Journal of intensive medicine最新文献

{"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":"4 3","pages":"Pages 393-399"},"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":"4 3","pages":"Pages 287-298"},"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}

{"title":"Compartmentalization of the inflammatory response during bacterial sepsis and severe COVID-19","authors":"Jean-Marc Cavaillon ,&nbsp;Benjamin G. Chousterman ,&nbsp;Tomasz Skirecki","doi":"10.1016/j.jointm.2024.01.001","DOIUrl":"10.1016/j.jointm.2024.01.001","url":null,"abstract":"<div><p>Acute infections cause local and systemic disorders which can lead in the most severe forms to multi-organ failure and eventually to death. The host response to infection encompasses a large spectrum of reactions with a concomitant activation of the so-called inflammatory response aimed at fighting the infectious agent and removing damaged tissues or cells, and the anti-inflammatory response aimed at controlling inflammation and initiating the healing process. Fine-tuning at the local and systemic levels is key to preventing local and remote injury due to immune system activation. Thus, during bacterial sepsis and Coronavirus disease 2019 (COVID-19), concomitant systemic and compartmentalized pro-inflammatory and compensatory anti-inflammatory responses are occurring. Immune cells (e.g., macrophages, neutrophils, natural killer cells, and T-lymphocytes), as well as endothelial cells, differ from one compartment to another and contribute to specific organ responses to sterile and microbial insult. Furthermore, tissue-specific microbiota influences the local and systemic response. A better understanding of the tissue-specific immune status, the organ immunity crosstalk, and the role of specific mediators during sepsis and COVID-19 can foster the development of more accurate biomarkers for better diagnosis and prognosis and help to define appropriate host-targeted treatments and vaccines in the context of precision medicine.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 3","pages":"Pages 326-340"},"PeriodicalIF":0.0,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X24000045/pdfft?md5=7590daf6861ffd42ec236c1e4825825f&pid=1-s2.0-S2667100X24000045-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140469726","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":"Importance of timely and adequate source control in sepsis and septic shock","authors":"Jan J. De Waele","doi":"10.1016/j.jointm.2024.01.002","DOIUrl":"10.1016/j.jointm.2024.01.002","url":null,"abstract":"<div><p>Source control is defined as the physical measures undertaken to eliminate the source of infection and control ongoing contamination, as well as restore anatomy and function at the site of infection. It is a key component of the management of patients with sepsis and septic shock and one of the main determinants of the outcome of infections that require source control. While not all infections may require source control, it should be considered in every patient presenting with sepsis; it is applicable and necessary in numerous infections, not only those occurring in the abdominal cavity. Although the biological rationale is clear, several aspects of source control remain under debate. The timing of source control may impact outcome; early source control is particularly relevant for patients with abdominal infections or necrotizing skin and soft tissue infections, as well as for those with more severe disease. Percutaneous procedures are increasingly used for source control; nevertheless, surgery—tailored to the patient and infection—remains a valid option for source control. For outcome optimization, adequate source control is more important than the strategy used. It should be acknowledged that source control interventions may often fail, posing a challenge in this setting. Thus, an individualized, multidisciplinary approach tailored to the infection and patient is preferable.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 3","pages":"Pages 281-286"},"PeriodicalIF":0.0,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X24000070/pdfft?md5=ffbb1b073bf9cca19274d820812937bb&pid=1-s2.0-S2667100X24000070-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140465223","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":"Cerebral autoregulation-directed optimal blood pressure management reduced the risk of delirium in patients with septic shock","authors":"Qianyi Peng ,&nbsp;Xia Liu ,&nbsp;Meilin Ai ,&nbsp;Li Huang ,&nbsp;Li Li ,&nbsp;Wei Liu ,&nbsp;Chunguang Zhao ,&nbsp;Chenghuan Hu ,&nbsp;Lina Zhang","doi":"10.1016/j.jointm.2023.12.003","DOIUrl":"10.1016/j.jointm.2023.12.003","url":null,"abstract":"<div><h3>Background</h3><p>When resuscitating patients with septic shock, cerebrovascular reactivity parameters are calculated by monitoring regional cerebral oxygen saturation (rSO₂) using near-infrared spectroscopy to determine the optimal blood pressure. Here, we aimed to analyze the impact of cerebral autoregulation-directed optimal blood pressure management on the incidence of delirium and the prognosis of patients with septic shock.</p></div><div><h3>Methods</h3><p>This prospective randomized controlled clinical study was conducted in the Xiangya Hospital of Central South University, China. Fifty-one patients with septic shock (December 2020–May 2022) were enrolled and randomly allocated to the experimental (<em>n</em>=26) or control group (<em>n</em>=25). Using the ICM⁺ software, we monitored the dynamic changes in rSO₂ and mean arterial pressure (MAP) and calculated the cerebrovascular reactivity parameter tissue oxygen reactivity index to determine the optimal blood pressure to maintain normal cerebral autoregulation function during resuscitation in the experimental group. The control group was treated according to the Surviving Sepsis Campaign Guidelines. Differences in the incidence of delirium and 28-day mortality between the two groups were compared, and the risk factors were analyzed.</p></div><div><h3>Results</h3><p>The 51 patients, including 39 male and 12 female, had a mean age of (57.0±14.9) years. The incidence of delirium was 40.1% (23/51), and the 28-day mortality rate was 29.4% (15/51). The mean MAP during the first 24 h of intensive care unit (ICU) admission was higher ([84.5±12.2] mmHg <em>vs.</em> [77.4±11.8] mmHg, <em>P</em>=0.040), and the incidence of delirium was lower (30.8% <em>vs.</em> 60.0%, <em>P</em>=0.036) in the experimental group than in the control group. The use of cerebral autoregulation-directed optimal blood pressure (odds ratio [OR]=0.090, 95% confidence interval [CI]: 0.009 to 0.923, <em>P</em>=0.043) and length of ICU stay (OR=1.473, 95% CI: 1.093 to 1.985, <em>P</em>=0.011) were risk factors for delirium during septic shock. Vasoactive drug dose (OR=8.445, 95% CI: 1.26 to 56.576, <em>P</em>=0.028) and partial pressure of oxygen (PaO₂) (OR=0.958, 95% CI: 0.921 to 0.996, <em>P</em>=0.032) were the risk factors for 28-day mortality.</p></div><div><h3>Conclusions</h3><p>The use of cerebral autoregulation-directed optimal blood pressure management during shock resuscitation reduces the incidence of delirium in patients with septic shock.</p></div><div><h3><strong>Trial Registration</strong></h3><p>ClinicalTrials.gov ldentifer: NCT03879317</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 3","pages":"Pages 376-383"},"PeriodicalIF":0.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X24000033/pdfft?md5=36e2277329e7a6cc912306adadac723d&pid=1-s2.0-S2667100X24000033-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139881780","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 mortality rates of carbapenem-resistant Gram-negative bacterial infections in intensive care units","authors":"Tulay Orhan Kuloglu ,&nbsp;Gamze Kalin Unuvar ,&nbsp;Fatma Cevahir ,&nbsp;Aysegul Ulu Kilic ,&nbsp;Emine Alp","doi":"10.1016/j.jointm.2023.11.007","DOIUrl":"10.1016/j.jointm.2023.11.007","url":null,"abstract":"<div><h3>Background</h3><p>The prevalence of hospital-acquired infections caused by carbapenem-resistant gram-negative bacteria (CRGNB) is increasing worldwide. Several risk factors have been associated with such infections. The present study aimed to identify risk factors and determine the mortality rates associated with CRGNB infections in intensive care units.</p></div><div><h3>Methods</h3><p>This retrospective case-control study was conducted at Erciyes University Hospital (Kayseri, Turkey) between January 2017 and December 2021. Demographic and laboratory data were obtained from the Infection Control Committee data and record system. Patients who had CRGNB infection 48–72 h after hospitalization were assigned to the case group, while those who were not infected with CRGNB during hospitalization formed the control group. Risk factors, comorbidity, demographic data, and mortality rates were compared between the two groups.</p></div><div><h3>Results</h3><p>Approximately 1449 patients (8.97%) were monitored during the active follow-up period; of those, 1171 patients were included in this analysis. CRGNB infection developed in 14 patients (70.00%) who had CRGNB colonization at admission; in 162 (78.26%) were colonized during hospitalization, whereas 515 (54.56%) were not colonized. There was no significant difference in age, sex (male/female) or comorbidities. The total length of hospital stay was statistically significantly longer (<em>P</em>=0.001) in the case group (median: 24 [interquartile range: 3–378] days) than the control group (median: 16 [interquartile range: 3–135] days). The rates of colonization at admission (25.5%; <em>vs.</em> 10.6%, <em>P</em>=0.001) and mortality (64.4% <em>vs.</em> 45.8%, <em>P</em>=0.001) were also significantly higher in the cases than in the control group, respectively. In the univariate analysis, prolonged hospitalization, the time from intensive care unit admission to the development of infection, presence of CRGNB colonization at admission, transfer from other hospitals, previous antibiotic use, enteral nutrition, transfusion, hemodialysis, mechanical ventilation, tracheostomy, reintubation, central venous catheter, arterial catheterization, chest tube, total parenteral nutrition, nasogastric tube use, and bronchoscopy procedures were significantly associated with CRGNB infections (<em>P</em> &lt;0<em>.</em>05). Multivariate analysis identified the total length of stay in the hospital (odds ratio [OR]=1.02; 95% confidence interval [CI]: 1.01 to 1.03; <em>P</em>=0.001), colonization (OR=2.19; 95% CI: 1.53 to 3.13; <em>P</em>=0.001), previous antibiotic use (OR=2.36; 95% CI: 1.53 to 3.62; <em>P</em>=0.001), intubation (OR=1.59; 95% CI: 1.14 to 2.20; <em>P</em>=0.006), tracheostomy (OR=1.42; 95% CI: 1.01 to 1.99; <em>P</em>=0.047), and central venous catheter use (OR=1.62; 95% CI: 1.20 to 2.19; <em>P</em>=0.002) as the most important risk factors for CRGNB infection.</p></div><div><h3>Conclusions</h3><p>Colo","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 3","pages":"Pages 347-354"},"PeriodicalIF":0.0,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X23000944/pdfft?md5=26c3611d22f92d86944a7bf9cb6ec976&pid=1-s2.0-S2667100X23000944-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139455544","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":"Genetic causal association between gut microbiota and sepsis: Evidence from a two-sample bidirectional Mendelian randomization analysis","authors":"Jungen Tang,&nbsp;Man Huang","doi":"10.1016/j.jointm.2023.11.006","DOIUrl":"10.1016/j.jointm.2023.11.006","url":null,"abstract":"<div><h3>Background</h3><p>Sepsis is a severe and potentially life-threatening condition characterized by a dysregulated host response and organ dysfunction. The causal relationship between intestinal microbiota and sepsis is unclear.</p></div><div><h3>Methods</h3><p>A two-sample Mendelian randomization (MR) study was performed to proxy the causal association between gut microbiota and sepsis. The genome-wide association study (GWAS) data of sepsis and gut microbiome were collected from the Integrative Epidemiology Unit (IEU) OpenGWAS, with summary-level data obtained from the UK Biobank. Five traditional methods were used to estimate the potential causal relationships between gut microbiota and sepsis, including the inverse-variance weighted method, weighted median method, MR-Egger regression, simple mode, and weighted mode. Reverse MR analysis was performed on the bacteria that were found to be causally associated with sepsis in forward MR analysis. Cochran's <em>Q</em> statistic was used to quantify the heterogeneity of instrumental variables.</p></div><div><h3>Results</h3><p>The inverse-variance weighted estimate suggested that class Lentisphaeria (odds ratio [OR]=0.86, 95% confidence interval [CI]: 0.78 to 0.94, <em>P</em>=0.0017, <em>q</em>=0.1596) and order Victivallales (OR=0.86, 95% CI: 0.78 to 0.94, <em>P</em>=0.0017, <em>q</em>=0.1596) have a protective effect on sepsis. The genus <em>Eubacterium eligens</em> group (OR=1.34, 95% CI: 1.11 to 1.63, <em>P</em>=0.0029, <em>q</em>=0.1881) was positively associated with the risk of sepsis. Sepsis may be a significant risk factor for genus <em>Odoribacter</em> (OR=1.18, 95% CI: 1.10 to 1.39, <em>P</em>=0.0415, <em>q</em>=0.9849) and <em>Phascolarctobacterium</em> (OR=1.21, 95% CI: 1.00 to 1.46, <em>P</em>=0.0471, <em>q</em>=0.9849), but this effect was not statistically significant after false discovery rate correction. There was a suggestive association between sepsis and <em>Faecalibacterium</em> (OR=0.85, 95% CI: 0.73 to 0.98, <em>P</em>=0.0278) and <em>Ruminococcus</em> 1 (OR=0.85, 95% CI: 0.73 to 1.00, <em>P</em>=0.0439), which were not significant after false discovery rate correction (<em>q</em>&gt;0.2).</p></div><div><h3>Conclusions</h3><p>This study found that class Lentisphaeria, order Victivallales, and genus <em>Eubacterium eligens</em> group may have a causal relationship with the risk of sepsis.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 3","pages":"Pages 362-367"},"PeriodicalIF":0.0,"publicationDate":"2024-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X23000932/pdfft?md5=90e584504586b97ba93b9b4a49b08027&pid=1-s2.0-S2667100X23000932-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139458436","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":"Late-onset Very long-chain acyl-CoA dehydrogenase deficiency diagnosis complicated by fulminant myocarditis in adult patient","authors":"Martin Gérard ,&nbsp;Clair Douillard ,&nbsp;Julien Poissy ,&nbsp;Mehdi Marzouk ,&nbsp;Christophe Vinsonneau","doi":"10.1016/j.jointm.2023.11.003","DOIUrl":"10.1016/j.jointm.2023.11.003","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 3","pages":"Pages 400-402"},"PeriodicalIF":0.0,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X23000890/pdfft?md5=b623cfc56f30021085b578fc6b101771&pid=1-s2.0-S2667100X23000890-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139394517","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":"Prevention of urinary tract infection using a silver alloy hydrogel-coated catheter in critically ill patients: A single-center prospective randomized controlled study","authors":"Menglong Zhao ,&nbsp;Shike Geng ,&nbsp;Lei Zhang,&nbsp;Xiaoqin Fan,&nbsp;Fei Tong,&nbsp;Xianlin Meng,&nbsp;Tianfeng Wang,&nbsp;Xiaowei Fang,&nbsp;Qing Mei,&nbsp;Aijun Pan","doi":"10.1016/j.jointm.2023.06.003","DOIUrl":"10.1016/j.jointm.2023.06.003","url":null,"abstract":"<div><h3>Background</h3><p>A new type of silver alloy hydrogel-coated (SAH) catheter has been shown to prevent bacterial adhesion and colonization by generating a microcurrent, and to block the retrograde infection pathway. However, these have only been confirmed in ordinary patients. This study aims to evaluate the effectiveness of a SAH catheter for preventing urinary tract infections in critically ill patients.</p></div><div><h3>Methods</h3><p>This was a prospective single-center, single-blind, randomized, controlled study. A total of 132 patients requiring indwelling catheterization in the intensive care unit (ICU) of the First Affiliated Hospital of the University of Science and Technology of China between October 2022 and February 2023 and who met the study inclusion/exclusion criteria were randomly divided into two groups. Patients in the SAH catheter group received a SAH catheter, while patients in the conventional catheter group received a conventional siliconized latex Foley catheter. The main outcome measure was the incidence of catheter-associated urinary tract infections (CAUTIs). Secondary outcome indicators included urine positivity for white blood cells and positive urine cultures on 3 days, 7 days, 10 days, and 14 days after catheterization, number of viable bacteria in the catheter biofilm on day 14, pathogenic characteristics of positive urine cultures, length of ICU stay, overall hospital stay, ICU mortality, and 28-day mortality. All the data were compared between the two groups.</p></div><div><h3>Results</h3><p>A total of 68 patients in the conventional catheter group and 64 patients in the SAH catheter group were included in the study. On day 7 after catheter placement, the positivity rate for urinary white blood cells was significantly higher in the conventional catheter group than in the SAH catheter group (33.8% <em>vs.</em> 15.6%, <em>P</em>=0.016). On day 10, the rates of positive urine cultures (27.9% <em>vs.</em> 10.9%, <em>P</em>=0.014) and CAUTIs (22.1% <em>vs.</em> 7.8%, <em>P</em>=0.023) were significantly higher in the conventional catheter group than in the SAH catheter group. On day 14, the numbers of viable bacteria isolated from the catheter tip ([3.21±1.91]×10⁶ colony-forming units [cfu]/mL <em>vs.</em> [7.44±2.22]×10⁴ cfu/mL, <em>P</em> &lt;0.001), balloon segment ([7.30±1.99]×10⁷ cfu/mL <em>vs.</em> [3.48±2.38]×10⁵ cfu/mL, <em>P</em> &lt;0.001), and tail section ([6.41±2.07]×10⁵ cfu/mL <em>vs.</em> [8.50±1.46]×10³ cfu/mL, <em>P</em> &lt;0.001) were significantly higher in the conventional catheter group than in the SAH catheter group. The most common bacteria in the urine of patients in both groups were <em>Escherichia coli</em> (<em>n</em>=13) and <em>Pseudomonas aeruginosa</em> (<em>n</em>=6), with only one case of <em>Candida</em> in each group. There were no significant differences between the two groups in terms of ICU hospitalization ","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 1","pages":"Pages 118-124"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X23000348/pdfft?md5=2ff58f39b2a4314ae0a3d4983938d6a5&pid=1-s2.0-S2667100X23000348-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48078485","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":"Massive abdominal muscle atrophy during prolonged mechanical ventilation: Implications for tracheostomy removal","authors":"Pascal Beuret,&nbsp;Florian Michelin,&nbsp;Audrey Tientcheu,&nbsp;Laurane Chalvet,&nbsp;Benedicte Philippon-Jouve,&nbsp;Jean-Charles Chakarian,&nbsp;Xavier Fabre","doi":"10.1016/j.jointm.2023.06.005","DOIUrl":"10.1016/j.jointm.2023.06.005","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 1","pages":"Pages 133-135"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X23000476/pdfft?md5=7c4bc0d7427059184f098f3e6561d27f&pid=1-s2.0-S2667100X23000476-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43219123","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}