Journal of intensive medicine最新文献

{"title":"Physiological effects and clinical evidence of high-flow nasal cannula during acute exacerbation in COPD patients: A narrative review","authors":"Nicolás Colaianni-Alfonso ,&nbsp;Federico Herrera ,&nbsp;Diego Flores ,&nbsp;Cristian Deana ,&nbsp;Mina Vapireva ,&nbsp;Daniele Guerino Biasucci ,&nbsp;Salvatore Maurizio Maggiore ,&nbsp;Luigi Vetrugno","doi":"10.1016/j.jointm.2024.10.005","DOIUrl":"10.1016/j.jointm.2024.10.005","url":null,"abstract":"<div><div>Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide. During severe exacerbations, COPD patients may develop acute respiratory failure (ARF), often necessitating hospital admission due to impaired gas exchange. In COPD patients, the diaphragm is subjected to an increased workload resulting from airflow limitations and geometric changes in the thorax due to pulmonary hyperinflation. Noninvasive ventilation (NIV) plays a crucial role in managing type II ARF by improving alveolar ventilation, reducing the work of breathing, minimizing the need for endotracheal intubation (ETI), and decreasing both hospital stays and mortality rates. Studies have shown that approximately 64% of patients with acute exacerbation of COPD (AECOPD) may fail NIV, primarily due to worsening respiratory function, interface intolerance, cardiovascular instability, or neurological deterioration. For patients intolerant to NIV, a trial with a high-flow nasal cannula (HFNC) is recommended. Recently, HFNC has gained popularity as a novel respiratory support system and is increasingly used in routine clinical practice for AECOPD patients. It delivers warmed, humidified, and oxygen-enriched air through a nasal cannula at flow rates of up to 60 L/min. This narrative review aims to describe the physiological effects of HFNC in the COPD population and provide an updated overview of HFNC's role in AECOPD patients requiring hospitalization.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 2","pages":"Pages 127-133"},"PeriodicalIF":0.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143724787","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":"Is it beneficial to allow the patient's family to attend cardiac resuscitation: Different cultural perspectives? A scoping review","authors":"Hasan Abualruz ,&nbsp;Mohammad A. Abu Sabra ,&nbsp;Elham H. Othman ,&nbsp;Malakeh Z. Malak ,&nbsp;Saleh Al Omar ,&nbsp;Reema R. Safadi ,&nbsp;Salah M. AbuRuz ,&nbsp;Khaled Suleiman","doi":"10.1016/j.jointm.2024.11.002","DOIUrl":"10.1016/j.jointm.2024.11.002","url":null,"abstract":"<div><h3>Background</h3><div>Family presence during resuscitation (FPDR) is a controversial issue that remains unresolved in contemporary practice. Although there are many research studies on FPDR and several published statements and guidelines supporting FPDR by international organizations, no conclusive position guides clinicians in making a decision. A scoping review was conducted to discuss the different healthcare professionals (HCPs) and cultural perspectives toward family presence during CPR is conducted.</div></div><div><h3>Methods</h3><div>Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines, we screened 797 studies published between 2000 and 2022 from the databases including Springer Link, MEDLINE, Pro-Quest Central, CINAHL Plus, and Google Scholar. All articles were filtered using inclusion criteria to eliminate redundant, irrelevant, and unnecessary content.</div></div><div><h3>Results</h3><div>A total of 34 studies that fulfill the eligibility criteria reported that there are multiple perspectives from HCPs and families about FPDR. HCPs felt that their performance had improved during resuscitation and received family support in breaking the bad news of death. Family relatives who attended cardiopulmonary resuscitation (CPR) had less stress, less anxiety, more positive grieving behavior, and enhanced family members’ decision-making. Contrastingly, some HCPs were against FPDR because they were concerned about the family's misinterpretation of resuscitation activities, psychological trauma to the family members, increased stress levels among staff, and worry about an unexpected response from the distressed family.</div></div><div><h3>Conclusions</h3><div>It is important to consider the culture and awareness of families when deciding on FPDR. It is the responsibility of HCPs to assess family members’ willingness and the benefits they attain from attending CPR. The decision should be based on the given situation, cultural context and beliefs, and current policy to guide practice.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 2","pages":"Pages 202-210"},"PeriodicalIF":0.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143724781","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":"Potential causal association between gut microbiota, inflammatory cytokines, and acute pancreatitis: A Mendelian randomization study","authors":"Xiaofeng Wang ,&nbsp;Yiwen Qiu ,&nbsp;Ying Di ,&nbsp;Hou Shaohua ,&nbsp;Wei Wu ,&nbsp;Weiyi Wang ,&nbsp;Huan Liu ,&nbsp;Pu Li","doi":"10.1016/j.jointm.2024.10.004","DOIUrl":"10.1016/j.jointm.2024.10.004","url":null,"abstract":"<div><h3>Background</h3><div>Acute pancreatitis (AP) ranks among the most frequently encountered gastrointestinal diseases in the emergency department. Recent studies have increasingly emphasized the substantial connection among gut microbiota, inflammatory cytokines, and AP.</div></div><div><h3>Methods</h3><div>A two-sample Mendelian randomization (MR) study was conducted using summary statistics of gut microbiota (GM) from the largest available meta-analysis of genome-wide association studies conducted by the MiBioGen consortium (<em>n</em>=18,340). For cytokines, the data were obtained from a study that investigated genome variant associations with 41 inflammatory cytokines and growth factors (<em>n</em>=8293). The summary statistics of AP were obtained from the FinnGen consortium version R5 data (3022 cases and 195,144 controls). The inverse variance weighted (IVW) method was used as the main analysis, with MR–Egger and weighted median as complementary analytical methods. Sensitivity analyses were performed using Cochran's <em>Q</em>-test, MR–Egger intercept test, leave-one-out analyses, and MR–PRESSO. In addition, we employed the reverse MR analysis and MR Steiger method to estimate the orientations of exposure and outcome.</div></div><div><h3>Result</h3><div>Among the 211 examined GM taxa, the IVW method revealed that Bacteroidales (odds ratio [OR]=1.412, 95% confidence interval [CI]:1.057 to 1.885, <em>P</em>=0.019), <em>Eubacterium fissicatena</em> group (OR=1.240, 95% CI:1.045 to 1.470, <em>P</em>=0.014), and Coprococcus3 (OR=1.481, 95 % CI:1.049 to 2.090, <em>P</em>=0.026) exhibited a positive association with AP. Conversely, Prevotella9 (OR=0.821, 95% CI:0.680 to 0.990, <em>P</em>=0.038), RuminococcaceaeUCG004 (OR=0.757, 95% CI:0.577 to 0.994, <em>P</em>=0.045), and Ruminiclostridium6 (OR=0.696, 95% CI:0.548 to 0.884, <em>P</em>=0.003) displayed a negative correlation with AP. Among the 41 inflammatory cytokines, only macrophage colony-stimulating factor (M_CSF, OR=0.894, 95% CI:0.847 to 0.943, <em>P</em>=0.037) exhibited a negative association with AP. Sensitivity analyses revealed no evidence of pleiotropy or heterogeneity. Nevertheless, the mediation analysis showed that M_CSF did not act as a mediating factor.</div></div><div><h3>Conclusion</h3><div>This two-sample MR study revealed causal associations between specific GM and inflammatory cytokines with AP, respectively. However, inflammatory cytokines did not appear to act as mediating factors in the pathway from GM to AP.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 2","pages":"Pages 185-192"},"PeriodicalIF":0.0,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143724779","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":"Preparing for future pandemics: Automated intensive care electronic health record data extraction to accelerate clinical insights","authors":"Lada Lijović ,&nbsp;Harm Jan de Grooth ,&nbsp;Patrick Thoral ,&nbsp;Lieuwe Bos ,&nbsp;Zheng Feng ,&nbsp;Tomislav Radočaj ,&nbsp;Paul Elbers","doi":"10.1016/j.jointm.2024.10.003","DOIUrl":"10.1016/j.jointm.2024.10.003","url":null,"abstract":"<div><h3>Background</h3><div>Manual data abstraction from electronic health records (EHRs) for research on intensive care patients is time-intensive and challenging, especially during high-pressure periods such as pandemics. Automated data extraction is a potential alternative but may raise quality concerns. This study assessed the feasibility and credibility of automated data extraction during the coronavirus disease 2019 (COVID-19) pandemic.</div></div><div><h3>Methods</h3><div>We retrieved routinely collected data from the COVID-Predict Dutch Data Warehouse, a multicenter database containing the following data on intensive care patients with COVID-19: demographic, medication, laboratory results, and data from monitoring and life support devices. These data were sourced from EHRs using automated data extraction. We used these data to determine indices of wasted ventilation and their prognostic value and compared our findings to a previously published original study that relied on manual data abstraction largely from the same hospitals.</div></div><div><h3>Results</h3><div>Using automatically extracted data, we replicated the original study. Among 1515 patients intubated for over 2 days, Harris–Benedict (HB) estimates of dead space fraction increased over time and were higher in non-survivors at each time point: at the start of ventilation (0.70±0.13 <em>vs</em>. 0.67±0.15, <em>P</em> &lt;0.001), day 1 (0.74±0.10 <em>vs</em>. 0.71±0.11, <em>P</em>&lt;0.001), day 2 (0.77±0.09 <em>vs</em>. 0.73±0.11, <em>P</em>&lt;0.001), and day 3 (0.78±0.09 <em>vs</em>. 0.74±0.10, <em>P</em>&lt;0.001). Patients with HB dead space fraction above the median had an increased mortality rate of 13.5%, compared to 10.1% in those with values below the median (<em>P</em>&lt;0.005). Ventilatory ratio showed similar trends, with mortality increasing from 10.8% to 12.9% (<em>P</em>=0.040). Conversely, the end-tidal-to-arterial partial pressure of carbon dioxide (PaCO₂) ratio was inversely related to mortality, with a lower 28-day mortality in the higher than median group (8.5% <em>vs</em>. 15.1%, <em>P</em>&lt;0.001). After adjusting for base risk, impaired ventilation markers showed no significant association with 28-day mortality.</div></div><div><h3>Conclusion</h3><div>Manual data abstraction from EHRs may be unnecessary for reliable research on intensive care patients, highlighting the feasibility and credibility of automated data extraction as a trustworthy and scalable solution to accelerate clinical insights, especially during future pandemics.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 2","pages":"Pages 167-175"},"PeriodicalIF":0.0,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143724777","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":"Effect of timing of norepinephrine administration on prognosis of patients with septic shock: A prospective cohort study","authors":"Yuting Li,&nbsp;Deyou Zhang,&nbsp;Hongxiang Li,&nbsp;Youquan Wang,&nbsp;Dong Zhang","doi":"10.1016/j.jointm.2024.10.002","DOIUrl":"10.1016/j.jointm.2024.10.002","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Sepsis and septic shock are major healthcare problems worldwide, associated with substantial mortality. Early administration of norepinephrine in septic shock patients has been associated with an increased survival rate, but the timing from septic shock to norepinephrine initiation is controversial. This study examined the associations between the timing of initial norepinephrine administration and clinical outcomes in adult patients with septic shock.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This prospective cohort study was conducted from September 2021 to June 2022 in an intensive care unit (ICU) of a tertiary general hospital. All enrolled patients were divided into early and late norepinephrine groups according to whether the time from the onset of septic shock to the first application of norepinephrine was &gt;1 h. The primary outcome was 28-day mortality. Secondary outcomes included ICU length of stay (LOS), hospital LOS, time to achieve a mean arterial pressure (MAP) ≥65 mmHg, 24-hour infusion volume, 6-hour Lac clearance, mechanical ventilation days, and continuous renal replacement therapy (CRRT )ratio. Multivariable logistic regression analysis was used to evaluate the independent risk factors for 28-day mortality.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;This study enrolled 120 patients, including 42 patients (35.0%) and 78 patients (65.0%) in the early and late norepinephrine groups, respectively. The 28-day mortality was lower in the early group than in the late group (28.6% &lt;em&gt;vs.&lt;/em&gt; 47.4%, &lt;em&gt;P&lt;/em&gt;=0.045). The median time to achieve MAP ≥65 mmHg was shorter in the early group than in the late group (1.0 h &lt;em&gt;vs.&lt;/em&gt; 1.5 h, &lt;em&gt;P&lt;/em&gt;=0.010). The median 24-hour intravenous fluids volume in the early group was lower than that in the late group (40.7% &lt;em&gt;vs.&lt;/em&gt; 14.9%, &lt;em&gt;P&lt;/em&gt;=0.030). The median 6-hour lactate (Lac) clearance rate in the early group was higher than that in the late group (40.7% &lt;em&gt;vs.&lt;/em&gt; 14.9%, &lt;em&gt;P&lt;/em&gt;=0.009). There were no significant differences between early and late groups by ICU LOS (&lt;em&gt;P&lt;/em&gt;=0.748), hospital LOS (&lt;em&gt;P&lt;/em&gt;=0.369), mechanical ventilation time (&lt;em&gt;P&lt;/em&gt;=0.128), and CRRT ratio (&lt;em&gt;P&lt;/em&gt;=0.637). The independent risk factors for 28-day mortality included being male (odds ratio [OR]=3.288, 95% confidence interval [CI]: 1.236 to 8.745, &lt;em&gt;P&lt;/em&gt; = 0.017), time to norepinephrine initiation &gt;1 h (OR=4.564, 95% CI: 1.382 to 15.079, &lt;em&gt;P&lt;/em&gt; = 0.013), and time to achieve MAP ≥65 mmHg (OR=1.800, 95% CI: 1.171 to 2.767, &lt;em&gt;P&lt;/em&gt; = 0.007).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Norepinephrine initiation ≤1 h is associated with lower 28-day mortality in patients with septic shock. Early norepinephrine administration is also associated with a shorter time to achieve MAP ≥65 mmHg, lower 24-hour intravenous fluids volume, and higher 6-hour Lac clearance rate. Being male, time to achieve MAP ≥65 mmHg, and norepinephrine initiation &gt;1 h are independent ris","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 2","pages":"Pages 160-166"},"PeriodicalIF":0.0,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143724776","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":"Critical care studies using large language models based on electronic healthcare records: A technical note","authors":"Zhongheng Zhang ,&nbsp;Hongying Ni","doi":"10.1016/j.jointm.2024.09.002","DOIUrl":"10.1016/j.jointm.2024.09.002","url":null,"abstract":"<div><div>The integration of large language models (LLMs) in clinical medicine, particularly in critical care, has introduced transformative capabilities for analyzing and managing complex medical information. This technical note explores the application of LLMs, such as generative pretrained transformer 4 (GPT-4) and Qwen-Chat, in interpreting electronic healthcare records to assist with rapid patient condition assessments, predict sepsis, and automate the generation of discharge summaries. The note emphasizes the significance of LLMs in processing unstructured data from electronic health records (EHRs), extracting meaningful insights, and supporting personalized medicine through nuanced understanding of patient histories. Despite the technical complexity of deploying LLMs in clinical settings, this document provides a comprehensive guide to facilitate the effective integration of LLMs into clinical workflows, focusing on the use of DashScope's application programming interface (API) services for judgment on patient prognosis and organ support recommendations based on natural language in EHRs. By illustrating practical steps and best practices, this work aims to lower the technical barriers for clinicians and researchers, enabling broader adoption of LLMs in clinical research and practice to enhance patient care and outcomes.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 2","pages":"Pages 137-150"},"PeriodicalIF":0.0,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143724789","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":"Parenteral calcium administration and outcomes in critically ill patients with hypocalcemia: A retrospective cohort study","authors":"Max Melchers ,&nbsp;Hanneke Pierre Franciscus Xaverius Moonen ,&nbsp;Tessa Maria Breeman ,&nbsp;Sjoerd Hendrika Willem van Bree ,&nbsp;Arthur Raymond Hubert van Zanten","doi":"10.1016/j.jointm.2024.08.003","DOIUrl":"10.1016/j.jointm.2024.08.003","url":null,"abstract":"<div><h3>Background</h3><div>Hypocalcemia is common among patients admitted to the intensive care unit (ICU). The administration of calcium in critically ill patients with hypocalcemia remains debated, as previous data on outcomes are conflicting, and subgroup analyses are lacking. This study aimed to investigate the association between parenteral calcium administration and clinical outcomes in critically ill patients who had hypocalcemia with and without sepsis.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included individuals who developed hypocalcemia during the first 7 days of admission to a mixed medical-surgical adult ICU at a University-affiliated teaching hospital. Patients who were not receiving renal replacement therapy, and were admitted to the ICU for at least 48 h between October 1, 2015 and September 24, 2020, were included. The primary outcomes included all-cause 180-day mortality and time-to-shock resolution. Subgroup analyses were conducted in sepsis and nonsepsis patients with mild or moderate hypocalcemia, based on median splits. Proportional hazard regression analyses were performed to identify the association between parenteral calcium administration and outcome parameters.</div></div><div><h3>Results</h3><div>Among the 1100 patients who met the inclusion criteria, 427 (38.8 %) patients were admitted for sepsis and 576 (52.4 %) patients received parenteral calcium. Patients who received and did not receive parenteral calcium demonstrated no significant difference in 180-day mortality (adjusted hazard ratio [aHR] = 1.18, 95 % confidence interval [CI]: 0.90 to 1.56). Intravenous calcium administration reduced the probability of a shorter time to shock resolution (adjusted odds ratio = 0.81, 95 % CI: 0.70 to 0.94). Subgroup analyses in patients with and without sepsis indicated no significant association between calcium administration (aHR = 1.63, 95 % CI: 0.99 to 2.69) and 180-day mortality (aHR = 1.06, 95  % CI: 0.74 to 1.51). Notably, parenteral calcium was associated with an elevated risk of 90- and 180-day mortality in patients who had sepsis and mild hypocalcemia (aHR = 1.88, 95 % CI: 1.02 to 3.47 and aHR = 1.79, 95 % CI: 1.07 to 3.00, respectively).</div></div><div><h3>Conclusions</h3><div>Intravenous calcium administration did not provide survival or shock resolution benefits in ICU patients with hypocalcemia, and may even be harmful. Further research, including randomized controlled trials, are needed to confirm these findings.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 2","pages":"Pages 151-159"},"PeriodicalIF":0.0,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143724864","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":"Diagnostic approach in acute hypoxemic respiratory failure","authors":"Pierre Bay ,&nbsp;Nicolas de Prost","doi":"10.1016/j.jointm.2024.09.003","DOIUrl":"10.1016/j.jointm.2024.09.003","url":null,"abstract":"<div><div>Acute hypoxemic respiratory failure (AHRF) is the leading cause of intensive care unit (ICU) admissions. Of patients with AHRF, 40 %–50 % will require invasive mechanical ventilation during their stay in the ICU, and 30 %–80 % will meet the Berlin Criteria for Acute Respiratory Distress Syndrome (ARDS). Rapid identification of the underlying cause of AHRF is necessary before initiating targeted treatment. Almost 10 % of patients with ARDS have no identified classic risk factors however, and the precise cause of AHRF may not be identified in up to 15 % of patients, particularly in cases of immunosuppression. In these patients, a multidisciplinary, comprehensive, and hierarchical diagnostic work-up is mandatory, including a detailed history and physical examination, chest computed tomography, extensive microbiological investigations, bronchoalveolar lavage fluid cytological analysis, immunological tests, and investigation of the possible involvement of pneumotoxic drugs.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 2","pages":"Pages 119-126"},"PeriodicalIF":0.0,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143724786","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":"Risk factors and outcomes of pediatric non-invasive respiratory support failure in Latin America","authors":"Diana Paola Escobar-Serna ,&nbsp;Juan Sebastian Barajas-Romero ,&nbsp;Juan Javier Peralta-Palmezano ,&nbsp;Juan Camilo Jaramillo-Bustamante ,&nbsp;Nicolas Monteverde-Fernandez ,&nbsp;Jesus Alberto Serra ,&nbsp;Paula Caporal ,&nbsp;Soledad Menta ,&nbsp;Ruben Lasso-Palomino ,&nbsp;Eliana Zemanate ,&nbsp;Javier Martínez ,&nbsp;Hernan Herrera ,&nbsp;Luis Martínez ,&nbsp;Francisca Castro Zamorano ,&nbsp;Cristobal Carvajal ,&nbsp;Monica Decía ,&nbsp;Roberto Jabornisky ,&nbsp;Franco Diaz ,&nbsp;Sebastian Gonzalez-Dambrauskas ,&nbsp;Pablo Vasquez-Hoyos ,&nbsp;Jennifer Silva","doi":"10.1016/j.jointm.2024.09.001","DOIUrl":"10.1016/j.jointm.2024.09.001","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Noninvasive respiratory support (NRS) is standard in pediatric intensive care units (PICUs) for respiratory diseases, but its failure can lead to complications requiring invasive mechanical ventilation (IMV). This study aimed to identify risk factors for NRS failure in children with acute respiratory failure (ARF) in PICUs, and compare complications and outcomes between IMV-only and NRS failure patients.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We conducted a cohort study using data from the LARed Network prospective registry (April 2017–November 2022), in children under 18 years admitted to PICUs for ARF. Cases were divided into subgroups: those managed with IMV only, those who experienced NRS failure requiring IMV, those who received NRS successfully, and those who did not require NRS or IMV. Exclusions included patients with home respiratory support prior to admission, patients without PICU discharge at the cutoff date of the analysis and those with incomplete data. Multivariate mixed models analyzed NRS failure risk factors, and complications between the IMV-only and NRS failure groups, using centers as a random effect.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 7374 children met the inclusion criteria, with 6208 in the NRS group and 1166 in the IMV-only group. The NRS success rate was 85.3 %. Risk factors for NRS failure included age (median of 4.6 months, interquartile range of 2.1–14.2 months), history of prematurity (adjusted odds ratio [aOR]=1.53, 95 % confidence interval [CI]: 1.20 to 1.95) or malnutrition (aOR=1.85, 95 % CI: 1.18 to 2.91), suspected bacterial infection (aOR=5.12, 95 % CI: 4.05to 6.49), FiO&lt;sub&gt;2&lt;/sub&gt; &gt;30 % (aOR=1.52, 95 % CI: 1.18 to 1.97), severe hypoxemia with SpO&lt;sub&gt;2&lt;/sub&gt;/FiO&lt;sub&gt;2&lt;/sub&gt; ≤150 (aOR=1.85, 95 % CI: 1.48 to 2.30), tachypnea (aOR=1.42, 95 % CI: 1.18 to 1.72), tachycardia (aOR=1.77, 95 % CI: 1.47 to 2.12), and lung consolidations (aOR=1.45, 95 % CI: 1.14 to 1.85) or interstitial infiltrates (aOR=1.29, 95 % CI: 1.05 to 1.58) on chest X-ray. There were no significant differences in morbidity, mortality, duration of IMV, or PICU length of stay between patients who received IMV only and those who experienced NRS failure. However, patients who experienced NRS failure were more likely to develop withdrawal symptoms related to sedative or opioid discontinuation and/or delirium (aOR=2.57, 95 % CI: 1.85 to 2.57).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;This study identified key risk factors for predicting NRS failure in children with acute ARF in PICUs, including younger age, prematurity, malnutrition, suspected bacterial infection, FiO&lt;sub&gt;2&lt;/sub&gt; &gt;30 %, severe hypoxemia (SpO&lt;sub&gt;2&lt;/sub&gt;/FiO&lt;sub&gt;2&lt;/sub&gt; ≤150), tachypnea, tachycardia, and radiological findings such as lung consolidation and interstitial infiltrates. Compared to patients managed with IMV from the start, those who experienced NRS failure were more likely to develop withdrawal symptoms and/or delirium, although","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 2","pages":"Pages 176-184"},"PeriodicalIF":0.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143724778","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":"Redefining sepsis management: The comprehensive impact of artificial intelligence","authors":"Jamie Ghossein ,&nbsp;Brett N. Hryciw ,&nbsp;Kwadwo Kyeremanteng","doi":"10.1016/j.jointm.2024.08.002","DOIUrl":"10.1016/j.jointm.2024.08.002","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 2","pages":"Pages 134-136"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143724788","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}