Annals of Intensive Care最新文献

{"title":"COVID-19 associated pulmonary aspergillosis in critically-ill patients: a prospective multicenter study in the era of Delta and Omicron variants","authors":"Pierre Bay, É. Audureau, S. Préau, R. Favory, A. Guigon, Nicholas Heming, E. Gault, Tài Pham, Amal Chaghouri, M. Turpin, L. Morand‐Joubert, S. Jochmans, A. Pitsch, Sylvie Meireles, Damien Contou, Amandine Henry, Adrien Joseph, M. Chaix, Fabrice Uhel, D. Roux, Diane Descamps, M. Emery, C. Garcia-Sanchez, David Lévy, S. Burrel, J. Mayaux, A. Kimmoun, C. Hartard, F. Pène, Flore Rozenberg, S. Gaudry, Ségolène Brichler, Antoine Guillon, L. Handala, F. Tamion, A. Moisan, T. Daix, S. Hantz, F. Delamaire, V. Thibault, B. Souweine, Cécile Henquell, Lucile Picard, Françoise Botterel, Christophe Rodriguez, A. Dessap, J. Pawlotsky, S. Fourati, N. de Prost","doi":"10.1186/s13613-024-01296-0","DOIUrl":"https://doi.org/10.1186/s13613-024-01296-0","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140664110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined cardiac, lung, and diaphragm ultrasound for predicting weaning failure during spontaneous breathing trial","authors":"Jia Song, Qiancheng Luo, Xinle Lai, Weihang Hu, Yihua Yu, Minjia Wang, Kai Yang, Gongze Chen, Wenwei Chen, Qian Li, Caibao Hu, Shijin Gong","doi":"10.1186/s13613-024-01294-2","DOIUrl":"https://doi.org/10.1186/s13613-024-01294-2","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Weaning from invasive mechanical ventilation (MV) is a complex and challenging process that involves multiple pathophysiological mechanisms. A combined ultrasound evaluation of the heart, lungs, and diaphragm during the weaning phase can help to identify risk factors and underlying mechanisms for weaning failure. This study aimed to investigate the accuracy of lung ultrasound (LUS), transthoracic echocardiography (TTE), and diaphragm ultrasound for predicting weaning failure in critically ill patients.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Patients undergoing invasive MV for &gt; 48 h and who were readied for their first spontaneous breathing trial (SBT) were studied. Patients were scheduled for a 2-h SBT using low-level pressure support ventilation. LUS and TTE were performed prospectively before and 30 min after starting the SBT, and diaphragm ultrasound was only performed 30 min after starting the SBT. Weaning failure was defined as failure of SBT, re-intubation, or non-invasive ventilation within 48 h.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Fifty-one patients were included, of whom 15 experienced weaning failure. During the SBT, the global, anterior, and antero-lateral LUS scores were higher in the failed group than in the successful group. Receiver operating characteristic curve analysis showed that the areas under the curves for diaphragm thickening fraction (DTF) and global and antero-lateral LUS scores during the SBT to predict weaning failure were 0.678, 0.719, and 0.721, respectively. There was no correlation between the LUS scores and the average E/e’ ratio during the SBT. Multivariate analysis identified antero-lateral LUS score &gt; 7 and DTF &lt; 31% during the SBT as independent predictors of weaning failure.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>LUS and diaphragm ultrasound can help to predict weaning failure in patients undergoing an SBT with low-level pressure support. An antero-lateral LUS score &gt; 7 and DTF &lt; 31% during the SBT were associated with weaning failure.</p><h3 data-test=\"abstract-sub-heading\">Graphical Abstract</h3>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2024-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140628466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microbiological features of drowning-associated pneumonia: a systematic review and meta-analysis","authors":"Vladimir L. Cousin, Laure F. Pittet","doi":"10.1186/s13613-024-01287-1","DOIUrl":"https://doi.org/10.1186/s13613-024-01287-1","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Drowning-associated pneumonia (DAP) is frequent in drowned patients, and possibly increases mortality. A better understanding of the microorganisms causing DAP could improve the adequacy of empirical antimicrobial therapy. We aimed to describe the pooled prevalence of DAP, the microorganisms involved, and the impact of DAP on drowned patients.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Systematic review and meta-analysis of studies published between 01/2000 and 07/2023 reporting on DAP occurrence and microorganisms involved.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Of 309 unique articles screened, 6 were included, involving 688 patients. All were retrospective cohort studies, with a number of patients ranging from 37 to 270. Studies were conducted in Europe (France N = 3 and Netherland N = 1), United States of America (N = 1) and French West Indies (N = 1). Mortality ranged between 18 to 81%. The pooled prevalence of DAP was 39% (95%CI 29–48), similarly following freshwater (pooled prevalence 44%, 95%CI 36–52) or seawater drowning (pooled prevalence 42%, 95%CI 32–53). DAP did not significantly impact mortality (pooled odds ratio 1.43, 95%CI 0.56–3.67) but this estimation was based on two studies only. Respiratory samplings isolated 171 microorganisms, mostly Gram negative (98/171, 57%) and mainly <i>Aeromonas </i>sp. (20/171, 12%). Gram positive microorganisms represented 38/171 (22%) isolates, mainly <i>Staphylococcus aureus</i> (21/171, 12%)<i>.</i> Water salinity levels had a limited impact on the distribution of microorganisms, except for <i>Aeromonas</i> sp. who were exclusively found following freshwater drowning (19/106, 18%) and never following seawater drowning (0%) (p = 0.001). No studies reported multidrug-resistant organisms but nearly 30% of the isolated microorganisms were resistant to amoxicillin-clavulanate, the drug that was the most commonly prescribed empirically for DAP.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>DAP are commonly caused by Gram-negative bacteria, especially <i>Aeromonas</i> sp. which is exclusively isolated following freshwater drowning. Empirical antimicrobial therapy should consider covering them, noting than amoxicillin-clavulanate may be inadequate in about one-third of the cases. The impact of DAP on patients’ outcome is still unclear.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2024-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140628273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methodological considerations in personalized methods for PEEP optimization with electrical impedance tomography","authors":"I. Frerichs, Tobias H Becher, Zhanqi Zhao","doi":"10.1186/s13613-024-01288-0","DOIUrl":"https://doi.org/10.1186/s13613-024-01288-0","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2024-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140679483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous breathing trial with pressure support on positive end-expiratory pressure and extensive use of non-invasive ventilation versus T-piece in difficult-to-wean patients from mechanical ventilation: a randomized controlled trial","authors":"Mehdi Mezidi, Hodane Yonis, Louis Chauvelot, Guillaume Deniel, François Dhelft, Maxime Gaillet, Ines Noirot, Laure Folliet, Paul Chabert, Guillaume David, William Danjou, Loredana Baboi, Clotilde Bettinger, Pauline Bernon, Mehdi Girard, Judith Provoost, Alwin Bazzani, Laurent Bitker, Jean-Christophe Richard","doi":"10.1186/s13613-024-01290-6","DOIUrl":"https://doi.org/10.1186/s13613-024-01290-6","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>The aim of this study is to assess whether a strategy combining spontaneous breathing trial (SBT) with both pressure support (PS) and positive end-expiratory pressure (PEEP) and extended use of post-extubation non-invasive ventilation (NIV) (extensively-assisted weaning) would shorten the time until successful extubation as compared with SBT with T-piece (TP) and post-extubation NIV performed in selected patients as advocated by guidelines (standard weaning), in difficult-to-wean patients from mechanical ventilation.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>The study is a single-center prospective open label, randomized controlled superiority trial with two parallel groups and balanced randomization with a 1:1 ratio. Eligible patients were intubated patients mechanically ventilated for more than 24 h who failed their first SBT using TP. In the extensively-assisted weaning group, SBT was performed with PS (7 cmH₂O) and PEEP (5 cmH₂O). In case of SBT success, an additional SBT with TP was performed. Failure of this SBT-TP was an additional criterion for post-extubation NIV in this group in addition to other recommended criteria. In the standard weaning group, SBT was performed with TP, and NIV was performed according to international guidelines. The primary outcome criterion was the time between inclusion and successful extubation evaluated with a Cox model with adjustment on randomization strata.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>From May 2019 to March 2023, 98 patients were included and randomized in the study (49 in each group). Four patients were excluded from the intention-to-treat population (2 in both groups); therefore, 47 patients were analyzed in each group. The extensively-assisted weaning group had a higher median age (68 [58–73] vs. 62 [55–71] yrs.) and similar sex ratio (62% male vs. 57%). Time until successful extubation was not significantly different between extensively-assisted and standard weaning groups (median, 172 [50–436] vs. 95 [47–232] hours, Cox hazard ratio for successful extubation, 0.88 [95% confidence interval: 0.55–1.42] using the standard weaning group as a reference; <i>p</i> = 0.60). All secondary outcomes were not significantly different between groups.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>An extensively-assisted weaning strategy did not lead to a shorter time to successful extubation than a standard weaning strategy.</p><p><i>Trial registration</i> The trial was registered on ClinicalTrials.gov (NCT03861117), on March 1, 2019, before the inclusion of the first patient. https://clinicaltrials.gov/study/NCT03861117.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140617144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The chain of survival and rehabilitation for sepsis: concepts and proposals for healthcare trajectory optimization","authors":"Romain Jouffroy, Félix Djossou, Rémi Neviere, Samir Jaber, Benoît Vivien, Nicholas Heming, Papa Gueye","doi":"10.1186/s13613-024-01282-6","DOIUrl":"https://doi.org/10.1186/s13613-024-01282-6","url":null,"abstract":"<p>This article describes the structures and processes involved in healthcare delivery for sepsis, from the prehospital setting until rehabilitation. Quality improvement initiatives in sepsis may reduce both morbidity and mortality. Positive outcomes are more likely when the following steps are optimized: early recognition, severity assessment, prehospital emergency medical system activation when available, early therapy (antimicrobials and hemodynamic optimization), early orientation to an adequate facility (emergency room, operating theater or intensive care unit), in-hospital organ failure resuscitation associated with source control, and finally a comprehensive rehabilitation program. Such a trajectory of care dedicated to sepsis amounts to a chain of survival and rehabilitation for sepsis. Implementation of this chain of survival and rehabilitation for sepsis requires full interconnection between each link. To date, despite regular international recommendations updates, the adherence to sepsis guidelines remains low leading to a considerable burden of the disease. Developing and optimizing such an integrated network could significantly reduce sepsis related mortality and morbidity.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140617080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of therapeutic plasmapheresis on the duration of organ failure in patients with hypertriglyceridemia-associated acute pancreatitis","authors":"Lanting Wang, Jing Zhou, Cheng Lv, Donghuang Hong, Zuozheng Wang, Wenjian Mao, Yuxiu Liu, Zixiong Zhang, Yuanzhen Li, Gang Li, Bo Ye, Baiqiang Li, Longxiang Cao, Zhihui Tong, Weiqin Li, Lu Ke","doi":"10.1186/s13613-024-01285-3","DOIUrl":"https://doi.org/10.1186/s13613-024-01285-3","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Plasmapheresis is widely used for severe hypertriglyceridemia-associated acute pancreatitis (HTG-AP) to remove excessive triglycerides from plasma. This study aimed to evaluate whether plasmapheresis could improve the duration of organ failure in HTG-AP patients.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We analyzed a cohort of patients from a multicenter, prospective, long-running registry (the PERFORM) collecting HTG-AP patients admitted to the study sites within 72 h from the onset of symptoms. This study was based on data collected from November 2020 to March 2023. Patients who had organ failure at enrollment were involved in the analyses. The primary outcome was time to organ failure resolution within 14 days. Multivariable Cox regression model was used to evaluate the association between plasmapheresis and time to organ failure resolution. Directed acyclic graph (DAG) was used to identify potential confounders.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>A total of 122 HTG-AP patients were included (median [IQR] sequential organ failure assessment (SOFA) score at enrollment, 3.00 [2.00–4.00]). Among the study patients, 46 underwent plasmapheresis, and 76 received medical treatment. The DAG revealed that baseline serum triglyceride, APACHE II score, respiratory failure, cardiovascular failure, and renal failure were potential confounders. After adjusting for the selected confounders, there was no significant difference in time to organ failure resolution between patients undergoing plasmapheresis and those receiving exclusive medical treatment (HR = 1.07; 95%CI 0.68–1.68; P = 0.777). Moreover, the use of plasmapheresis was associated with higher ICU requirements (97.8% [45/46] vs. 65.8% [50/76]; OR, 19.33; 95%CI 2.20 to 169.81; P = 0.008).</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>In HTG-AP patients with early organ failure, plasmapheresis was not associated with accelerated organ failure resolution compared to medical treatment but may be associated with more ICU admissions.</p><p><i>Trial registration</i>: The PERFORM study was registered in the Chinese Clinical Trial Registry (ChiCTR2000039541). Registered 30 October 2020.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140588574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oxygenation management during veno-arterial ECMO support for cardiogenic shock: a multicentric retrospective cohort study","authors":"Hadrien Winiszewski, Thibault Vieille, Pierre-Grégoire Guinot, Nicolas Nesseler, Mael Le Berre, Laure Crognier, Anne-Claude Roche, Jean-Luc Fellahi, Nicolas D’Ostrevy, Zied Ltaief, Juliette Didier, Osama Abou Arab, Simon Meslin, Vincent Scherrer, Guillaume Besch, Alexandra Monnier, Gael Piton, Antoine Kimmoun, Gilles Capellier","doi":"10.1186/s13613-024-01286-2","DOIUrl":"https://doi.org/10.1186/s13613-024-01286-2","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Backgound</h3><p>Hyperoxemia is common and associated with poor outcome during veno-arterial extracorporeal membrane oxygenation (VA ECMO) support for cardiogenic shock. However, little is known about practical daily management of oxygenation. Then, we aim to describe sweep gas oxygen fraction (F_SO₂), postoxygenator oxygen partial pressure (P_POSTO₂), inspired oxygen fraction (F_IO₂), and right radial arterial oxygen partial pressure (P_aO₂) between day 1 and day 7 of peripheral VA ECMO support. We also aim to evaluate the association between oxygenation parameters and outcome. In this retrospective multicentric study, each participating center had to report data on the last 10 eligible patients for whom the ICU stay was terminated. Patients with extracorporeal cardiopulmonary resuscitation were excluded. Primary endpoint was individual mean F_SO₂ during the seven first days of ECMO support (F_SO₂ _{<i>mean (day 1−7)</i>}).</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Between August 2019 and March 2022, 139 patients were enrolled in 14 ECMO centers in France, and one in Switzerland. Among them, the median value for F_SO₂ _{<i>mean (day 1−7)</i>} was 70 [57; 79] % but varied according to center case volume. Compared to high volume centers, centers with less than 30 VA-ECMO runs per year were more likely to maintain F_SO₂ ≥ 70% (OR 5.04, CI 95% [1.39; 20.4], <i>p</i> = 0.017). Median value for right radial P_aO₂ _{<i>mean (day 1−7)</i>} was 114 [92; 145] mmHg, and decreased from 125 [86; 207] mmHg at day 1, to 97 [81; 133] mmHg at day 3 (<i>p</i> &lt; 0.01). Severe hyperoxemia (i.e. right radial P_aO₂ ≥ 300 mmHg) occurred in 16 patients (12%). P_POSTO₂, a surrogate of the lower body oxygenation, was measured in only 39 patients (28%) among four centers. The median value of P_POSTO₂ _{<i>mean (day 1−7)</i>} value was 198 [169; 231] mmHg. By multivariate analysis, age (OR 1.07, CI95% [1.03–1.11], <i>p</i> &lt; 0.001), F_SO₂ _{<i>mean (day 1−3)</i>}(OR 1.03 [1.00-1.06], <i>p</i> = 0.039), and right radial P_aO₂ _{<i>mean (day 1−3)</i>} (OR 1.03, CI95% [1.00-1.02], <i>p</i> = 0.023) were associated with in-ICU mortality.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>In a multicentric cohort of cardiogenic shock supported by VA ECMO, the median value for F_SO₂ _{<i>mean (day 1−7)</i>} was 70 [57; 79] %. P_POSTO₂ monitoring was infrequent and revealed significant hyperoxemia. Higher F_SO₂ _{<i>mean (day 1−3)</i>} and right radial P_aO₂ <sub><i>mean (day 1−3)</i>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140588519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with adverse outcome among children with sickle cell disease admitted to the pediatric intensive care unit: an observational cohort","authors":"Michaël Levy, Jérôme Naudin, Guillaume Geslain, Arielle Maroni, Bérengère Koehl, Fleur Le Bourgeois, Géraldine Poncelet, Maryline Chomton, Anna Deho, Sébastien Julliand, Stéphane Dauger, Julie Sommet","doi":"10.1186/s13613-024-01283-5","DOIUrl":"https://doi.org/10.1186/s13613-024-01283-5","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Sickle cell disease (SCD) is one of the most frequent inherited diseases in the world. Over the last decades, in high-income countries, an important decrease in mortality have been observed due to the improvement of care. However, children with SCD can become critically ill and require admission in Pediatric Intensive Care Units (PICU). The purpose of this study was to describe the epidemiology of children with SCD admitted to PICU for acute crisis and to identify factors associated with adverse outcome (AO).</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We conducted a retrospective study in a Tertiary Hospital in France including all consecutive children with SCD admitted to PICU between January 1st, 2009 and December 31, 2019. We collected baseline patient’s characteristics, clinical and biological data as well as treatments and life sustaining therapies used in the PICU. Patients were defined as experiencing AO in case of death during stay and/or need for invasive mechanical ventilation (MV) and/or for non-invasive ventilation (NIV) for more than 3 days and/or need for vasopressors and/or need for renal replacement therapy.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>We included 579 admissions in 395 patients, mainly of SS genotype (90%) with a median age of 9.2 years [5.5–13.4] and a median baseline hemoglobin of 8.0 g/dl (7.5–8.8). The two main reasons for admission were acute chest syndrome (ACS) (<i>n</i> = 331, 57%) and vaso-occlusive crisis refractory to first line therapy (<i>n</i> = 99, 17%). Half of patients required NIV and 47 (8%) required MV. The overall length of stay was 3 days [1–4] and seven (1%) patients died during PICU stay.There was a total of 113 (20%) admissions with AO and on multivariable analysis, baseline hemoglobin &lt; 8 g/dL, history of bronchial obstruction and admission for ACS were associated with AO. There was no difference in the proportion of hydroxyurea treatment or exchange transfusion program between patients with AO and the other patients.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>Baseline hemoglobin &lt; 8 g/dL, history of bronchial obstruction and admission for ACS were the strongest risk factors for severe evolution in SCD children admitted to PICU. These factors could be taken into consideration when choosing the adequate therapeutic options.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140588523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of volume infusion on left atrial strain in acute circulatory failure","authors":"Marta Cicetti, François Bagate, Cristina Lapenta, Ségolène Gendreau, Paul Masi, Armand Mekontso Dessap","doi":"10.1186/s13613-024-01274-6","DOIUrl":"https://doi.org/10.1186/s13613-024-01274-6","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Left atrial strain (LAS) is a measure of atrial wall deformation during cardiac cycle and reflects atrial contribution to cardiovascular performance. Pathophysiological significance of LAS in critically ill patients with hemodynamic instability has never been explored. This study aimed at describing LAS and its variation during volume expansion and to assess the relationship between LAS components and fluid responsiveness.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>This prospective observational study was performed in a French ICU and included patients with acute circulatory failure, for whom the treating physician decided to proceed to volume expansion (rapid infusion of 500 mL of crystalloid solution). Trans-thoracic echocardiography was performed before and after the fluid infusion. LAS analysis was performed offline. Fluid responsiveness was defined as an increase in velocity-time integral (VTI) of left ventricular outflow tract ≥ 10%.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Thirty-eight patients were included in the final analysis. Seventeen (45%) patients were fluid responders. LAS analysis had a good feasibility and reproducibility. Overall, LAS was markedly reduced in all its components, with values of 19 [15 – 32], -9 [-19 – -7] and − 9 [-13 – -5] % for LAS reservoir (LASr), conduit (LAScd) and contraction (LASct), respectively. LASr, LAScd and LASct significantly increased during volume expansion in the entire population. Baseline value of LAS did not predict fluid responsiveness and the changes in LAS and VTI during volume expansion were not significantly correlated.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>LAS is severely altered during acute circulatory failure. LAS components significantly increase during fluid administration, but cannot be used to predict or assess fluid responsiveness.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140588612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}