Journal of intensive medicine最新文献

{"title":"MicroRNA-30a inhibits cell proliferation in a sepsis-induced acute kidney injury model by targeting the YAP-TEAD complex","authors":"Junfeng Su ,&nbsp;Ying Wang ,&nbsp;Jing Xie ,&nbsp;Long Chen ,&nbsp;Xinxin Lin ,&nbsp;Jiandong Lin ,&nbsp;Xiongjian Xiao","doi":"10.1016/j.jointm.2023.08.004","DOIUrl":"10.1016/j.jointm.2023.08.004","url":null,"abstract":"<div><h3>Background</h3><p>Acute kidney injury (AKI) is a primary feature of renal complications in patients with sepsis. MicroRNA (miRNA/miR)-30a is an essential regulator of cardiovascular diseases, tumors, phagocytosis, and other physical processes, but whether it participates in sepsis-induced AKI (sepsis-AKI) is unknown. We aimed to elucidate the functions and molecular mechanism underlying miR-30a activity in sepsis-AKI.</p></div><div><h3>Methods</h3><p>The classical cecal ligation and puncture (CLP) method and lipopolysaccharide (LPS)-induced Human Kidney 2 (HK-2) cells were used to establish <em>in vivo</em> and <em>in vitro</em> sepsis-AKI models. Specific pathogen-free and mature male Sprague-Dawley (SD) rats, aged 6–8 weeks (weight 200–250 g), were randomly divided into five-time phase subgroups. Fluid resuscitation with 30 mL/kg 37 °C saline was administered after the operation, without antibiotics. Formalin-fixed, paraffin-embedded kidney sections were stained with hematoxylin and eosin. SD rat kidney tissue samples were collected for analysis by real-time quantitative polymerase chain reaction and enzyme-linked immunosorbent assay. HK-2 cells were transfected with hsa-miR-30a-3p mimics or inhibitors, and compared with untreated normal controls. RNA, protein, and cell viability were evaluated by quantitative reverse transcription-polymerase chain reaction (qRT-PCR), western blot, and cell counting kit-8 methods. A Dual-Luciferase Assay Kit (Promega) was used to measure luciferase activity 48 h after transfection with miR-30a-3p mimics.</p></div><div><h3>Results</h3><p>Expression levels of miR-30a-3p and miR-30a-5p in renal tissues of the sepsis group were significantly reduced at 12 h and 24 h (<em>P</em> &lt;0.05). Tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) were significantly increased in renal tissue 3 h after the operation in rats (<em>P</em> &lt;0.05), and gradually decreased 6 h, 12 h, and 24 h after CLP. Levels of miR-30a-5p and miR-30a-3p were significantly down-regulated at 3 h after LPS treatment (<em>P</em> &lt;0.05), and gradually decreased in HK-2 cells. One hour after LPS (10 µg/mL) treatment, TNF-α and IL-1β levels in HK-2 cells were significantly up-regulated (<em>P</em> &lt; 0.05), and they were markedly down-regulated after 3 h (<em>P</em> &lt;0.05). IL-6 expression levels began to rise after LPS treatment of cells, peaked at 6 h (<em>P</em> &lt;0.05), and then decreased to the initial level within a few hours. Stimulation with 10 µg/mL LPS promoted HK-2 cells proliferation, which was inhibited after miR-30a-3p-mimic transfection. Bioinformatics prediction identified 37 potential miR-30a-3p target genes, including transcriptional enhanced associate domain 1 (<em>TEAD1</em>). After transfection of HK-2 cells with miR-30a-3p mimics and miR-30a-3p inhibitor, <em>TEAD1</em> transcript was significantly up- and down-regulated, respectively (both <em>P</em> &lt;0.05). After LPS treatment (24 h), expression ","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/S2667100X23000609/pdfft?md5=59eb5345e21f729473bb2f9d369d6a63&pid=1-s2.0-S2667100X23000609-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135663637","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 music therapy on short-term psychological and physiological outcomes in mechanically ventilated patients: A randomized clinical pilot study","authors":"","doi":"10.1016/j.jointm.2024.01.006","DOIUrl":"10.1016/j.jointm.2024.01.006","url":null,"abstract":"<div><h3>Background</h3><p>Elevated anxiety levels are common in patients on mechanical ventilation (MV) and may challenge recovery. Research suggests music-based interventions may reduce anxiety during MV. However, studies investigating specific music therapy techniques, addressing psychological and physiological well-being in patients on MV, are scarce.</p></div><div><h3>Methods</h3><p>This three-arm randomized clinical pilot study was conducted with MV patients admitted to the intensive care unit (ICU) of Hospital San José in Bogotá, Colombia between March 7, 2022, and July 11, 2022. Patients were divided into three groups: intervention group 1 (IG1), music-assisted relaxation; intervention group 2 (IG2), patient-preferred therapeutic music listening; and control group (CG), standard care. The main outcome measure was the 6-item State-Anxiety Inventory. Secondary outcomes were: pain (measured with a visual analog scale), resilience (measured with the Brief Resilience Scale), agitation/sedation (measured with the Richmond Agitation–Sedation Scale), vital signs (including heart rate, blood pressure, oxygen saturation, and respiratory rate), days of MV, extubation success, and days in the ICU. Additionally, three patients underwent electroencephalography during the interventions.</p></div><div><h3>Results</h3><p>Data from 23 patients were analyzed in this study. The age range of the patients was 24.0–84.0 years, with a median age of 66.0 years (interquartile range: 57.0–74.0). Of the 23 patients, 19 were female (82.6%). No statistically significant differences between the groups were observed for anxiety (<em>P</em>=0.330), pain (<em>P</em>=0.624), resilience (<em>P</em>=0.916), agitation/sedation (<em>P</em>=0.273), length of ICU stay (<em>P</em>=0.785), or vital signs. A statistically significant difference between the groups was found for days of MV (<em>P</em>=0.019). Electroencephalography measurements showed a trend toward delta and theta band power decrease for two patients and a power increase on both beta frequencies (slow and fast) in the frontal areas of the brain for one patient.</p></div><div><h3>Conclusions</h3><p>In this pilot study, music therapy did not significantly affect the anxiety levels in patients on MV. However, the interventions were widely accepted by the staff, patients, and caregivers and were safe, considering the critical medical status of the participants. Further large-scale randomized controlled trials are needed to investigate the potential benefits of music therapeutic interventions in this population.</p><p><strong>Trial Registration</strong> ISRCTN trial registry identifier: ISRCTN16964680</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X24000161/pdfft?md5=9bf738c306eba37149375a60ce5fb945&pid=1-s2.0-S2667100X24000161-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140400507","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":"Bloodstream infections in the era of the COVID-19 pandemic: Changing epidemiology of antimicrobial resistance in the intensive care unit","authors":"Fotinie Ntziora,&nbsp;Efthymia Giannitsioti","doi":"10.1016/j.jointm.2023.12.004","DOIUrl":"10.1016/j.jointm.2023.12.004","url":null,"abstract":"<div><p>The Coronavirus disease 2019 (COVID-19) pandemic increased the burden of critically ill patients who required hospitalization in the intensive care unit (ICU). Bacterial and fungal co-infections, including bloodstream infections (BSIs), increased significantly in ICU patients with COVID-19; this had a significant negative impact on patient outcomes. Reported data pertaining to BSI episodes from the ICU setting during the COVID-19 pandemic were collected and analyzed for this narrative review. We searched the PubMed database for articles published between March 2020 and October 2023; the terms “COVID-19” AND “bloodstream infections” AND “ICU” were used for the search. A total of 778 articles were retrieved; however, only 27 were exclusively related to BSIs in ICU patients with COVID-19. Data pertaining to the epidemiological characteristics, risk factors, characteristics of bacterial and fungal BSIs, patterns of antimicrobial resistance, and comparisons between ICU and non-ICU patients during and before the COVID-19 pandemic were obtained. Data on antimicrobial stewardship and infection-control policies were also included. The rates of BSI were found to have increased among ICU patients with COVID-19 than in non-COVID-19 patients and those admitted during the pre-pandemic period. Male gender, 60–70 years of age, increased body mass index, high Sequential Organ Failure Assessment scores at admission, prolonged hospital and ICU stay, use of central lines, invasive ventilation, and receipt of extracorporeal membrane oxygenation were all defined as risk factors for BSI. The use of immune modulators for COVID-19 appeared to increase the risk of BSI; however, the available data are conflicting. Overall, <em>Enterococci, Acinetobacter baumannii</em>, and <em>Candida</em> spp. emerged as prominent infecting organisms during the pandemic; along with <em>Enterobacterales</em> and <em>Pseudomonas aeruginosa</em> they had a significant impact on mortality. Multidrug-resistant organisms prevailed in the ICU, especially if antimicrobial resistance was established before the COVID-19 pandemic and were significantly associated with increased mortality rates. The unnecessary and widespread use of antibiotics further increased the prevalence of multidrug-resistant organisms during COVID-19. Notably, the data indicated a significant increase in contaminants in blood cultures; this highlighted the decline in compliance with infection-control measures, especially during the initial waves of the pandemic. The implementation of infection-control policies along with antibiotic stewardship succeeded in significantly reducing the rates of blood contamination and BSI pathogens. BSIs considerably worsened outcomes in patients with COVID-19 who were admitted to ICUs. Further studies are needed to evaluate adequate preventive and control measures that may increase preparedness for the future.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X24000057/pdfft?md5=848e5bd6aed77c0f723e4656794b0573&pid=1-s2.0-S2667100X24000057-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140399555","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":"The causal role of immune cells in susceptibility and severity of COVID-19: A bidirectional Mendelian randomization study","authors":"","doi":"10.1016/j.jointm.2024.02.001","DOIUrl":"10.1016/j.jointm.2024.02.001","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X24000148/pdfft?md5=c5e592c7e70ab6e88cbe11d7720ce27f&pid=1-s2.0-S2667100X24000148-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140271788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of intracranial hemorrhage in critically ill patients with acute leukemia: Results of a retrospective cohort study","authors":"","doi":"10.1016/j.jointm.2023.12.008","DOIUrl":"10.1016/j.jointm.2023.12.008","url":null,"abstract":"<div><h3>Background</h3><p>Admission to the intensive care unit (ICU) is frequently required for patients with acute leukemia (AL) because of life-threatening complications such as intracranial hemorrhage (IH). In this study, we evaluated the impact of IH on survival and neurological outcomes in this population.</p></div><div><h3>Methods</h3><p>This was a single-center retrospective cohort study including adult patients with AL requiring ICU admission and experiencing IH between 2002 and 2019 at Saint Louis Hospital. Leukemia type was determined according to the French–American–British classification. Brain imaging (either computed tomography or magnetic resonance imaging) was available for all the patients. The primary endpoint of the study was to describe the clinical and biological characteristics and evaluate the mortality and neurological outcome of patients hospitalized in the ICU with newly diagnosed AL and IH. The secondary endpoint was to identify predictive factors of IH in these patients.</p></div><div><h3>Results</h3><p>Thirty-five patients with AL were included, median age of the patients was 59.00 (interquartile range [IQR]: 36.00–66.00) years. Twenty-nine patients (82.9%) had acute myeloid leukemia, including 12 patients with acute promyelocytic leukemia. Thrombocytopenia was constant, and 48.5% of patients had disseminated intravascular coagulation (DIC). At ICU admission, the median Sequential Organ Failure Assessment score was 5 (IQR: 3–9). The median time between AL onset and IH was 2.0 (IQR: 0.0–9.5) days. The ICU and hospital mortality rates were 60.0% (<em>n</em> =21) and 65.7% (<em>n</em>=23), respectively. In univariate analysis, mechanical ventilation and stupor were associated with mortality, but DIC and acute promyelocytic leukemia were not. Upon multivariate analysis, stupor or coma was the only factor significantly associated with a poor outcome (odds ratio = 8.56, 95 % confidence interval: 2.40 to 30.46).</p></div><div><h3>Conclusion</h3><p>IH is associated with a high mortality rate in AL patients, with stupor or coma at the onset of intracranial bleeding being independently associated with poor outcomes.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X24000124/pdfft?md5=fd66dff394e3f26b528e1d20a4d2c436&pid=1-s2.0-S2667100X24000124-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140269591","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":"Hygrometry behavior during high-flow nasal oxygen therapy and non-invasive mechanical ventilation: A narrative review of bench to clinical studies","authors":"","doi":"10.1016/j.jointm.2024.01.004","DOIUrl":"10.1016/j.jointm.2024.01.004","url":null,"abstract":"<div><p>Recently, there has been growing interest in knowing the best hygrometry level during high-flow nasal oxygen and non-invasive ventilation (NIV) and its potential influence on the outcome. Various studies have shown that breathing cold and dry air results in excessive water loss by nasal mucosa, reduced mucociliary clearance, increased airway resistance, reduced epithelial cell function, increased inflammation, sloughing of tracheal epithelium, and submucosal inflammation. With the Coronavirus Disease 2019 pandemic, using high-flow nasal oxygen with a heated humidifier has become an emerging form of non-invasive support among clinicians. However, we cannot always assume stable humidification. Similarly, there are no clear guidelines for using humidification during NIV, although humidification of inspired gas during invasive ventilation is an accepted standard of care. NIV disturbs the normal physiological system that warms and humidifies inspired gases. If NIV is supplied through an intensive care unit ventilator that utilizes anhydrous gases from compressed wall air and oxygen, the risk of dryness increases. In addition, patients with acute respiratory failure tend to breathe through the mouth during NIV, which is a less efficient route than nasal breathing for adding heat and moisture to the inspired gas. Obstructive sleep apnea syndrome is one of the most important indications for chronic use of NIV at home. Available data suggest that up to 60% of patients with obstructive sleep apnea syndrome who use continuous positive airway pressure therapy experience nasal congestion and dryness of the mouth and nose. Therefore, humidifying the inspired gas in NIV may be essential for patient comfort and compliance with treatment. We aimed to review the available bench and clinical studies that addressed the utility of hygrometry in NIV and nasal high-flow oxygen and discuss the technical limitations of different humidification systems for both systems.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X24000136/pdfft?md5=325633d61f40d18b8f4b164323eeb410&pid=1-s2.0-S2667100X24000136-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140281515","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":"Fungal infections in immunocompromised critically ill patients","authors":"José Garnacho-Montero,&nbsp;Irene Barrero-García,&nbsp;Cristina León-Moya","doi":"10.1016/j.jointm.2024.01.005","DOIUrl":"10.1016/j.jointm.2024.01.005","url":null,"abstract":"<div><p>Diverse pathogenic fungi can produce severe infections in immunocompromised patients, thereby justifying intensive care unit (ICU) admissions. In some cases, the infections can develop in immunocompromised patients who were previously admitted to the ICU. <em>Aspergillus</em> spp., <em>Pneumocystis jirovecii, Candida</em> spp., and Mucorales are the fungi that are most frequently involved in these infections. Diagnosis continues to be challenging because symptoms and signs are unspecific. Herein, we provide an in-depth review about the diagnosis, with emphasis on recent advances, and treatment of these invasive fungal infections in the ICU setting.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X2400015X/pdfft?md5=23378d89e8f5f2142ec0842afffcde3b&pid=1-s2.0-S2667100X2400015X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140273820","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":"When to start renal replacement therapy in acute kidney injury: What are we waiting for?","authors":"Lixia Liu,&nbsp;Zhenjie Hu","doi":"10.1016/j.jointm.2023.12.005","DOIUrl":"10.1016/j.jointm.2023.12.005","url":null,"abstract":"<div><p>Acute kidney injury remains a serious condition with a high mortality risk. In the absence of any new drugs, renal replacement therapy (RRT) is the most important treatment option. Randomized controlled trials have concluded that in critically ill patients without an emergency indication for RRT, a watchful waiting strategy is safe; however, further delays in RRT did not seem to confer any benefit, rather was associated with potential harm. During this process, balancing the risks of complications due to an unnecessary intervention with the risk of not correcting a potentially life-threatening complication remains a challenge. Dynamic renal function assessment, especially dynamic assessment of renal demand-capacity matching, combined with renal biomarkers such as neutrophil gelatinase-associated lipocalin and furosemide stress test, is helpful to identify which patients and when the patients may benefit from RRT.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X24000069/pdfft?md5=dab5276132e80c4a79e14419f90eb0da&pid=1-s2.0-S2667100X24000069-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140276179","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":"The 6-hour lactate clearance rate in predicting 30-day mortality in cardiogenic shock","authors":"Junfeng Wang,&nbsp;Mingxia Ji","doi":"10.1016/j.jointm.2024.01.003","DOIUrl":"10.1016/j.jointm.2024.01.003","url":null,"abstract":"<div><h3>Background</h3><p>Early evaluation of prognosis in cardiogenic shock (CS) is crucial for tailored treatment selection. Both lactate clearance and lactate levels are considered useful prognostic biomarkers in patients with CS. However, there is yet no literature comparing the 6-hour lactate clearance rate (Δ6Lac) with lactate levels measured at admission (L1) and after 6 h (L2) to predict 30-day mortality in CS.</p></div><div><h3>Methods</h3><p>In this observational cohort study, 95 patients with CS were treated at Department of Intensive Care Unit, Yiwu Central Hospital between January 2020 and December 2022. Of these, 88 patients met the eligibility criteria. The lactate levels were measured after admission (L1) as the baseline lactate value, and were measured after 6 h (L2) following admission. The primary endpoint of the study was survival rate at 30 days. A receiver operating characteristic curve was used for data analysis. Univariate and multivariate Cox regression analyses were performed based on Δ6Lac. Kaplan–Meier (KM) survival curves were generated to compare the 30-day survival rates among L1, L2, and Δ6Lac.</p></div><div><h3>Results</h3><p>The Δ6Lac model showed the highest area under the curve value (0.839), followed by the L2 (0.805) and L1 (0.668) models. The Δ6Lac model showed a sensitivity of 84.2% and specificity of 75.4%. The L1 and L2 models had sensitivities of 57.9% each and specificities of 89.9% and 98.6%, respectively. The cut-off values for Δ6Lac, L1, and L2 were 18.2%, 6.7 mmol/L, and 6.1 mmol/L, respectively. Univariate Cox regression analysis revealed a significant association between Δ6Lac and 30-day mortality. After adjusting for five models in multivariate Cox regression, Δ6Lac remained a significant risk factor for 30-day mortality in patients with CS. In our fifth multivariate Cox regression model, Δ6Lac remained a risk factor associated with 30-day mortality (hazard ratio [HR]=5.14, 95% confidence interval [CI]: 1.48 to 17.89, <em>P</em>=0.010) as well as L2 (HR=8.42, 95% CI: 1.26 to 56.22, <em>P</em>=0.028). The KM survival curve analysis revealed that L1 &gt;6.7 mmol/L (HR=8.08, 95% CI: 3.23 to 20.20, <em>P</em> &lt;0.001), L2 &gt;6.1 mmol/L (HR=25.97, 95% CI: 9.76 to 69.15, <em>P</em> &lt;0.001), and Δ6Lac ≤18.2% (HR=8.92, 95% CI: 2.95 to 26.95, <em>P</em> &lt;0.001) were associated with a higher risk of 30-day mortality.</p></div><div><h3>Conclusions</h3><p>Δ6Lac is a better predictor for 30-day mortality in CS than lactate levels at admission. It has a predictive value equivalent to that of lactate level at 6 h after admission, making it an important surrogate indicator for evaluating the suitability as well as poor prognosis after CS treatment. We found that a cut-off value of 18.2% for Δ6Lac provided the most accurate assessment of early prognosis in CS.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X24000112/pdfft?md5=bd8b5539076cac8494a1d18d7fe70aaa&pid=1-s2.0-S2667100X24000112-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140087757","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":"Understanding antimicrobial pharmacokinetics in critically ill patients to optimize antimicrobial therapy: A narrative review","authors":"Claire Roger","doi":"10.1016/j.jointm.2023.12.007","DOIUrl":"10.1016/j.jointm.2023.12.007","url":null,"abstract":"<div><p>Effective treatment of sepsis not only demands prompt administration of appropriate antimicrobials but also requires precise dosing to enhance the likelihood of patient survival. Adequate dosing refers to the administration of doses that yield therapeutic drug concentrations at the infection site. This ensures a favorable clinical and microbiological response while avoiding antibiotic-related toxicity. Therapeutic drug monitoring (TDM) is the recommended approach for attaining these goals. However, TDM is not universally available in all intensive care units (ICUs) and for all antimicrobial agents. In the absence of TDM, healthcare practitioners need to rely on several factors to make informed dosing decisions. These include the patient's clinical condition, causative pathogen, impact of organ dysfunction (requiring extracorporeal therapies), and physicochemical properties of the antimicrobials. In this context, the pharmacokinetics of antimicrobials vary considerably between different critically ill patients and within the same patient over the course of ICU stay. This variability underscores the need for individualized dosing. This review aimed to describe the main pathophysiological changes observed in critically ill patients and their impact on antimicrobial drug dosing decisions. It also aimed to provide essential practical recommendations that may aid clinicians in optimizing antimicrobial therapy among critically ill patients.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X24000094/pdfft?md5=f2c846ee17691e22dd7a2eb034c01622&pid=1-s2.0-S2667100X24000094-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140470002","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}