Journal of intensive medicine最新文献

{"title":"Severe asthma exacerbation: Changes in patient characteristics, management, and outcomes from 1997 to 2016 in 40 ICUs in the greater Paris area","authors":"Romy Younan ,&nbsp;Jean Loup Augy ,&nbsp;Bertrand Hermann ,&nbsp;Bertrand Guidet ,&nbsp;Philippe Aegerter ,&nbsp;Emmanuel Guerot ,&nbsp;Ana Novara ,&nbsp;Caroline Hauw-Berlemont ,&nbsp;Amer Hamdan ,&nbsp;Clotilde Bailleul ,&nbsp;Francesca Santi ,&nbsp;Jean-Luc Diehl ,&nbsp;Nicolas Peron ,&nbsp;Nadia Aissaoui","doi":"10.1016/j.jointm.2023.08.008","DOIUrl":"10.1016/j.jointm.2023.08.008","url":null,"abstract":"<div><h3>Background</h3><p>Despite advances in asthma treatments, severe asthma exacerbation (SAE) remains a life-threatening condition in adults, and there is a lack of data derived from adult patients admitted to intensive care units (ICUs) for SAE. The current study investigated changes in adult patient characteristics, management, and outcomes of SAE over a 20-year period in 40 ICUs in the greater Paris area.</p></div><div><h3>Methods</h3><p>In this retrospective observational study, admissions to 40 ICUs in the greater Paris area for SAE from January 1, 1997, to December 31, 2016 were analyzed. The primary outcome was the proportion of ICU admissions for SAE during 5-year periods. Secondary outcomes were ICU and hospital mortality, and the use of mechanical ventilation and catecholamine. Multivariate analysis was performed to assess factors associated with ICU mortality.</p></div><div><h3>Results</h3><p>A total of 7049 admissions for SAE were recorded. For each 5-year period, the proportion decreased over time, with SAE accounting for 2.84% of total ICU admissions (<em>n</em>=2841) between 1997 and 2001, 1.76% (<em>n</em>=1717) between 2002 and 2006, 1.05% (<em>n</em>=965) between 2007 and 2011, and 1.05% (<em>n</em>=1526) between 2012 and 2016. The median age was 46 years (interquartile range [IQR]: 32–59 years), 55.41% were female, the median Simplified Acute Physiology Score II was 20 (IQR: 13–28), and 19.76% had mechanical ventilation. The use of mechanical ventilation remained infrequent throughout the 20-year period, whereas the use of catecholamine decreased. ICU and hospital mortality rates decreased. Factors associated with ICU mortality were renal replacement therapy, catecholamine, cardiac arrest, pneumothorax, acute respiratory distress syndrome, sepsis, and invasive mechanical ventilation (IMV). Non-survivors were older, had more severe symptoms, and were more likely to have received IMV.</p></div><div><h3>Conclusion</h3><p>ICU admission for SAE remains uncommon, and the proportion of cases decreased over time. Despite a slight increase in symptom severity during a 20-year period, ICU and hospital mortality decreased. Patients requiring IMV had a higher mortality rate.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X23000786/pdfft?md5=e0ff932d3368a9ded6771ca7c84932a5&pid=1-s2.0-S2667100X23000786-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135762523","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":"TRPV1: The key bridge in neuroimmune interactions","authors":"","doi":"10.1016/j.jointm.2024.01.008","DOIUrl":"10.1016/j.jointm.2024.01.008","url":null,"abstract":"<div><p>The nervous and immune systems are crucial in fighting infections and inflammation and in maintaining immune homeostasis. The immune and nervous systems are independent, yet tightly integrated and coordinated organizations. Numerous molecules and receptors play key roles in enabling communication between the two systems. Transient receptor potential vanilloid subfamily member 1 (TRPV1) is a non-selective cation channel, recently shown to be widely expressed in the neuroimmune axis and implicated in neuropathic pain, autoimmune disorders, and immune cell function. TRPV1 is a key bridge in neuroimmune interactions, allowing for smooth and convenient communication between the two systems. Here, we discuss the coordinated cross-talking between the immune and nervous systems and the functional role and the functioning manner of the TRPV1 involved. We suggest that TRPV1 provides new insights into the collaborative relationship between the nervous and immune systems, highlighting exciting opportunities for advanced therapeutic approaches to treating neurogenic inflammation and immune-mediated diseases.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X2400032X/pdfft?md5=c89ebda7d6bd06da8655c68eccce2495&pid=1-s2.0-S2667100X2400032X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140778434","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":"Latest developments in early diagnosis and specific treatment of severe influenza infection","authors":"Francisco Valenzuela-Sánchez ,&nbsp;Blanca Valenzuela-Méndez ,&nbsp;Juan Francisco Rodríguez-Gutiérrez ,&nbsp;Ángel Estella","doi":"10.1016/j.jointm.2023.09.006","DOIUrl":"10.1016/j.jointm.2023.09.006","url":null,"abstract":"<div><p>Influenza pandemics are unpredictable recurrent events with global health, economic, and social consequences. The objective of this review is to provide an update on the latest developments in early diagnosis and specific treatment of the disease and its complications, particularly with regard to respiratory organ failure. Despite advances in treatment, the rate of mortality in the intensive care unit remains approximately 30%. Therefore, early identification of potentially severe viral pneumonia is extremely important to optimize treatment in these patients. The pathogenesis of influenza virus infection depends on viral virulence and host response. Thus, in some patients, it is associated with an excessive systemic response mediated by an authentic cytokine storm. This process leads to severe primary pneumonia and acute respiratory distress syndrome. Initial prognostication in the emergency department based on comorbidities, vital signs, and biomarkers (e.g., procalcitonin, ferritin, human leukocyte antigen-DR, mid-regional proadrenomedullin, and lactate) is important. Identification of these biomarkers on admission may facilitate clinical decision-making to determine early admission to the hospital or the intensive care unit. These decisions are reached considering pathophysiological circumstances that are associated with a poor prognosis (e.g., bacterial co-infection, hyperinflammation, immune paralysis, severe endothelial damage, organ dysfunction, and septic shock). Moreover, early implementation is important to increase treatment efficacy. Based on a limited level of evidence, all current guidelines recommend using oseltamivir in this setting. The possibility of drug resistance should also be considered. Alternative options include other antiviral drugs and combination therapies with monoclonal antibodies. Importantly, it is not recommended to use corticosteroids in the initial treatment of these patients. Furthermore, the implementation of supportive measures for respiratory failure is essential. Current recommendations are limited, heterogeneous, and not regularly updated. Early intubation and mechanical ventilation is the basic treatment for patients with severe respiratory failure. Prone ventilation should be promptly performed in patients with acute respiratory distress syndrome, while early tracheostomy should be considered in case of planned prolonged mechanical ventilation. Clinical trials on antiviral treatment and respiratory support measures specifically for these patients, as well as specific recommendations for different at-risk populations, are necessary to improve outcomes.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X23000877/pdfft?md5=e1f9c2697cfdf935c044147d0184f6ad&pid=1-s2.0-S2667100X23000877-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139020599","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":"Prediction of Th17/Treg cell balance on length of stay in intensive care units of patients with sepsis","authors":"Yu Wu ,&nbsp;Guosheng Wu ,&nbsp;Minyu Li ,&nbsp;Yongqing Chang ,&nbsp;Miao Yu ,&nbsp;Yan Meng ,&nbsp;Xiaojian Wan","doi":"10.1016/j.jointm.2023.09.005","DOIUrl":"10.1016/j.jointm.2023.09.005","url":null,"abstract":"<div><h3>Background</h3><p>Prolonged length of stay (LOS) of sepsis can drain a hospital's material and human resources. This study investigated the correlations between T helper type 17 (Th17) and regulatory T (Treg) balance with LOS in sepsis.</p></div><div><h3>Methods</h3><p>A prospective clinical observational study was designed in Changhai Hospital affiliated to Naval Medical University in Shanghai, China, from January to October 2020. The patients diagnosed with sepsis and who met the inclusion and exclusion criteria were recruited and whether the levels of cytokines, procalcitonin, subtypes, and biomarkers of T cells in the peripheral blood were detected. We analyzed the correlation between these and LOS.</p></div><div><h3>Results</h3><p>Sixty septic patients were classified into two groups according to whether their intensive care unit (ICU) stay exceeded 14 days. The patients with LOS ≥14 days were older ([72.6±7.5] years <em>vs</em>. [63.3±10.4] years, <em>P</em>=0.015) and had higher Sequential Organ Failure Assessment (SOFA) (median [interquartile range]: 6.5 [5.0–11.0] <em>vs</em>. 4.0 [3.0–6.0], <em>P</em>=0.001) and higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores (16.0 [13.0–21.0] <em>vs</em>. 8.5 [7.0–14.0], <em>P</em>=0.001). There was no difference in other demographic characteristics and cytokines, interleukin-6, tumor necrosis factor-α, and interleukin-10 between the two groups. The Th17/Treg ratio of sepsis with LOS &lt;14 days was considerably lower (0.48 [0.38–0.56] <em>vs</em>. 0.69 [0.51–0.98], <em>P</em>=0.001). For patients with LOS ≥14 days, the area under the receiver operating characteristic curve for the Th17/Treg ratio was 0.766. It improved to 0.840 and 0.850 when combined with the SOFA and APACHE II scores, respectively.</p></div><div><h3>Conclusions</h3><p>The Th17/Treg ratio was proportional to septic severity and can be used as a potential predictor of ICU stay in sepsis, presenting a new option for ICU practitioners to better care for patients with sepsis.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X23000853/pdfft?md5=321ab9d2b5242e0e171ec49293fa0b44&pid=1-s2.0-S2667100X23000853-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138993281","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":"Glucocorticoid therapy for acute respiratory distress syndrome: Current concepts","authors":"","doi":"10.1016/j.jointm.2024.02.002","DOIUrl":"10.1016/j.jointm.2024.02.002","url":null,"abstract":"<div><p>Acute respiratory distress syndrome (ARDS), a fatal critical disease, is induced by various insults. ARDS represents a major global public health burden, and the management of ARDS continues to challenge healthcare systems globally, especially during the pandemic of the coronavirus disease 2019 (COVID-19). There remains no confirmed specific pharmacotherapy for ARDS, despite advances in understanding its pathophysiology. Debate continues about the potential role of glucocorticoids (GCs) as a promising ARDS clinical therapy. Questions regarding GC agent, dose, and duration in patients with ARDS need to be answered, because of substantial variations in GC administration regimens across studies. ARDS heterogeneity likely affects the therapeutic actions of exogenous GCs. This review includes progress in determining the GC mechanisms of action and clinical applications in ARDS, especially during the COVID-19 pandemic.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X24000331/pdfft?md5=1311ef563468151d4818f26145e2e53e&pid=1-s2.0-S2667100X24000331-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140790963","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":"Prognostic value of time-varying dead space estimates in mechanically ventilated patients with acute respiratory distress syndrome","authors":"Lianlian Jiang ,&nbsp;Hui Chen ,&nbsp;Jianfeng Xie ,&nbsp;Ling Liu ,&nbsp;Yi Yang","doi":"10.1016/j.jointm.2023.08.002","DOIUrl":"10.1016/j.jointm.2023.08.002","url":null,"abstract":"<div><h3>Background</h3><p>The dead space fraction (V_D/V_T) has proven to be a powerful predictor of higher mortality in acute respiratory distress syndrome (ARDS). However, its measurement relies on expired carbon dioxide, limiting its widespread application in clinical practice. Several estimates employing routine variables have been found to be reliable substitutes for direct measurement of V_D/V_T. In this study, we evaluated the prognostic value of these dead space estimates obtained in the first 7 days following the initiation of ventilation.</p></div><div><h3>Methods</h3><p>This retrospective observational study was conducted using data from the Chinese database in intensive care (CDIC). Eligible participants were adult ARDS patients receiving invasive mechanical ventilation while in the intensive care unit between 1st January 2014 and 31st March 2021. We collected data during the first 7 days of ventilation to calculate various dead space estimates, including ventilatory ratio (VR), corrected minute ventilation (<span><math><msub><mover><mi>V</mi><mo>˙</mo></mover><mtext>Ecorr</mtext></msub></math></span>), V_D/V_T (Harris–Benedict), V_D/V_T (Siddiki estimate), and V_D/V_T (Penn State estimate) longitudinally. A time-dependent Cox model was used to handle these time-varying estimates.</p></div><div><h3>Results</h3><p>A total of 392 patients (median age 66 [interquartile range: 55–77] years, median SOFA score 9 [interquartile range: 7–12]) were finally included in our analysis, among whom 132 (33.7%) patients died within 28 days of admission. VR (hazard ratio [HR]=1.04 per 0.1 increase, 95% confidence interval [CI]: 1.01 to 1.06; <em>P</em>=0.013), <span><math><msub><mover><mi>V</mi><mo>˙</mo></mover><mtext>Ecorr</mtext></msub></math></span> (HR=1.08 per 1 increase, 95% CI: 1.04 to 1.12; <em>P</em> &lt; 0.001), V_D/V_T (Harris–Benedict) (HR=1.25 per 0.1 increase, 95% CI: 1.06 to 1.47; <em>P</em>=0.006), and V_D/V_T (Penn State estimate) (HR=1.22 per 0.1 increase, 95% CI: 1.04 to 1.44; <em>P</em>=0.017) remained significant after adjustment, while V_D/V_T (Siddiki estimate) (HR=1.10 per 0.1 increase, 95% CI: 1.00 to 1.20; <em>P</em>=0.058) did not. Given a large number of negative values, V_D/V_T (Siddiki estimate) and V_D/V_T (Penn State estimate) were not recommended as reliable substitutes. Long-term exposure to VR &gt;1.3, <span><math><msub><mover><mi>V</mi><mo>˙</mo></mover><mtext>Ecorr</mtext></msub></math></span> &gt;7.53, and V_D/V_T (Harris–Benedict) &gt;0.59 was independently associated with an increased risk of mortality in ARDS patients. These findings were validated in the fluid and catheter treatment trial (FACTT) database.</p></div><div><h3>Conclusions</h3><p>In cases where V_D/V_T cannot ","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X23000579/pdfft?md5=0ac9da0cfca8c02b622234d8102decc2&pid=1-s2.0-S2667100X23000579-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135607151","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":"A retrospective analysis of carbapenem-resistant Acinetobacter baumannii infections in critically ill patients: Experience at a tertiary-care teaching hospital ICU","authors":"Leyla Ferlicolak ,&nbsp;Neriman Defne Altintas ,&nbsp;Fugen Yoruk","doi":"10.1016/j.jointm.2023.11.004","DOIUrl":"10.1016/j.jointm.2023.11.004","url":null,"abstract":"<div><h3>Background</h3><p><em>Acinetobacter baumannii</em> is a clinically significant pathogen with a high incidence of multidrug resistance that is associated with life-threatening nosocomial infections. Here, we aimed to provide an insight into the clinical characteristics and outcomes of a unique group of <em>A. baumannii</em> infections in which the isolates were resistant to carbapenems and most other antibiotic groups in a tertiary-care intensive care unit (ICU).</p></div><div><h3>Methods</h3><p>We performed a retrospective observational study in which records of patients hospitalized in the ICU between June 1, 2021 and June 1, 2023 were reviewed. We checked the clinical, laboratory, and microbiological records of all adult patients who had carbapenem-resistant <em>A. baumannii</em> (CRAB) infections. Prior antibiotic treatments and definitive antibiotic treatments after culture positivity and susceptibility test results were recorded<strong>.</strong> C-reactive protein (CRP) and procalcitonin levels and leukocyte counts were noted. Length of ICU stay and 30-day mortality were defined as the outcome parameters.</p></div><div><h3>Results</h3><p>During the study period, 57 patients were diagnosed with CRAB infections. The respiratory tract was the leading infection site (80.7%). In non-survivors, bloodstream infections (21.9% <em>vs.</em> 4.0% <em>P</em>=0.05) and colistin-resistant (col-R) CRAB infections (43.8% <em>vs.</em> 24.0%, <em>P</em>=0.12) were more common than in survivors, but these parameters were not statistically significant. The length of ICU stay was not different between survivors and non-survivors. Overall, the rate of col-R among CRAB clinical isolates was 35.1%. The 30-day mortality in all patients with CRAB infection was 56.1%. Mortality in col-R CRAB and colistin-susceptible (col-S) CRAB infections was 70.0% and 48.6%, respectively (<em>P</em>=0.12). Prior carbapenem use was 56.1%. Prior colistin use before col-R and col-S CRAB infections was not significant (35.0% <em>vs.</em> 27.0%, <em>P</em>=0.53).</p></div><div><h3>Conclusions</h3><p>Our study provides real-world data on highly resistant <em>A. baumannii</em> infections and shares the characteristics of infections with such resistant strains. Unfortunately, carbapenem resistance in <em>A. baumannii</em> is a challenge for intensive care specialists who are faced with few treatment options, and colistin resistance further complicates the problem.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X23000907/pdfft?md5=86f94941361c491c86f93b2100f0145d&pid=1-s2.0-S2667100X23000907-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139393743","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":"Septic shock due to Capnocytophaga canimorsus treated with IgM-enriched immunoglobulin as adjuvant therapy in an immunocompetent woman","authors":"Josephine Braunsteiner,&nbsp;Stephanie Siedler,&nbsp;Dominik Jarczak,&nbsp;Stefan Kluge,&nbsp;Axel Nierhaus","doi":"10.1016/j.jointm.2023.08.003","DOIUrl":"10.1016/j.jointm.2023.08.003","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X23000592/pdfft?md5=849d3111cbff4d5246b41b4617c81be1&pid=1-s2.0-S2667100X23000592-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134917363","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 accuracy of ePOS score in predicting DNR labeling after ICU admission: A prospective observational study (ePOS-DNR)","authors":"Omar E. Ramadan ,&nbsp;Ahmed F. Mady ,&nbsp;Mohammed A. Al-Odat ,&nbsp;Ahmed N. Balshi ,&nbsp;Ahmed W. Aletreby ,&nbsp;Taisy J. Stephen ,&nbsp;Sheena R. Diolaso ,&nbsp;Jennifer Q. Gano ,&nbsp;Waleed Th. Aletreby","doi":"10.1016/j.jointm.2023.09.003","DOIUrl":"10.1016/j.jointm.2023.09.003","url":null,"abstract":"<div><h3>Background</h3><p>Resuscitation can sometimes be futile and making a do-not-resuscitate (DNR) decision is in the best interest of the patient. The electronic poor outcome screening (ePOS) score was developed to predict 6-month poor outcomes of critically ill patients. We explored the diagnostic accuracy of the ePOS score in predicting DNR decisions in the intensive care unit (ICU).</p></div><div><h3>Methods</h3><p>This study was conducted at the ICU of a tertiary referral hospital in Saudi Arabia between March and May 2023. Prospectively, we calculated ePOS scores for all eligible consecutive admissions after 48 h in the ICU and recorded the DNR orders. The ability of the score to predict DNR was explored using logistic regression. Youden's ideal cut-off value was calculated using the DeLong method, and different diagnostic accuracy measures were generated with corresponding 95 % confidence intervals (CIs).</p></div><div><h3>Results</h3><p>We enrolled 857 patients, 125 received a DNR order and 732 did not. The average ePOS score of DNR and non-DNR patients was 28.2±10.7 and 15.2±9.7, respectively. ePOS score, as a predictor of DNR order, had an area under receiver operator characteristic (AUROC) curve of 81.8 % (95% CI: 79.0 to 84.3, <em>P</em> &lt;0.001). Youden's ideal cut-off value &gt;17 was associated with a sensitivity of 87.2 (95% CI: 80.0 to 92.5, <em>P</em> &lt;0.001), specificity of 63.9 (95% CI: 60.3 to 67.4, <em>P</em> &lt;0.001), positive predictive value of 29.2 (95% CI: 24.6 to 33.8, <em>P</em> &lt;0.001), negative predictive value of 96.7 (95% CI: 95.1 to 98.3, <em>P</em> &lt;0.001), and diagnostic odds ratio 12.1 (95% CI: 7.0 to 20.8, <em>P</em> &lt;0.001).</p></div><div><h3>Conclusions</h3><p>In this study, the ePOS score performed well as a diagnostic test for patients who will be labeled as DNR during their ICU stay. A cut-off score &gt;17 may help guide clinical decisions to withhold or commence resuscitative measures.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X23000798/pdfft?md5=1c3da08ab34201aa2f3d09d3325a9bef&pid=1-s2.0-S2667100X23000798-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135455062","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":"Factors associated with decreased compliance after on-site extracorporeal membrane oxygenation cannulation for acute respiratory distress syndrome: A retrospective, observational cohort study","authors":"Sylvain Le Pape ,&nbsp;Florent Joly ,&nbsp;François Arrivé ,&nbsp;Jean-Pierre Frat ,&nbsp;Maeva Rodriguez ,&nbsp;Maïa Joos ,&nbsp;Laura Marchasson ,&nbsp;Mathilde Wairy ,&nbsp;Arnaud W. Thille ,&nbsp;Rémi Coudroy","doi":"10.1016/j.jointm.2023.09.004","DOIUrl":"10.1016/j.jointm.2023.09.004","url":null,"abstract":"<div><h3>Background</h3><p>Extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome (ARDS) is systematically associated with decreased respiratory system compliance (CRS). It remains unclear whether transportation to the referral ECMO center, changes in ventilatory mode or settings to achieve ultra-protective ventilation, or the natural evolution of ARDS drives this change in respiratory mechanics. Herein, we assessed the precise moment when CRS decreases after ECMO cannulation and identified factors associated with decreased CRS.</p></div><div><h3>Methods</h3><p>To rule out the effect of transportation and the different modes of ventilation on CRS, we conducted a retrospective, single-center, observational cohort study from January 2013 to May 2020, on 22 patients with severe ARDS requiring on-site ECMO and ventilated in pressure-controlled mode to achieve ultra-protective ventilation. CRS was assessed at different time points ranging from 12 h before ECMO cannulation to 72 h after ECMO cannulation. The primary outcome was the relative change in CRS between 3 h before and 3 h after ECMO cannulation. The secondary outcomes included variables associated with the relative changes in CRS within the first 3 h after ECMO cannulation and the relative changes in CRS at each time point.</p></div><div><h3>Results</h3><p>CRS decreased within the first 3 h after ECMO cannulation (−28.3%, 95% confidence interval [CI]: −38.8 to −17.9, <em>P</em>&lt;0.001), while the decrease was mild before and after these first 3 h after ECMO cannulation. To achieve ultra-protective ventilation, respiratory rate decreased in the mean by –13 breaths/min (95% CI: −15 to −11) and driving pressure by −8.3 cmH₂O (95% CI: −11.2 to −5.3), resulting in decreased tidal volume by −3.3 mL/kg of predicted body weight (95% CI: −3.9 to −2.6) as compared to before ECMO cannulation (<em>P</em> &lt;0.001 for all). Plateau pressure reduction, driving pressure reduction, and tidal volume reduction were significantly associated with decreased CRS after ECMO cannulation, whereas neither respiratory rate, positive end-expiratory pressure, inspired fraction of oxygen, fluid balance, nor mean airway pressure was associated with decreased CRS.</p></div><div><h3>Conclusions</h3><p>Decreased driving pressure resulting in lower tidal volume to achieve ultra-protective ventilation after ECMO cannulation was associated with a marked decrease in CRS in ARDS patients with on-site ECMO cannulation.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X23000841/pdfft?md5=61183c699b866e26d06227c467462980&pid=1-s2.0-S2667100X23000841-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139023674","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}