>This retrospective, observational, multicenter study was conducted at the intensive care units of six Brazilian hospitals from March to December 2020. The primary outcome was the need for intubation up to 7 days after starting the high-flow nasal cannula.</p><p><strong>Results: </strong>A total of 444 patients were included in the study, and 261 (58.7%) were subjected to intubation. An analysis of the area under the receiver operating characteristic curve (AUROC) showed that the ability to discriminate between successful and failed high-flow nasal cannula oxygen therapy within 7 days was greater for the ROX index measured at 24 hours (AUROC 0.80; 95%CI 0.76 - 0.84). The median interval between high-flow nasal cannula initiation and intubation was 24 hours (24 - 72), and the most accurate predictor of intubation obtained before 24 hours was the ROX index measured at 12 hours (AUROC 0.75; 95%CI 0.70 - 0.79). Kaplan-Meier curves revealed a greater probability of intubation within 7 days in patients with a ROX index ≤ 5.54 at 12 hours (hazard ratio 3.07; 95%CI 2.24 - 4.20) and ≤ 5.96 at 24 hours (hazard ratio 5.15; 95%CI 3.65 - 7.27).</p><p><strong>Conclusion: </strong>The ROX index can aid in the early identification of patients with acute respiratory failure due to COVID-19 who will progress to the failure of high-flow nasal cannula supportive therapy and the need for intubation.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"36 ","pages":"e20240203en"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11208043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141494449","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":"Boswellia serrata intoxication manifesting with syndrome of inappropriate antidiuretic hormone secretion, hyponatremia, seizure, and rhabdomyolysis.","authors":"Josef Finsterer","doi":"10.62675/2965-2774.20240049-en","DOIUrl":"10.62675/2965-2774.20240049-en","url":null,"abstract":"<p><p>Boswellia serrata is an herbal extract from the Boswellia serrata tree that has anti-inflammatory and analgesic properties and alleviates pain caused by rheumatoid arthritis, gout, osteoarthritis, and sciatica. Syndrome of inappropriate antidiuretic hormone secretion accompanied by hyponatremia, seizures, and rhabdomyolysis as a manifestation of Boswellia serrata intoxication has not been reported previously. A 38-year-old female suffered clinically isolated syndrome and has since been regularly taking B. serrata capsules (200mg/d) to strengthen her immune system. She experienced hypersensitivity to light, ocular pain, nausea, dizziness, and lower limb weakness four days after receiving her first BNT162b2 vaccine dose, and she increased the dosage of B. serrata to five capsules (1000mg/d) one week after vaccination. After taking B. serrata at a dosage of 1000mg/d for 3 weeks, she was admitted to the intensive care unit because of a first, unprovoked generalized tonic-clonic seizure. The patient's workup revealed syndrome of inappropriate antidiuretic hormone secretion, which resolved completely upon treatment and discontinuation of B. serrata. In summary, B. serrata potentially causes syndrome of inappropriate antidiuretic hormone secretion when it is taken at high doses. Patients should not self-medicate.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":"36 ","pages":"e20240049en"},"PeriodicalIF":0.0,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11152439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452263","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}