Critical care explorations最新文献

{"title":"Mindfulness Exercises Reduce Acute Physiologic Stress Among Female Clinicians.","authors":"Amy H J Wolfe, Pamela S Hinds, Adre J du Plessis, Heather Gordish-Dressman, Vicki Freedenberg, Lamia Soghier","doi":"10.1097/CCE.0000000000001171","DOIUrl":"10.1097/CCE.0000000000001171","url":null,"abstract":"<p><strong>Importance: </strong>Approximately 50% of clinicians experience excessive emotional, physical, and mental stress, with repercussions across the entire medical system. Mindfulness exercises may mitigate this excessive stress. Heart rate variability (HRV) is an objective stress measure that can quantify which mindfulness exercises provide the greatest stress reduction.</p><p><strong>Objectives: </strong>To define the impact of specific mindfulness exercises on HRV, a surrogate for physiologic stress, and the relationship between physiologic (HRV) and subjective stress measured by the State-Trait Anxiety Inventory during a one-day mindfulness workshop.</p><p><strong>Design, setting, and participants: </strong>This was a prospective observational pilot study performed at a quaternary children's hospital with diverse subspecialists of pediatric nurses, nurse practitioners, and physicians.</p><p><strong>Main outcomes and measures: </strong>Our primary outcome measure was change in HRV from baseline during three mindfulness exercises.</p><p><strong>Results: </strong>The grounding, deep breathing, and body scan exercises all produced statistically significant changes in HRV among our 13 female participants. The body scan exercise produced statistically significant changes in all studied HRV parameters compared with baseline. We observed significant increases in Root Mean Square of Successive Differences between normal heartbeats (p = 0.026), high frequency (p ≤ 0.001), and the parasympathetic nervous system index (p ≤ 0.001) reflecting increased parasympathetic tone (e.g., relaxation), whereas sd 2/sd 1 ratio (p ≤ 0.001) and the stress index (p = 0.004) were decreased reflecting sympathetic withdrawal (e.g., decreased stress). Subjective stress decreased after 1-day mindfulness training (44.6 to 27.2) (p < 0.001). Individuals with the largest decrease in subjective stress also had the most improvement in HRV during the body scan exercise.</p><p><strong>Conclusions: </strong>Clinician stress levels (HRV) improved after participating in grounding, deep breathing, and body scan meditations, which may highlight their importance as stress reduction tools for clinicians. Monitoring of HRV during mindfulness exercises may provide deeper understanding of which specific exercises produce the greatest physiologic stress reduction for individual participants and the trend of these changes over time.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11519409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514766","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":"Travel Distances for Interhospital Transfers of Critically Ill Children: A Geospatial Analysis.","authors":"Allan M Joseph, Christopher M Horvat, Billie S Davis, Jeremy M Kahn","doi":"10.1097/CCE.0000000000001175","DOIUrl":"10.1097/CCE.0000000000001175","url":null,"abstract":"<p><strong>Importance: </strong>The U.S. pediatric acute care system has become more centralized, placing increasing importance on interhospital transfers.</p><p><strong>Objectives: </strong>We conducted a geospatial analysis of critically ill children undergoing interfacility transfer with a specific focus on understanding travel distances between the patient's residence and the hospitals in which they receive care.</p><p><strong>Design, setting, and participants: </strong>Retrospective geospatial analysis using five U.S. state-level administrative databases; four states observed from 2016 to 2019 and one state from 2018 to 2019. Participants included 10,665 children who experienced 11,713 episodes of critical illness involving transfer between two hospitals.</p><p><strong>Main outcomes and measures: </strong>Travel distances and the incidence of \"potentially suboptimal triage,\" in which patients were transferred to a second hospital less than five miles further from their residence than the first hospital.</p><p><strong>Results: </strong>Patients typically present to hospitals near their residence (median distance from residence to first hospital, 4.2 miles; interquartile range [IQR], 1.8-9.6 miles). Transfer distances are relatively large (median distance between hospitals, 28.9 miles; IQR, 11.2-53.2 miles), taking patients relatively far away from their residences (median distance from residence to second hospital, 30.1 miles; IQR, 12.2-54.9 miles). Potentially suboptimal triage was frequent: 24.2 percent of patients were transferred to a hospital less than five miles further away from their residence than the first hospital. Potentially suboptimal triage was most common in children living in urban counties, and became less common with increasing medical complexity.</p><p><strong>Conclusions and relevance: </strong>The current pediatric critical care system is organized in a hub-and-spoke model, which requires large travel distances for some patients. Some transfers might be prevented by more efficient prehospital triage. Current transfer patterns suggest the choice of initial hospital is influenced by geography as well as by attempts to match hospital resources with perceived patient needs.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11519404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514702","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 for Increased Opioid Use During Postoperative Intensive Care.","authors":"Lauriane Guichard, Milo C Engoren, Yi-Ju Li, Matthew J Sigakis, Xinming An, Chad M Brummett, Matthew C Mauck, Karthik Raghunathan, Daniel J Clauw, Vijay Krishnamoorthy","doi":"10.1097/CCE.0000000000001172","DOIUrl":"10.1097/CCE.0000000000001172","url":null,"abstract":"<p><strong>Importance: </strong>In the ICU, opioids treat pain and improve ventilator tolerance as part of an analgosedation approach. Identifying predictors of opioid consumption during the ICU course might highlight actionable items to reduce opioid consumption.</p><p><strong>Objectives: </strong>To identify risk factors for opioid use during a postoperative ICU course.</p><p><strong>Design, setting, and participants: </strong>Patients enrolled in the Michigan Genomics Initiative single-center prospective observational cohort study completed baseline preoperative sociodemographic and mental/physical health questionnaires and provided blood samples for genetic analysis. Included patients were 18 years old and older, admitted to ICU postoperatively, and received opioids postoperatively.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was ICU mean daily oral morphine equivalent (OME) use. The association between OME and phenotypic risk factors and genetic variants previously associated with pain were analyzed through univariable and multivariable linear regression models.</p><p><strong>Results: </strong>The cohort consisted of 1865 mixed-surgical patients with mean age of 56 years (sd, 15 yr). Preoperative opioid users were more likely to continue to receive opioids throughout their ICU stay than opioid-naive patients. OME (log10 scale) was most strongly associated with ICU mechanical ventilation (β = 0.27; 95% CI, 0.15-0.38; p < 0.0001; effect size 1.85 for receiving > 24 hours of mechanical ventilation), preoperative opioid use (β = 0.22; 95% CI, 0.16-0.29; p < 0.0001; effect size 1.67 for receiving preoperative opioids), major surgery (β = 0.21; 95% CI, 0.12-0.30; p < 0.0001; effect size 1.62 compared with minor surgery), and current/former illicit drug use (β = 0.12; 95% CI, 0.01-0.23; p = 0.04; effect size 1.30 for drug use). Younger age, centralized pain, and longer anesthetic duration were also significantly associated with OME but with smaller effect sizes. Selected genetic variants (FKBP5, COMT, and OPRM1) were not associated with OME use.</p><p><strong>Conclusions and relevance: </strong>Mechanical ventilation and preoperative opioids were the strongest risk factors for postoperative ICU opioid consumption, whereas psychologic factors and genetic variants were not associated.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11519407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514701","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 Continuous and Noninvasive Method to Estimate Pao₂/Fio₂ Ratio.","authors":"Francis-Olivier Beauchamp, Michaël Sauthier","doi":"10.1097/CCE.0000000000001174","DOIUrl":"10.1097/CCE.0000000000001174","url":null,"abstract":"<p><strong>Objectives: </strong>To validate a method for continuously estimating the Pao₂/Fio₂ (PF) ratio in all critically ill pediatric patients using only standard continuous data monitoring.</p><p><strong>Design: </strong>Retrospective study on a high temporal resolution database.</p><p><strong>Setting: </strong>PICU in Montreal, QC, Canada.</p><p><strong>Patients/subjects: </strong>We included any patients admitted from May 2015 to May 2023 who had an arterial blood gas (ABG) with concurrent continuous pulsed oximetry saturation (Spo₂) values. We used our previously validated mathematical model to determine the magnitude of hypoxemia by computing the estimated ePao₂/Fio₂ (ePF) ratio and comparing it to the Spo₂/Fio₂ (SF), using PF ratio as the reference standard.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We analyzed a total of 20,828 ABGs. When Spo₂ was below or equal to 97%, the ePF ratio showed a significantly better hypoxemia classification (none, light/moderate, or severe) than the SF ratio (0.80 vs. 0.72; <i>p</i> < 0.001), a lower fixed bias (16.26 vs. -35.24; <i>p</i> < 0.001), a lower mean absolute error (37.92 vs. 63.93; <i>p</i> < 0.001) and a lower proportional bias (slope of 1.01 vs. 0.81; <i>p</i> < 0.001). ePF ratio has also a better limits of agreement difference from Bland-Altman plot (248.10 vs. 292.45; <i>p</i> < 0.001) and coefficient of determination (0.68 vs. 0.59; <i>p</i> < 0.001). When Spo₂ was above 97%, the ePF ratio had better classification with Kappa (0.53 vs. 0.43; <i>p</i> < 0.001) and lower fixed bias (-0.63 vs. 65.68; <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>The PF ratio based on ePF allows for a continuous estimation of hypoxemia severity with a better performance than the SF ratio.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11519398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549501","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":"Associations Between Clinical Factors and Postoperative Thrombosis in Pediatric Cardiac Surgery Patients: A Single-Center Retrospective Study.","authors":"Sven Chlench, Noa J Freudenthal","doi":"10.1097/CCE.0000000000001170","DOIUrl":"https://doi.org/10.1097/CCE.0000000000001170","url":null,"abstract":"<p><strong>Importance: </strong>Postoperative thrombosis is a significant complication in pediatric cardiac surgery patients, contributing to morbidity and mortality. Identifying clinical factors associated with thrombosis can improve patient outcomes by guiding early detection and intervention.</p><p><strong>Objectives: </strong>This study aimed to assess factors associated with postoperative thrombosis or thromboembolism in pediatric patients under 12 months old who underwent surgery for congenital heart disease (CHD). Design, Setting, and Participants: This retrospective cohort study analyzed electronic medical records from pediatric patients admitted to the Pediatric Cardiovascular Intensive Care Unit (PCICU) at the German Paediatric Heart Center, Bonn, between March 1, 2020, and March 1, 2021. A total of 197 children under 12 months old who underwent cardiac surgery were included in the analysis.</p><p><strong>Main outcomes and measures: </strong>Thrombosis was diagnosed postoperatively using imaging modalities such as ultrasound, echocardiography, and computed tomography. The primary outcome was the incidence of thrombosis and its association with clinical factors such as age, central venous catheter (CVC) duration, CRP levels, and D-dimer levels.</p><p><strong>Results: </strong>Among 197 patients, the incidence of thrombosis was 8.63%, predominantly venous (70.6%). Initial associations were observed between thrombosis and younger age, lower body weight, higher hematocrit, cyanosis, longer central venous catheter (CVC) use, and elevated C-reactive protein (CRP) and d-dimer levels. Receiver operating characteristic analysis indicated a higher risk in patients with d-dimer levels above 5.47 mg/L. The stepwise multiregression analysis identified longer CVC duration in situ (β = 0.553; p < 0.001), higher CRP levels (β = 0.217; p = 0.022), and younger age at admission (β = -0.254; p = 0.006) as significant predictors of thrombosis. Decision tree analysis identified CVC use longer than 12.5 days and CRP levels above 118.01 mg/L as the most critical risk factors.</p><p><strong>Conclusions and relevance: </strong>Postoperative thrombosis is a notable risk in pediatric CHD patients, particularly in neonates. Prolonged CVC use and elevated CRP levels are critical risk factors. Routine monitoring of D-dimer and CRP levels, along with timely sonographic screening, can aid early thrombosis detection and intervention. Further research is warranted to optimize thrombosis prevention strategies in this population.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11495689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514764","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":"Utility of Clinical Features in Identifying Electrographic Seizures in Hospitalized Patients Admitted for Non-Neurological Diagnoses.","authors":"Carolyn Tsai, Courtney Blodgett, Sunghyun Seo, Rizk Alghorazi, Lang Li, Bahjat Qaqish, William J Powers, Clio Rubinos","doi":"10.1097/CCE.0000000000001168","DOIUrl":"10.1097/CCE.0000000000001168","url":null,"abstract":"<p><strong>Importance: </strong>Electrographic seizures (ESz) are seizures without prominent motor activity diagnosed with electroencephalogram and are a common complication in critically ill patients with alterations of consciousness. Previous studies suggested clinical signs, including ocular movement abnormalities, facial/periorbital twitching, or remote seizure risk factors, are sensitive for presence of ESz.</p><p><strong>Objectives: </strong>To assess the utility of clinical features in identifying ESz in critically ill patients with alterations of consciousness.</p><p><strong>Design, setting, and participants: </strong>This is a retrospective case-control study of 50 patients admitted to the University of North Carolina (UNC) Medical Center and UNC Rex Hospital. Inpatients older than 18 years old undergoing continuous video electroencephalogram (cEEG) were included. Patients admitted for neurologic diagnoses were excluded. A total of 25 patients with ESz (Sz-EEG) were matched with 25 controls by electroencephalogram duration ± 12 hours (No-Sz-EEG). Elements of patient's history and physical findings previously shown to be sensitive for presence of ESz were collected. Descriptive statistical analyses were used.</p><p><strong>Results: </strong>Most patients were admitted to medical ICUs (72%; n = 36). There was no difference between groups in clinical findings previously shown to be sensitive for ESz. Positive and negative likelihood ratios for these findings generally fell between 1-2 and 0.5-1, respectively, indicating they are inaccurate predictors for ESz. Patients with ESz had significantly higher mortality (p = 0.012).</p><p><strong>Conclusions and relevance: </strong>Our matched case-control study showed that in the critically ill patient population hospitalized in tertiary care centers and admitted for non-neurologic primary diagnoses, incidence of ocular movement abnormalities, facial/periorbital twitching, and presence of remote risk factors for seizures had low predictive accuracy for ESz. However, these findings are not generalizable to patients with neurologic diseases or to other practice settings with different levels of access to cEEG. We concluded that in this exploratory analysis of hospitalized critically ill patients with non-neurologic diagnoses, these clinical signs did not reliably stratify risk for ESz on cEEG. However, further prospective studies are needed to better evaluate these conclusions.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11495720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142483250","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":"Neurosurgical Procedures in Patients Requiring Extracorporeal Membrane Oxygenation.","authors":"Ryan Lee, Samantha Helmy, Jeronimo Cardona, David Zhao, Raymond Rector, Joseph Rabin, Michael Mazzeffi, Sung-Min Cho, Gunjan Parikh, Nicholas A Morris, Imad Khan","doi":"10.1097/CCE.0000000000001166","DOIUrl":"https://doi.org/10.1097/CCE.0000000000001166","url":null,"abstract":"<p><strong>Objectives: </strong>Extracorporeal membrane oxygenation (ECMO) is often withheld in patients with significant neurologic injury or recent neurosurgical intervention due to perceived futility. Studies of neurosurgical interventions before or during ECMO are limited to case reports or single-center series, limiting generalizability, and outcomes in this population are unknown. We therefore sought to report the outcomes of ECMO patients with acute neurosurgical interventions at four high-volume ECMO and comprehensive stroke centers.</p><p><strong>Design: </strong>Retrospective case series.</p><p><strong>Setting: </strong>Four academic tertiary referral hospitals in the United States.</p><p><strong>Patients: </strong>Adults (<i>n</i> = 24) having undergone neurosurgical procedures before or during ECMO.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We retrospectively reviewed adults at four institutions who had undergone neurosurgical procedures immediately before or during ECMO from 2015 to 2023. The primary outcome was survival to hospital discharge. Secondary outcomes included favorable neurologic outcome (Cerebral Performance Category 1 or 2) and neurosurgical complications. Twenty-four of 2957 ECMO patients (0.8%) were included. Primary indications for neurosurgical intervention included traumatic brain (<i>n</i> = 8) or spinal (<i>n</i> = 3) injury, spontaneous intracranial hemorrhage (<i>n</i> = 6), and acute ischemic stroke (<i>n</i> = 5). Procedures included extraventricular drain (EVD) and/or intracranial pressure monitor placement (<i>n</i> = 10), craniectomy/craniotomy (<i>n</i> = 5), endovascular thrombectomy (<i>n</i> = 4), and spinal surgery (<i>n</i> = 3). Fifteen patients (63%) survived to hospital discharge, of whom 12 (80%) were discharged with favorable neurologic outcomes. Survival to discharge was similar for venoarterial and venovenous ECMO patients (8/12 vs. 7/12; <i>p</i> = 0.67) and those who had neurosurgery before vs. during ECMO (8/13 vs. 7/11; <i>p</i> = 0.92). One patient (4%) experienced a neurosurgical complication, a nonlethal tract hemorrhage from EVD placement. Survival to discharge was similar for neurosurgical and nonneurosurgical ECMO patients at participating institutions (63% vs. 57%; <i>p</i> = 0.58).</p><p><strong>Conclusions: </strong>Patients with acute neurologic injury can feasibly undergo neurosurgery during ECMO or can undergo ECMO after recent neurosurgery. Larger studies are needed to fully understand risks for bleeding and other procedure-related complications.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11495759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514765","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":"Procalcitonin-Guided Management and Duration of Antibiotic Therapy in Critically Ill Cancer Patients With Sepsis (Pro-Can Study): A Randomized Controlled Trial.","authors":"Lama H Nazer, Wedad Awad, Hadeel Thawabieh, Aseel Abusara, Deema Abdelrahman, Awad Addassi, Osama Abuatta, Maher Sughayer, Yahya Shehabi","doi":"10.1097/CCE.0000000000001173","DOIUrl":"10.1097/CCE.0000000000001173","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the effect of procalcitonin-guided management on the duration of antibiotic therapy in critically ill cancer patients with sepsis.</p><p><strong>Design: </strong>Randomized, controlled, single-blinded trial.</p><p><strong>Setting: </strong>A comprehensive multidisciplinary cancer hospital in Jordan.</p><p><strong>Patients: </strong>Adults with cancer treated in the ICU who were started on antibiotics for suspected infection, met the SEPSIS-3 criteria, and were expected to stay in the ICU greater than or equal to 48 hours.</p><p><strong>Interventions: </strong>Patients were randomized to the procalcitonin-guided or standard care (SC) arms. All patients had procalcitonin measured daily, up to 5 days or until ICU discharge or death. For the procalcitonin arm, a procalcitonin-guided algorithm was provided to guide antibiotic management, but clinicians were allowed to override the algorithm, if clinically indicated. In the SC arm, ICU clinicians were blinded to the procalcitonin levels.</p><p><strong>Measurements and main results: </strong>Primary outcome was time to antibiotic cessation. We also evaluated the number of antibiotic-free days at 28 days, hospital discharge, or death, whichever came first, and antibiotic defined daily doses (DDDs). We enrolled 77 patients in the procalcitonin arm and 76 in the SC arm. Mean age was 58 ± 14 (sd) years, 67% were males, 74% had solid tumors, and 13% were neutropenic. Median (interquartile range [IQR]) Sequential Organ Failure Assessment scores were 7 (6-10) and 7 (5-9) and procalcitonin concentrations (ng/mL) at baseline were 3.4 (0.8-16) and 3.4 (0.5-26), in the procalcitonin and SC arms, respectively. There was no difference in the median (IQR) time to antibiotic cessation in the procalcitonin and SC arms, 8 (4-11) and 8 (5-13), respectively (p = 0.463). Median (IQR) number of antibiotic-free days were 20 (17-24) and 20 (16-23), (p = 0.484) and total DDDs were 1541.4 and 2050.4 in the procalcitonin and SC arms, respectively.</p><p><strong>Conclusions: </strong>In critically ill cancer patients with sepsis, procalcitonin-guided management did not reduce the duration of antibiotic treatment.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11495690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142483248","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":"Ultra-Low-Field Portable MRI and Extracorporeal Membrane Oxygenation: Preclinical Safety Testing.","authors":"Jin Kook Kang, Eric Etchill, Kate Verdi, Ana K Velez, Sean Kearney, Jeffrey Dodd-O, Errol Bush, Samantha By, Eddy Boskamp, Christopher Wilcox, Chun Woo Choi, Bo Soo Kim, Glenn J R Whitman, Sung-Min Cho","doi":"10.1097/CCE.0000000000001169","DOIUrl":"10.1097/CCE.0000000000001169","url":null,"abstract":"<p><strong>Context: </strong>Conventional MRI is incompatible with extracorporeal membrane oxygenation (ECMO) cannulas and pumps. Ultra-low-field portable MRI (ULF-pMRI) with 0.064 Tesla may provide a solution, but its safety and compatibility is unknown.</p><p><strong>Hypothesis: </strong>ULF-pMRI does not cause significant displacement and heating of ECMO cannulas and does not affect ECMO pump function.</p><p><strong>Methods and models: </strong>ECMO cannulas in various sizes were tested ex vivo using phantom models to assess displacement force and heating according to the American Society for Testing and Materials criteria. ECMO pump function was assessed by pump flow and power consumption. In vivo studies involved five female domestic pigs (20-42 kg) undergoing different ECMO configurations (peripheral and central cannulation) and types of cannulas with an imaging protocol consisting of T2-weighted, T1-weighted, FLuid-Attenuated Inversion Recovery, and diffusion-weighted imaging sequences.</p><p><strong>Results: </strong>Phantom models demonstrated that ECMO cannulas, both single lumen with various sizes (15-24-Fr) and double lumen cannula, had average displacement force less than gravitational force within 5 gauss safety line of ULF-pMRI and temperature changes less than 1°C over 15 minutes of scanning and ECMO pump maintained stable flow and power consumption immediately outside of the 5 gauss line. All pig models showed no visible motion due to displacement force or heating of the cannulas. ECMO flow and the animals' hemodynamic status maintained stability, with no changes greater than 10%, respectively.</p><p><strong>Interpretation and conclusions: </strong>ULF-pMRI is safe and feasible for use with standard ECMO configurations, supporting its clinical application as a neuroimaging modality in ECMO patients.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11495706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142483249","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":"Persistent Fatigue, Weakness, and Aberrant Muscle Mitochondria in Survivors of Critical COVID-19.","authors":"Kirby P Mayer, Ahmed Ismaeel, Anna G Kalema, Ashley A Montgomery-Yates, Melissa K Soper, Philip A Kern, Jonathan D Starck, Stacey A Slone, Peter E Morris, Esther E Dupont-Versteegden, Kate Kosmac","doi":"10.1097/CCE.0000000000001164","DOIUrl":"https://doi.org/10.1097/CCE.0000000000001164","url":null,"abstract":"<p><strong>Objectives: </strong>Persistent skeletal muscle dysfunction in survivors of critical illness due to acute respiratory failure is common, but biological data elucidating underlying mechanisms are limited. The objective of this study was to elucidate the prevalence of skeletal muscle weakness and fatigue in survivors of critical illness due to COVID-19 and determine if cellular changes associate with persistent skeletal muscle dysfunction.</p><p><strong>Design: </strong>A prospective observational study in two phases: 1) survivors of critical COVID-19 participating in physical outcome measures while attending an ICU Recovery Clinic at short-term follow-up and 2) a nested cohort of patients performed comprehensive muscle and physical function assessments with a muscle biopsy; data were compared with non-COVID controls.</p><p><strong>Setting: </strong>ICU Recovery Clinic and clinical laboratory.</p><p><strong>Patients/subjects: </strong>Survivors of critical COVID-19 and non-COVID controls.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>One hundred twenty patients with a median of 56 years old (interquartile range [IQR], 42-65 yr old), 43% female, and 33% individuals of underrepresented race attended follow-up 44 ± 17 days after discharge. Patients had a median Acute Physiology and Chronic Health Evaluation-II score of 24.0 (IQR, 16-29) and 98 patients (82%) required mechanical ventilation with a median duration of 14 days (IQR, 9-21 d). At short-term follow-up significant physical dysfunction was observed with 93% of patients reporting generalized fatigue and performing mean 218 ± 151 meters on 6-minute walk test (45% ± 30% of predicted). Eleven patients from this group agreed to participate in long-term assessment and muscle biopsy occurring a mean 267 ± 98 days after discharge. Muscle tissue from COVID exhibited a greater abundance of M2-like macrophages and satellite cells and lower activity of mitochondrial complex II and complex IV compared with controls.</p><p><strong>Conclusions: </strong>Our findings suggest that aberrant repair and altered mitochondrial activity in skeletal muscle associates with long-term impairments in patients surviving an ICU admission for COVID-19.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11487221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142483247","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}