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Correction to: Neurological monitoring and management for adult extracorporeal membrane oxygenation patients: Extracorporeal Life Support Organization consensus guidelines 更正:成人体外膜氧合患者的神经监测和管理:体外生命支持组织共识指南
IF 15.1 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-10-07 DOI: 10.1186/s13054-024-05107-7
Sung‑Min Cho, Jaeho Hwang, Giovanni Chiarini, Marwa Amer, Marta V. Antonini, Nicholas Barrett, Jan Belohlavek, Daniel Brodie, Heidi J. Dalton, Rodrigo Diaz, Alyaa Elhazmi, Pouya Tahsili‑Fahadan, Jonathon Fanning, John Fraser, Aparna Hoskote, Jae‑Seung Jung, Christopher Lotz, Graeme MacLaren, Giles Peek, Angelo Polito, Jan Pudil, Lakshmi Raman, Kollengode Ramanathan, Dinis Dos Reis Miranda, Daniel Rob, Leonardo Salazar Rojas, Fabio Silvio Taccone, Glenn Whitman, Akram M. Zaaqoq, Roberto Lorusso
<p><b>Correction to</b><b>: </b><b>Critical Care (2024) 28:296 </b><b>https://doi.org/10.1186/s13054-024-05082-z</b></p><p>Following publication of the original article [1], the authors identified an error that it lacked the statement: This article has been co-published with permission in <i>Critical Care</i> and the <i>ASAIO Journal</i>.</p><p>The statement has been indicated in this correction article.</p><ol data-track-component="outbound reference" data-track-context="references section"><li data-counter="1."><p>Cho SM, Hwang J, Chiarini G, et al. Neurological monitoring and management for adult extracorporeal membrane oxygenation patients: Extracorporeal Life Support Organization consensus guidelines. Crit Care. 2024;28:296. https://doi.org/10.1186/s13054-024-05082-z.</p><p>Article PubMed PubMed Central Google Scholar </p></li></ol><p>Download references<svg aria-hidden="true" focusable="false" height="16" role="img" width="16"><use xlink:href="#icon-eds-i-download-medium" xmlns:xlink="http://www.w3.org/1999/xlink"></use></svg></p><span>Author notes</span><ol><li><p>Akram M. Zaaqoq and Roberto Lorusso have contributed equally as senior authors.</p></li></ol><h3>Authors and Affiliations</h3><ol><li><p>Divisions of Neuroscience Critical Care and Cardiac Surgery Departments of Neurology, Neurosurgery, and Anaesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps 455, Baltimore, MD, 21287, USA</p><p>Sung‑Min Cho, Jaeho Hwang & Pouya Tahsili‑Fahadan</p></li><li><p>Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA</p><p>Sung‑Min Cho & Glenn Whitman</p></li><li><p>Cardiothoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands</p><p>Giovanni Chiarini & Roberto Lorusso</p></li><li><p>Division of Anaesthesiology, Intensive Care and Emergency Medicine, Spedali Civili University, Affiliated Hospital of Brescia, Brescia, Italy</p><p>Giovanni Chiarini</p></li><li><p>Medical/Critical Pharmacy Division, King Faisal Specialist Hospital and Research Center, 11564 Al Mathar Ash Shamali, Riyadh, Saudi Arabia</p><p>Marwa Amer & Alyaa Elhazmi</p></li><li><p>Alfaisal University College of Medicine, Riyadh, Saudi Arabia</p><p>Marwa Amer & Alyaa Elhazmi</p></li><li><p>Bufalini Hospital, AUSL Della Romagna, Cesena, Italy</p><p>Marta V. Antonini</p></li><li><p>Department of Critical Care Medicine, Guy’s and St Thomas’ National Health Service Foundation Trust, London, UK</p><p>Nicholas Barrett</p></li><li><p>2nd Department of Medicine, Cardiology and Angiologiy, General University Hospital and 1St School of Medicine, Charles University, Prague, Czech Republic</p><p>Jan Belohlavek & Daniel Rob</p></li><li><p>Division of Pulmonary, and Critical Care Medicine, Department of Medicine, The Johns Hopkins Univers
Antonini查看作者发表的作品您也可以在PubMed Google Scholar中搜索该作者Nicholas Barrett查看作者发表的作品您也可以在PubMed Google Scholar中搜索该作者Jan Belohlavek查看作者发表的作品您也可以在PubMed Google Scholar中搜索该作者Daniel Brodie查看作者发表的作品您也可以在PubMed Google Scholar中搜索该作者Heidi J. Dalton查看作者发表的作品您也可以在PubMed Google Scholar中搜索该作者Rodrigo Diaz查看作者发表的作品您也可以在PubMed Google Scholar中搜索该作者DaltonView作者发表作品您也可以在PubMed Google Scholar中搜索该作者Rodrigo DiazView作者发表作品您也可以在PubMed Google Scholar中搜索该作者Alyaa ElhazmiView作者发表作品您也可以在PubMed Google Scholar中搜索该作者Pouya Tahsili-FahadanView作者发表作品您也可以在PubMed Google Scholar中搜索该作者Jonathon FanningView作者发表作品您也可以在PubMed Google Scholar中搜索该作者JohnFraserView 作者发表作品您也可以在 PubMed Google ScholarAparna HoskoteView 作者发表作品您也可以在 PubMed Google ScholarJae-Seung JungView 作者发表作品您也可以在 PubMed Google ScholarChristopher LotzView 作者发表作品您也可以在 PubMed Google ScholarGraeme MacLarenView 作者发表作品您也可以在 PubMed Google ScholarGilesPeekView 作者发表作品您也可以在 PubMed Google ScholarAngelo PolitoView 作者发表作品您也可以在 PubMed Google ScholarJan PudilView 作者发表作品您也可以在 PubMed Google ScholarLakshmi RamanView 作者发表作品您也可以在 PubMed Google ScholarKollengode RamanathanView 作者发表作品您也可以在 PubMed Google ScholarDinis Dos ReisMirandaView 作者发表作品您也可以在 PubMed Google ScholarDaniel RobView 作者发表作品您也可以在 PubMed Google ScholarLeonardo Salazar RojasView 作者发表作品您也可以在 PubMed Google ScholarFabio Silvio TacconeView 作者发表作品您也可以在 PubMed Google ScholarGlenn WhitmanView 作者发表作品您也可以在 PubMed Google ScholarAkram M. Zaaqoq查看作者ZaaqoqView author publications您也可以在PubMed Google Scholar中搜索该作者Roberto LorussoView author publications您也可以在PubMed Google Scholar中搜索该作者Corresponding authorCorrespondence to Sung-Min Cho.出版商说明Springer Nature对出版地图和机构隶属关系中的管辖权主张保持中立。开放获取 本文采用知识共享署名 4.0 国际许可协议,该协议允许以任何媒介或格式使用、共享、改编、分发和复制本文,但须注明原作者和出处,提供知识共享许可协议的链接,并说明是否进行了修改。本文中的图片或其他第三方材料均包含在文章的知识共享许可协议中,除非在材料的署名栏中另有说明。如果材料未包含在文章的知识共享许可协议中,且您打算使用的材料不符合法律规定或超出许可使用范围,则您需要直接从版权所有者处获得许可。如需查看该许可的副本,请访问 http://creativecommons.org/licenses/by/4.0/.Reprints and permissionsCite this articleCho, S., Hwang, J., Chiarini, G. et al. Correction to:成人体外膜氧合患者的神经监测和管理:体外生命支持组织共识指南》。Crit Care 28, 327 (2024). https://doi.org/10.1186/s13054-024-05107-7Download citationPublished: 07 October 2024DOI: https://doi.org/10.1186/s13054-024-05107-7Share this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard Provided by the Springer Nature SharedIt content-sharing initiative
{"title":"Correction to: Neurological monitoring and management for adult extracorporeal membrane oxygenation patients: Extracorporeal Life Support Organization consensus guidelines","authors":"Sung‑Min Cho, Jaeho Hwang, Giovanni Chiarini, Marwa Amer, Marta V. Antonini, Nicholas Barrett, Jan Belohlavek, Daniel Brodie, Heidi J. Dalton, Rodrigo Diaz, Alyaa Elhazmi, Pouya Tahsili‑Fahadan, Jonathon Fanning, John Fraser, Aparna Hoskote, Jae‑Seung Jung, Christopher Lotz, Graeme MacLaren, Giles Peek, Angelo Polito, Jan Pudil, Lakshmi Raman, Kollengode Ramanathan, Dinis Dos Reis Miranda, Daniel Rob, Leonardo Salazar Rojas, Fabio Silvio Taccone, Glenn Whitman, Akram M. Zaaqoq, Roberto Lorusso","doi":"10.1186/s13054-024-05107-7","DOIUrl":"https://doi.org/10.1186/s13054-024-05107-7","url":null,"abstract":"&lt;p&gt;&lt;b&gt;Correction to&lt;/b&gt;&lt;b&gt;: &lt;/b&gt;&lt;b&gt;Critical Care (2024) 28:296 &lt;/b&gt;&lt;b&gt;https://doi.org/10.1186/s13054-024-05082-z&lt;/b&gt;&lt;/p&gt;&lt;p&gt;Following publication of the original article [1], the authors identified an error that it lacked the statement: This article has been co-published with permission in &lt;i&gt;Critical Care&lt;/i&gt; and the &lt;i&gt;ASAIO Journal&lt;/i&gt;.&lt;/p&gt;&lt;p&gt;The statement has been indicated in this correction article.&lt;/p&gt;&lt;ol data-track-component=\"outbound reference\" data-track-context=\"references section\"&gt;&lt;li data-counter=\"1.\"&gt;&lt;p&gt;Cho SM, Hwang J, Chiarini G, et al. Neurological monitoring and management for adult extracorporeal membrane oxygenation patients: Extracorporeal Life Support Organization consensus guidelines. Crit Care. 2024;28:296. https://doi.org/10.1186/s13054-024-05082-z.&lt;/p&gt;&lt;p&gt;Article PubMed PubMed Central Google Scholar &lt;/p&gt;&lt;/li&gt;&lt;/ol&gt;&lt;p&gt;Download references&lt;svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"&gt;&lt;use xlink:href=\"#icon-eds-i-download-medium\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"&gt;&lt;/use&gt;&lt;/svg&gt;&lt;/p&gt;&lt;span&gt;Author notes&lt;/span&gt;&lt;ol&gt;&lt;li&gt;&lt;p&gt;Akram M. Zaaqoq and Roberto Lorusso have contributed equally as senior authors.&lt;/p&gt;&lt;/li&gt;&lt;/ol&gt;&lt;h3&gt;Authors and Affiliations&lt;/h3&gt;&lt;ol&gt;&lt;li&gt;&lt;p&gt;Divisions of Neuroscience Critical Care and Cardiac Surgery Departments of Neurology, Neurosurgery, and Anaesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps 455, Baltimore, MD, 21287, USA&lt;/p&gt;&lt;p&gt;Sung‑Min Cho, Jaeho Hwang &amp; Pouya Tahsili‑Fahadan&lt;/p&gt;&lt;/li&gt;&lt;li&gt;&lt;p&gt;Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA&lt;/p&gt;&lt;p&gt;Sung‑Min Cho &amp; Glenn Whitman&lt;/p&gt;&lt;/li&gt;&lt;li&gt;&lt;p&gt;Cardiothoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands&lt;/p&gt;&lt;p&gt;Giovanni Chiarini &amp; Roberto Lorusso&lt;/p&gt;&lt;/li&gt;&lt;li&gt;&lt;p&gt;Division of Anaesthesiology, Intensive Care and Emergency Medicine, Spedali Civili University, Affiliated Hospital of Brescia, Brescia, Italy&lt;/p&gt;&lt;p&gt;Giovanni Chiarini&lt;/p&gt;&lt;/li&gt;&lt;li&gt;&lt;p&gt;Medical/Critical Pharmacy Division, King Faisal Specialist Hospital and Research Center, 11564 Al Mathar Ash Shamali, Riyadh, Saudi Arabia&lt;/p&gt;&lt;p&gt;Marwa Amer &amp; Alyaa Elhazmi&lt;/p&gt;&lt;/li&gt;&lt;li&gt;&lt;p&gt;Alfaisal University College of Medicine, Riyadh, Saudi Arabia&lt;/p&gt;&lt;p&gt;Marwa Amer &amp; Alyaa Elhazmi&lt;/p&gt;&lt;/li&gt;&lt;li&gt;&lt;p&gt;Bufalini Hospital, AUSL Della Romagna, Cesena, Italy&lt;/p&gt;&lt;p&gt;Marta V. Antonini&lt;/p&gt;&lt;/li&gt;&lt;li&gt;&lt;p&gt;Department of Critical Care Medicine, Guy’s and St Thomas’ National Health Service Foundation Trust, London, UK&lt;/p&gt;&lt;p&gt;Nicholas Barrett&lt;/p&gt;&lt;/li&gt;&lt;li&gt;&lt;p&gt;2nd Department of Medicine, Cardiology and Angiologiy, General University Hospital and 1St School of Medicine, Charles University, Prague, Czech Republic&lt;/p&gt;&lt;p&gt;Jan Belohlavek &amp; Daniel Rob&lt;/p&gt;&lt;/li&gt;&lt;li&gt;&lt;p&gt;Division of Pulmonary, and Critical Care Medicine, Department of Medicine, The Johns Hopkins Univers","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":null,"pages":null},"PeriodicalIF":15.1,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142383839","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}
引用次数: 0
Phenotypes based on respiratory drive and effort to identify the risk factors when P0.1 fails to estimate ∆PES in ventilated children. 当 P0.1 无法估计通气儿童的 ∆PES 时,基于呼吸驱动力的表型和识别风险因素的努力。
IF 8.8 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-10-04 DOI: 10.1186/s13054-024-05103-x
Meryl Vedrenne-Cloquet, Y Ito, J Hotz, M J Klein, M Herrera, D Chang, A K Bhalla, C J L Newth, R G Khemani

Background: Monitoring respiratory effort and drive during mechanical ventilation is needed to deliver lung and diaphragm protection. Esophageal pressure (∆PES) is the gold standard measure of respiratory effort but is not routinely available. Airway occlusion pressure in the first 100 ms of the breath (P0.1) is a readily available surrogate for both respiratory effort and drive but is only modestly correlated with ∆PES in children. We sought to identify risk factors for P0.1 over or underestimating ∆PES in ventilated children.

Methods: Secondary analysis of physiological data from children and young adults enrolled in a randomized controlled trial testing lung and diaphragm protective ventilation in pediatric acute respiratory distress syndrome (PARDS) (NCT03266016). ∆PES (∆PES-REAL), P0.1 and predicted ∆PES (∆PES-PRED = 5.91*P0.1) were measured daily to identify phenotypes based upon the level of respiratory effort and drive: one passive (no spontaneous breathing), three where ∆PES-REAL and ∆PES-PRED were aligned (low, normal, and high effort and drive), two where ∆PES-REAL and ∆PES-PRED were mismatched (high underestimated effort, and overestimated effort). Logistic regression models were used to identify factors associated with each mismatch phenotype (High underestimated effort, or overestimated effort) as compared to all other spontaneous breathing phenotypes.

Results: We analyzed 953 patient days (222 patients). ∆PES-REAL and ∆PES-PRED were aligned in 536 (77%) of the active patient days. High underestimated effort (n = 119 (12%)) was associated with higher airway resistance (adjusted OR 5.62 (95%CI 2.58, 12.26) per log unit increase, p < 0.001), higher tidal volume (adjusted OR 1.53 (95%CI 1.04, 2.24) per cubic unit increase, p = 0.03), higher opioid use (adjusted OR 2.4 (95%CI 1.12, 5.13, p = 0.024), and lower set ventilator rate (adjusted OR 0.96 (95%CI 0.93, 0.99), p = 0.005). Overestimated effort was rare (n = 37 (4%)) and associated with higher alveolar dead space (adjusted OR 1.05 (95%CI 1.01, 1.09), p = 0.007) and lower respiratory resistance (adjusted OR 0.32 (95%CI 0.13, 0.81), p = 0.017).

Conclusions: In patients with PARDS, P0.1 commonly underestimated high respiratory effort particularly with high airway resistance, high tidal volume, and high doses of opioids. Future studies are needed to investigate the impact of measures of respiratory effort, drive, and the presence of a mismatch phenotype on clinical outcome.

Trial registration: NCT03266016; August 23, 2017.

背景:需要在机械通气过程中监测呼吸强度和驱动力,以提供肺和膈肌保护。食管压力(∆PES)是衡量呼吸强度的黄金标准,但并非常规可用。呼吸前 100 毫秒的气道闭塞压(P0.1)是呼吸强度和驱动力的现成替代指标,但在儿童中与ΔPES 的相关性不大。我们试图找出通气儿童 P0.1 高估或低估 ∆PES 的风险因素:对参加小儿急性呼吸窘迫综合征(PARDS)肺和膈肌保护性通气随机对照试验(NCT03266016)的儿童和年轻成人的生理数据进行二次分析。∆每天测量ΔPES(ΔPES-REAL)、P0.1 和预测ΔPES(ΔPES-PRED = 5.91*P0.1)进行每日测量,根据呼吸努力和驱动力水平确定表型:一种是被动型(无自主呼吸),三种是 ∆PES-REAL 和 ∆PES-PRED 一致型(低、正常和高努力和驱动力),两种是 ∆PES-REAL 和 ∆PES-PRED 不匹配型(高度低估努力和高估努力)。与所有其他自主呼吸表型相比,我们使用逻辑回归模型确定了与每种不匹配表型(高水平低估用力或高估用力)相关的因素:我们对 953 个患者日(222 名患者)进行了分析。∆在 536 个(77%)活跃患者日中,ΔPES-REAL 和 ΔPES-PRED是一致的。高度低估的努力(n = 119 (12%))与较高的气道阻力相关(调整后 OR 为 5.62 (95%CI 2.58, 12.26) 每对数单位的增加,p 结论:在 PARDS 患者中,P0.1 通常低估了高呼吸强度,尤其是在高气道阻力、高潮气量和大剂量阿片类药物的情况下。未来的研究需要调查呼吸强度、驱动力和错配表型的存在对临床结果的影响:NCT03266016;2017年8月23日。
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引用次数: 0
A narrative review on antimicrobial dosing in adult critically ill patients on extracorporeal membrane oxygenation. 关于使用体外膜氧合的成年重症患者抗菌药物剂量的叙述性综述。
IF 8.8 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-10-04 DOI: 10.1186/s13054-024-05101-z
Myeongji Kim, Maryam Mahmood, Lynn L Estes, John W Wilson, Nathaniel J Martin, Joseph E Marcus, Ankit Mittal, Casey R O'Connell, Aditya Shah

The optimal dosing strategy of antimicrobial agents in critically ill patients receiving extracorporeal membrane oxygenation (ECMO) is unknown. We conducted comprehensive review of existing literature on effect of ECMO on pharmacokinetics and pharmacodynamics of antimicrobials, including antibacterials, antifungals, and antivirals that are commonly used in critically ill patients. We aim to provide practical guidance to clinicians on empiric dosing strategy for these patients. Finally, we discuss importance of therapeutic drug monitoring, limitations of current literature, and future research directions.

在接受体外膜氧合(ECMO)的重症患者中,抗菌药物的最佳剂量策略尚不清楚。我们就 ECMO 对抗菌药物(包括重症患者常用的抗菌药、抗真菌药和抗病毒药)的药代动力学和药效学的影响对现有文献进行了全面回顾。我们旨在为临床医生提供有关这些患者经验性用药策略的实用指导。最后,我们将讨论治疗药物监测的重要性、现有文献的局限性以及未来的研究方向。
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引用次数: 0
Polymyxin-containing regimens for treating of pneumonia caused by multidrug-resistant gram-negative bacteria: Mind the breakpoints and the standardization of nebulization therapy 治疗耐多药革兰氏阴性菌引起的肺炎的含多粘菌素方案:注意断点和雾化治疗的标准化
IF 15.1 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-10-04 DOI: 10.1186/s13054-024-05111-x
Lihui Wang, Chunhui Xu, Lining Si, Guifen Gan, Bin Lin, Yuetian Yu
<p>With great interest we read the recent network meta-analysis by Zhou et al. which found that the intravenous plus inhaled polymyxin-containing regimen could reduce the all-cause mortality of patients with pneumonia caused by multidrug-resistant gram-negative bacterial (MDRGNB) [1]. This is undoubtedly an encouraging result and provides evidence for the subsequent clinical implementation of such regimens. However, there are still some issues that need further attention.</p><p>Pneumonia caused by MDRGNB remains a huge challenge in the intensive care unit (ICU). Currently, the available effective antibiotics are limited, and polymyxins are still the cornerstones for treatment. However, with the introduction of new antibiotics into clinical practice (especially new beta-lactam and beta-lactamase inhibitor combination) and the potential renal toxicity of polymyxins, since 2020, the performance standards for antimicrobial susceptibility testing of the Clinical and Laboratory Standards Institute (CLSI) have canceled the susceptibility breakpoints of polymyxins for <i>Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter baumannii</i>. It defines a minimal inhibitory concentration (MIC) of ≤ 2 ug/mL as intermediate (https://clsi.org). At present, the newly available antibiotics for the treatment of MDRGNB pneumonia in China is limited. Therefore, Chinese Medical Association (CMA) still define MIC ≤ 2 ug/mL as susceptible according to the previous versions of CLSI before 2020 or the 10th version of European Committee on Antimicrobial Susceptibility Testing (EUCAST), to guide clinical treatment. The international approved and recognized method for susceptibility testing of polymyxins is broth microdilution (BMD), but its manual operation is complex and time-consuming, making it difficult for laboratories to routinely carry out. Thus, most laboratories still use automated or semi-automated instruments nowadays to detect the susceptibility, and the accuracy of the results still needs further evaluation.</p><p>In addition, the clinical pharmacokinetic/pharmacodynamic (PK/PD) target of polymyxins for efficacy is unclear [2]. Some guidelines recommended that for polymyxin B the AUC<sub>ss,24h</sub> should be about 50 mg h/L and possibly 50–100 mg h/L, with the latter corresponding to an average steady-state concentration across 24 h (C<sub>ss,avg</sub>) of 2–4 ug/mL for pathogens with MIC of ≤ 2 ug/mL [3]. Therefore, careful interpretation is needed for the susceptible judgment of polymyxins, the optimal PK/PD index, and the effectiveness of antibiotic therapy.</p><p>The presence of the blood-alveolar barrier prevents satisfactory concentrations of antibiotics in the epithelial lining fluid (ELF) when antibiotics are administered intravenously, and increasing the dosage of intravenous administration may lead to high rate of side effects such as acute kidney injury. Nebulization therapy can convert liquid antibiotic preparations into particles of 3–5 
我们饶有兴趣地阅读了 Zhou 等人最近进行的网络荟萃分析,结果发现静脉注射加吸入含多粘菌素的治疗方案可降低耐多药革兰氏阴性菌(MDRGNB)引起的肺炎患者的全因死亡率[1]。这无疑是一个令人鼓舞的结果,并为随后在临床上实施此类治疗方案提供了证据。然而,仍有一些问题需要进一步关注。由 MDRGNB 引起的肺炎仍是重症监护室(ICU)面临的巨大挑战。目前,可用的有效抗生素有限,多粘菌素仍是治疗的基石。然而,随着新型抗生素(尤其是新型β-内酰胺与β-内酰胺酶抑制剂复方制剂)被引入临床实践,以及多粘菌素潜在的肾毒性,自 2020 年起,美国临床与实验室标准协会(CLSI)的抗菌药物药敏试验性能标准取消了多粘菌素对肠杆菌科、铜绿假单胞菌和鲍曼不动杆菌的药敏断点。它将最小抑菌浓度(MIC)≤ 2 ug/mL 定义为中间值(https://clsi.org)。目前,中国用于治疗 MDRGNB 肺炎的新抗生素有限。因此,中华医学会(CMA)仍根据2020年前CLSI的旧版本或欧洲抗菌药物敏感性检测委员会(EUCAST)的第10版将MIC≤2 ug/mL定义为易感,以指导临床治疗。国际上批准和认可的多粘菌素药敏试验方法是肉汤微量稀释法(BMD),但其手工操作复杂耗时,实验室难以常规开展。因此,目前大多数实验室仍使用自动化或半自动化仪器检测药敏性,其结果的准确性仍需进一步评估。此外,多粘菌素的临床药代动力学/药效学(PK/PD)疗效目标尚不明确[2]。一些指南建议,多粘菌素 B 的 AUCss,24h 应为约 50 毫克/小时/升,也可能为 50-100 毫克/小时/升,对于 MIC ≤ 2 微克/毫升的病原体,后者相当于 24 小时内的平均稳态浓度(Css,avg)为 2-4 微克/毫升[3]。由于血肺泡屏障的存在,静脉注射抗生素时上皮内衬液(ELF)中的抗生素浓度无法达到令人满意的水平,而增加静脉注射的剂量可能会导致急性肾损伤等副作用的高发。雾化疗法可将液体抗生素制剂转化为 3-5 微米的颗粒,使其沉积在肺泡中,从而有效提高感染部位的浓度,改善临床疗效。由于患者纳入标准、可乐定剂量和雾化程序存在显著差异,每项结果的证据质量从 "非常低 "到 "低 "不等。研究表明,静脉注射联合雾化吸入可乐定可提高呼吸机相关性肺炎(VAP)患者的临床反应和微生物根除率,同时降低感染相关死亡率。然而,这并不影响总死亡率(几率比,0.74;95% CI 0.54-1.01;P = 0.06;I2 = 25%)[4]。另一项荟萃分析纳入了 11 项随机对照试验(RCT),比较了雾化联合静脉注射抗生素(可乐定、阿米卡星和妥布霉素)治疗 VAP 的安全性和有效性。研究还发现,联合治疗策略并未降低死亡率(相对风险为 1.00;95% CI 为 0.82-1.21;I2 = 45%)[5]。经过近 40 年的发展,该疗法的疗效已显著提高[6]。一项为期两周的横断面研究分析了在重症监护室接受机械通气的 2808 名患者的雾化治疗过程。研究发现,77% 的医生在雾化治疗过程中没有调整机械通气参数,只有 65% 的雾化过程包括在呼气末添加过滤器,28% 的医生没有更换过滤器[7]。中国的另一项基于问卷的横断面调查招募了 2203 名经常在重症监护室工作的医务人员。调查显示,32.7% 的受访者在雾化过程中从未改变过呼吸机的设置。
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引用次数: 0
What criteria for neuropronostication: consciousness or ability? The neuro-intensivist’s dilemma 神经错乱的标准是什么:意识还是能力?神经元学家的两难选择
IF 15.1 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-10-03 DOI: 10.1186/s13054-024-05098-5
Nicolas Engrand, Armelle Nicolas-Robin, Pierre Trouiller, Stéphane Welschbillig
<p>Rohaut et al. published the results of a remarkable 12-year evolutionary project, showing a positive association between substantial improvement in consciousness 1 month after brain injury and a favorable outcome (Glasgow Outcome Scale-Extended [GOS-E] score ≥ 4) 1 year later, with an odds ratio of 14.6 [1]. This is a major new finding on neuropronostication, a fundamental issue in neurocritical care.</p><p>The multimodal assessment (MMA) based on seven objective criteria, combined with a critical reading by a panel of experts (the “DoC team”) comprising neuro-intensivists, neurologists, neurophysiologists, neuroradiologists and neuroscientists, allowed for predicting GOS-E score 1–3 at 1 year with 100% accuracy in the group with predicted poor prognosis. Assuming that the aim of the MMA is to give a chance for neurological recovery to every patient with a capacity for recovery, these results are highly effective. This also means that at 1 month after brain injury, when the MMA and DoC team predicted a poor 1-year prognosis, they were right. So, the first important lesson for neuro-intensivists is that they can withhold or even withdraw life-sustaining therapies according to this result, without compromising a significant chance of neurological recovery, sparing the patient 1 year of invasive care and rehabilitation.</p><p>However, only 39% of the group with predicted good prognosis achieved a GOS-E score ≥ 4 (excluding withdrawal of life-sustaining therapies and unknown decisions). Similarly, only 24% of patients in the group with an uncertain prognosis achieved this good result. Therefore, the MMA’s prediction of an uncertain or favorable outcome exposed the patient to the risk of continuing treatment inappropriately, thus leading to a large number of disabilities and dependencies. In other words, there were very few early “good-prognosis patients,” and even after the MMA, 83% of the 277 patients had a GOS-E score < 4. So, although increasing the number of modalities improved accuracy, the MMA still remained not able to reliably detect long-term ability.</p><p>These results raise the question of the goal of neurocritical care.</p><p>Although it is known that all patients ultimately recover wakefulness after severe brain injury [2] and many even recover substantial consciousness [3], some will never regain the ability to interact with their environment. These latter conditions, classified as unresponsive wakefulness syndrome or vegetative state without consciousness, are widely considered failure of care. However, what about a conscious but highly dependent patient with modified Rankin Scale (mRS) score 4 or 5 or GOS-E score 4 or 3? In neurovascular studies, an mRS score of 4 (often even 3) is considered failure. For example, this score is considered an outcome to be avoided in decompressive craniectomy studies [4] (with the exception of the recent Switch study [5]) but considered a success in studies of consciousness recovery [6].</p><p>A
Rohaut 等人发表了一项历时 12 年的杰出进化项目的结果,显示脑损伤后 1 个月意识的实质性改善与 1 年后的良好预后(格拉斯哥预后量表扩展版 [GOS-E] 评分≥ 4 分)之间存在正相关,几率比为 14.6 [1]。基于七项客观标准的多模式评估(MMA),结合由神经重症监护专家、神经学家、神经生理学家、神经放射学家和神经科学家组成的专家小组("DoC 团队")的批判性解读,可以预测预后不良组 1 年后 GOS-E 评分 1-3 的准确率为 100%。假定 MMA 的目的是为每一位有康复能力的患者提供神经康复的机会,那么这些结果就是非常有效的。这也意味着,在脑损伤后 1 个月,MMA 和 DoC 团队预测 1 年预后不佳时,他们是正确的。因此,对于神经重症医生来说,第一个重要的教训就是,他们可以根据这一结果暂停甚至撤消维持生命的疗法,而不影响神经功能恢复的重要机会,使患者免于1年的侵入性护理和康复。然而,在预测预后良好的组别中,只有39%的患者达到了GOS-E评分≥4分(不包括撤消维持生命疗法和未知决定)。同样,预后不确定组中也只有 24% 的患者达到了这一良好结果。因此,MMA 对预后不确定或良好结果的预测使患者面临继续治疗不当的风险,从而导致大量残疾和依赖。换句话说,早期 "预后良好的患者 "非常少,即使在 MMA 之后,277 名患者中仍有 83% 的 GOS-E 评分为 4 分。这些结果提出了神经重症护理的目标问题。虽然众所周知,所有患者在严重脑损伤后最终都会恢复清醒[2],许多患者甚至会恢复实质性意识[3],但有些患者却永远无法恢复与环境互动的能力。后一种情况被归类为无反应清醒综合征或无意识植物状态,被广泛认为是护理失败。然而,对于意识清醒但高度依赖的患者,如果改良 Rankin 量表(mRS)评分为 4 分或 5 分,或 GOS-E 评分为 4 分或 3 分,又该如何处理呢?在神经血管研究中,mRS 评分 4 分(通常甚至是 3 分)即被视为治疗失败。例如,在颅骨减压切除术的研究中,这一评分被认为是应该避免的结果[4](最近的 Switch 研究除外[5]),但在意识恢复的研究中,这一评分被认为是成功的结果[6]。然而,即使是 mRS 评分为 5 分和患有锁闭综合征的患者,其长期满意度研究结果仍然相当乐观[8, 9]。因此,神经精神科医生的治疗目标有时与他们的神经科医生和神经外科医生的治疗目标相左,神经科医生和神经外科医生要求患者的 mRS 评分≤ 2 或 3 分,而意识专家则建议患者一旦有一丝接触的希望,就应继续治疗,同时患者的 QoL 似乎是可以接受的,或者在任何情况下都是大多数患者可以接受的。然而,MMA 过程中包含的所有临床和准临床检查(DTI-MRI 除外)都侧重于患者当前的意识状态,这难道不是有助于大量高度依赖性患者的产生吗?为了更好地针对远程 GOS-E 或 mRS 评分进行治疗,难道不应该在多学科评估小组中加入康复科医生以及老年病科医生吗?虽然从历史上看,重症监护的预后研究首先关注的是存活率,然后是预期残疾率,但现在他们可以关注质量调整生命年(包括生活质量和数量),甚至是有意识但残疾患者的满意度,尽管这更难量化[8, 10],尤其是因为失语或严重认知障碍患者的认知障碍。进一步的进展应包括更好地预测 GOS-E 或 mRS 评分,并将这一预后与患者的预嘱进行比较,同时牢记预嘱本身具有严重的局限性,尤其是在急性脑损伤的情况下[11]。
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引用次数: 0
Consensus statements for the establishment of medical intensive care in low-resource settings: international study using modified Delphi methodology. 在低资源环境中建立医疗重症监护的共识声明:使用改良德尔菲方法进行的国际研究。
IF 8.8 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-10-03 DOI: 10.1186/s13054-024-05113-9
Pedja Kovacevic, Jadranka Vidovic, Boris Tomic, Jihad Mallat, Ali Ait Hssain, Muyiwa Rotimi, Owoniya Temitope Akindele, Kent Doi, Rajesh Mishra, F Joachim Meyer, Ivan Palibrk, Ranko Skrbic, Enrique Boloña, Oguz Kilickaya, Ognjen Gajic

Background: The inadequacy of intensive care medicine in low-resource settings (LRS) has become significantly more visible after the COVID-19 pandemic. Recommendations for establishing medical critical care are scarce and rarely include expert clinicians from LRS.

Methods: In December 2023, the National Association of Intensivists from Bosnia and Herzegovina organized a hybrid international conference on the topic of organizational structure of medical critical care in LRS. The conference proceedings and literature review informed expert statements across several domains. Following the conference, the statements were distributed via an online survey to conference participants and their wider professional network using a modified Delphi methodology. An agreement of ≥ 80% was required to reach a consensus on a statement.

Results: Out of the 48 invited clinicians, 43 agreed to participate. The study participants came from 20 countries and included clinician representatives from different base specialties and health authorities. After the two rounds, consensus was reached for 13 out of 16 statements across 3 domains: organizational structure, staffing, and education. The participants favored multispecialty medical intensive care units run by a medical team with formal intensive care training. Recognition and support by health care authorities was deemed critical and the panel underscored the important roles of professional organizations, clinician educators trained in high-income countries, and novel technologies such as tele-medicine and tele-education.

Conclusion: Delphi process identified a set of consensus-based statements on how to create a sustainable patient-centered medical intensive care in LRS.

背景:在 COVID-19 大流行之后,低资源环境(LRS)重症医学的不足变得更加明显。建立重症医学护理的建议很少,而且很少包括来自低资源环境的临床专家:方法:2023 年 12 月,波斯尼亚和黑塞哥维那全国重症医学专家协会组织了一次混合国际会议,主题是 LRS 重症医学护理的组织结构。会议记录和文献综述为多个领域的专家声明提供了依据。会后,采用改良的德尔菲方法,通过在线调查向与会者及其更广泛的专业网络分发了声明。结果:结果:在受邀的 48 名临床医生中,43 人同意参与。研究参与者来自 20 个国家,包括来自不同基础专科和卫生部门的临床医生代表。经过两轮讨论,在组织结构、人员配备和教育 3 个领域的 16 项声明中,有 13 项达成了共识。与会者倾向于由受过正规重症监护培训的医疗团队管理的多专科医疗重症监护病房。医疗机构的认可和支持被认为至关重要,小组强调了专业组织、在高收入国家接受过培训的临床教育工作者以及远程医疗和远程教育等新技术的重要作用:德尔菲进程确定了一套基于共识的声明,内容涉及如何在长者健康服务中创建以患者为中心的可持续医疗重症监护。
{"title":"Consensus statements for the establishment of medical intensive care in low-resource settings: international study using modified Delphi methodology.","authors":"Pedja Kovacevic, Jadranka Vidovic, Boris Tomic, Jihad Mallat, Ali Ait Hssain, Muyiwa Rotimi, Owoniya Temitope Akindele, Kent Doi, Rajesh Mishra, F Joachim Meyer, Ivan Palibrk, Ranko Skrbic, Enrique Boloña, Oguz Kilickaya, Ognjen Gajic","doi":"10.1186/s13054-024-05113-9","DOIUrl":"10.1186/s13054-024-05113-9","url":null,"abstract":"<p><strong>Background: </strong>The inadequacy of intensive care medicine in low-resource settings (LRS) has become significantly more visible after the COVID-19 pandemic. Recommendations for establishing medical critical care are scarce and rarely include expert clinicians from LRS.</p><p><strong>Methods: </strong>In December 2023, the National Association of Intensivists from Bosnia and Herzegovina organized a hybrid international conference on the topic of organizational structure of medical critical care in LRS. The conference proceedings and literature review informed expert statements across several domains. Following the conference, the statements were distributed via an online survey to conference participants and their wider professional network using a modified Delphi methodology. An agreement of ≥ 80% was required to reach a consensus on a statement.</p><p><strong>Results: </strong>Out of the 48 invited clinicians, 43 agreed to participate. The study participants came from 20 countries and included clinician representatives from different base specialties and health authorities. After the two rounds, consensus was reached for 13 out of 16 statements across 3 domains: organizational structure, staffing, and education. The participants favored multispecialty medical intensive care units run by a medical team with formal intensive care training. Recognition and support by health care authorities was deemed critical and the panel underscored the important roles of professional organizations, clinician educators trained in high-income countries, and novel technologies such as tele-medicine and tele-education.</p><p><strong>Conclusion: </strong>Delphi process identified a set of consensus-based statements on how to create a sustainable patient-centered medical intensive care in LRS.</p>","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":null,"pages":null},"PeriodicalIF":8.8,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11451122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Derivation and validation of generalized sepsis-induced acute respiratory failure phenotypes among critically ill patients: a retrospective study. 重症患者中由败血症诱发的急性呼吸衰竭表型的推导和验证:一项回顾性研究。
IF 8.8 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-10-01 DOI: 10.1186/s13054-024-05061-4
Tilendra Choudhary, Pulakesh Upadhyaya, Carolyn M Davis, Philip Yang, Simon Tallowin, Felipe A Lisboa, Seth A Schobel, Craig M Coopersmith, Eric A Elster, Timothy G Buchman, Christopher J Dente, Rishikesan Kamaleswaran

Background: Septic patients who develop acute respiratory failure (ARF) requiring mechanical ventilation represent a heterogenous subgroup of critically ill patients with widely variable clinical characteristics. Identifying distinct phenotypes of these patients may reveal insights about the broader heterogeneity in the clinical course of sepsis, considering multi-organ dynamics. We aimed to derive novel phenotypes of sepsis-induced ARF using observational clinical data and investigate the generalizability of the derived phenotypes.

Methods: We performed a multi-center retrospective study of ICU patients with sepsis who required mechanical ventilation for ≥ 24 h. Data from two different high-volume academic hospital centers were used, where all phenotypes were derived in MICU of Hospital-I (N = 3225). The derived phenotypes were validated in MICU of Hospital-II (N = 848), SICU of Hospital-I (N = 1112), and SICU of Hospital-II (N = 465). Clinical data from 24 h preceding intubation was used to derive distinct phenotypes using an explainable machine learning-based clustering model interpreted by clinical experts.

Results: Four distinct ARF phenotypes were identified: A (severe multi-organ dysfunction (MOD) with a high likelihood of kidney injury and heart failure), B (severe hypoxemic respiratory failure [median P/F = 123]), C (mild hypoxia [median P/F = 240]), and D (severe MOD with a high likelihood of hepatic injury, coagulopathy, and lactic acidosis). Patients in each phenotype showed differences in clinical course and mortality rates despite similarities in demographics and admission co-morbidities. The phenotypes were reproduced in external validation utilizing the MICU of Hospital-II and SICUs from Hospital-I and -II. Kaplan-Meier analysis showed significant difference in 28-day mortality across the phenotypes (p < 0.01) and consistent across MICU and SICU of both Hospital-I and -II. The phenotypes demonstrated differences in treatment effects associated with high positive end-expiratory pressure (PEEP) strategy.

Conclusion: The phenotypes demonstrated unique patterns of organ injury and differences in clinical outcomes, which may help inform future research and clinical trial design for tailored management strategies.

背景:出现需要机械通气的急性呼吸衰竭(ARF)的败血症患者是重症患者中的一个异质性亚群,其临床特征千差万别。考虑到多器官的动态变化,识别这些患者的不同表型可能会揭示脓毒症临床过程中更广泛的异质性。我们的目的是利用临床观察数据得出脓毒症诱发 ARF 的新表型,并研究得出的表型的可推广性:我们对需要机械通气≥24小时的ICU脓毒症患者进行了一项多中心回顾性研究,数据来自两个不同的高容量学术医院中心,其中所有表型均来自医院I的MICU(N = 3225)。得出的表型在第二医院的 MICU(848 人)、第一医院的 SICU(1112 人)和第二医院的 SICU(465 人)中进行了验证。插管前 24 小时的临床数据被用来通过临床专家解释的基于机器学习的可解释聚类模型得出不同的表型:结果:确定了四种不同的 ARF 表型:A(严重多器官功能障碍(MOD),极有可能出现肾损伤和心力衰竭)、B(严重缺氧性呼吸衰竭[中位 P/F = 123])、C(轻度缺氧[中位 P/F = 240])和 D(严重 MOD,极有可能出现肝损伤、凝血病和乳酸酸中毒)。尽管人口统计学和入院并发症相似,但每种表型的患者在临床病程和死亡率上都存在差异。在外部验证中,利用第二医院的 MICU 以及第一和第二医院的 SICU 对表型进行了重现。Kaplan-Meier 分析表明,不同表型的患者 28 天死亡率存在显著差异(p 结论:表型显示了独特的器官功能模式:表型显示了器官损伤的独特模式和临床结果的差异,这可能有助于为未来的研究和临床试验设计提供信息,以制定量身定制的管理策略。
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引用次数: 0
Comparison of mechanical versus manual cardiopulmonary resuscitation in cardiac arrest 心脏骤停时机械与人工心肺复苏术的比较
IF 15.1 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-09-27 DOI: 10.1186/s13054-024-05088-7
Yang Zhao, Da Chen, Qian Wang
<p>To the editor</p><p>We read with great interest the article by El-Menyar et al., titled “Mechanical versus manual cardiopulmonary resuscitation (CPR): an umbrella review of contemporary systematic reviews and more”, recently published in <i>Critical Care</i> [1]. The findings from the umbrella review and the new systematic review in this study suggest that mechanical CPR is not superior to manual CPR in achieving return of spontaneous circulation (ROSC).</p><p>Although this article offers valuable insights, several issues warrant further discussion and clarification. In Fig. 2’s Forest plot for ROSC from El-Menyar et al.’s article, we observed some issues with the study selection. The umbrella meta-analysis included duplicated studies [2, 3] and studies with no ROSC-related data upon our detailed review [4, 5]. Additionally, the inclusion of just the abstracts from three studies [6, 7, 8] could potentially limit the robustness of the findings. Moreover, when replicating the authors’ search strategy, we identified a missing randomized controlled trial (RCT) comparing mechanical and manual CPR in in-hospital cardiac arrest (IHCA) settings [9].</p><p>We consolidated studies from the umbrella review and the new systematic review, excluding improperly included studies and adding the newly identified RCT. Using Stata Version 16.0 (StataCorp, College Station, TX), we conducted subgroup analyses for out-of-hospital cardiac arrest (OHCA) and IHCA patients across RCTs and non-RCTs. For OHCA patients, mechanical CPR did not improve ROSC rates in either study type. However, the IHCA outcomes varied by study type: RCTs showed a higher probability of ROSC with mechanical CPR, whereas non-RCTs indicated a reduced likelihood of achieving ROSC (Figs. 1 and 2)</p><figure><figcaption><b data-test="figure-caption-text">Fig. 1</b></figcaption><picture><source srcset="//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-024-05088-7/MediaObjects/13054_2024_5088_Fig1_HTML.png?as=webp" type="image/webp"/><img alt="figure 1" aria-describedby="Fig1" height="631" loading="lazy" src="//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-024-05088-7/MediaObjects/13054_2024_5088_Fig1_HTML.png" width="685"/></picture><p>Forest plot of ROSC in mechanical CPR versus manual CPR in RCTs. ROSC, return of spontaneous circulation; CPR, cardiopulmonary resuscitation; OHCA, out-of-hospital cardiac arrest; IHCA, in-hospital cardiac arrest; RCT, randomized controlled trial; CI, confidence interval</p><span>Full size image</span><svg aria-hidden="true" focusable="false" height="16" role="img" width="16"><use xlink:href="#icon-eds-i-chevron-right-small" xmlns:xlink="http://www.w3.org/1999/xlink"></use></svg></figure><figure><figcaption><b data-test="figure-caption-text">Fig. 2</b></figcaption><picture><source srcset="//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-024-05088-7/MediaObjects/13054_2024_5088_Fig2_
致编辑我们饶有兴趣地阅读了 El-Menyar 等人最近发表在《重症监护》(Critical Care)[1]上的题为 "机械心肺复苏(CPR)与徒手心肺复苏(CPR):当代系统综述及其他"(Mechanical versus manual cardiopulmonary resuscitation (CPR): an umbrella review of contemporary systematic reviews and more)的文章。虽然这篇文章提供了有价值的见解,但有几个问题值得进一步讨论和澄清。在图 2 El-Menyar 等人文章中的 ROSC 森林图中,我们发现研究选择存在一些问题。总括荟萃分析包括了重复的研究[2, 3],以及经我们详细审查后没有 ROSC 相关数据的研究[4, 5]。此外,仅纳入三项研究[6、7、8]的摘要可能会限制研究结果的稳健性。此外,在复制作者的搜索策略时,我们发现了一项缺失的随机对照试验(RCT),该试验比较了院内心脏骤停(IHCA)情况下机械心肺复苏术和人工心肺复苏术[9]。我们使用 Stata 16.0 版(StataCorp,College Station,Texas)对院外心脏骤停(OHCA)和 IHCA 患者的 RCT 和非 RCT 进行了分组分析。对于院外心脏骤停患者,在两种研究类型中,机械心肺复苏都没有提高ROSC率。但是,IHCA 的结果因研究类型而异:研究表明,机械心肺复苏的 ROSC 概率较高,而非研究表明,达到 ROSC 的概率较低(图 1 和图 2)。ROSC,自主循环恢复;CPR,心肺复苏;OHCA,院外心脏骤停;IHCA,院内心脏骤停;RCT,随机对照试验;CI,置信区间全尺寸图片图 2非 RCT 中机械心肺复苏与徒手心肺复苏的 ROSC 树状图。ROSC:自发性循环恢复;CPR:心肺复苏;OHCA:院外心脏骤停;IHCA:院内心脏骤停;RCT:随机对照试验;CI:置信区间全尺寸图片。虽然我们的分析支持 El-Menyar 等人的荟萃分析中强调的机械心肺复苏并不能提高 OHCA 情况下的 ROSC 率这一结论,但 IHCA 的不同结果表明需要进一步研究。特别是,在 IHCA 情况下,RCT 与非 RCT 之间的差异意味着可能影响 CPR 结果的潜在差异。这些差异可能包括患者特征、响应时间和医院环境的不同。此外,研究设计中的局限性(如观察性研究中常见的选择偏差)也可能是影响因素之一。要确定机械心肺复苏术与徒手心肺复苏术在改善心脏骤停患者预后方面的有效性,还需要进一步开展大规模的 RCT 研究。机械心肺复苏(CPR)与徒手心肺复苏(CPR):当代系统性综述及更多综述。Crit Care.2024;28(1):259.Article PubMed PubMed Central Google Scholar Hock Ong ME、Fook-Chong S、Annathurai A、Ang SH、Tiah L、Yong KL、Koh ZX、Yap S、Sultana P. 在急诊科就诊的心脏骤停患者中使用自动负荷分配带胸外按压装置提高了神经功能完好者的存活率。Crit Care.2012;16(4):R144.Article PubMed PubMed Central Google Scholar Casner M, Andersen D, Isaacs SM.新型心肺复苏辅助装置对院外心脏骤停患者自主循环恢复率的影响》。Prehosp Emerg Care.2005; 9(1):61-7.Article PubMed Google Scholar Axelsson C, Herrera MJ, Fredriksson M, Lindqvist J, Herlitz J. 在急救医疗服务系统中对院外心脏骤停患者实施机械胸外按压。Am J Emerg Med.2013;31(8):1196-200.Article PubMed Google Scholar Jennings PA, Harriss L, Bernard S, Bray J, Walker T, Spelman T, Smith K, Cameron P. An automated CPR device compared with standard chest compressions for out-of-hospital resuscitation.BMC Emerg Med.2012; 12:8.Article PubMed PubMed Central Google Scholar Lairet JR, Lee M. A comparison of standard manual cardiopulmonary resuscitation versus the autopulse mechanical cardiopulmonary resuscitation device.Ann Emerg Med.2005; 46(3).Paradis NAKD, Ghilarducci D, Palazzolo J. 加利福尼亚自动脉冲注册指导委员会。加利福尼亚自动脉冲质量保证注册。循环。2009;120:S1457.Google Scholar Morozov SNAS, Fedorov AY.
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引用次数: 0
Exploring the effectiveness of eHealth interventions in treating Post Intensive Care Syndrome (PICS) outcomes: a systematic review 探索电子保健干预措施在治疗重症监护后综合征(PICS)结果方面的有效性:系统性综述
IF 15.1 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-09-27 DOI: 10.1186/s13054-024-05089-6
Daniel Jie Lai, Zhao Liu, Elaine Johnston, Lisa Dikomitis, Teresa D’Oliveira, Sukhi Shergill
It remains unclear how to optimise critical care rehabilitation to reduce the constellation of long-term physical, psychological and cognitive impairments known as Post Intensive Care Syndrome (PICS). Possible reasons for poor recovery include access to care and delayed treatment. eHealth could potentially aid in increasing access and providing consistent care remotely. Our review aimed to evaluate the effectiveness of eHealth interventions on PICS outcomes. Studies reporting eHealth interventions targeting Post Intensive Care Syndrome outcomes, published in Medline, CINAHL, PsycINFO, Embase, and Scopus from 30th January 2010 to 12th February 2024, were included in the review. Study eligibility was assessed by two reviewers with any disagreements discussed between them or resolved by a third reviewer. Study quality and risk of bias were assessed using the Mixed Method Appraisal Tool. Further to the identification of effective strategies, our review also aimed to clarify the timeline of recovery considered and the outcomes or domains targeted by the interventions. Thirteen studies were included in our review. Study duration, eHealth intervention delivery format, and outcome measures varied considerably. No studies reported a theory of behavioural change and only one study was co-produced with patients or carers. Most studies were conducted in the early post-discharge phase (i.e., < 3 months) and had feasibility as a primary outcome. The cognitive domain was the least targeted and no intervention targeted all three domains. Interventions targeting the psychological domain suggest generally positive effects. However, results were underpowered and preliminary. Though all studies were concluded to be feasible, most studies did not assess acceptability. In studies that did assess acceptability, the main facilitators of acceptability were usability and perceived usefulness, and the main barrier was sensitivity to mental health and cognitive issues. Our systematic review highlighted the promising contributions of eHealth with preliminary support for the feasibility of interventions in the early stages of post-critical care rehabilitation. Future research should focus on demonstrating effectiveness, acceptability, the cognitive domain, and multi-component interventions.
目前仍不清楚如何优化重症监护康复,以减少被称为 "重症监护后综合征"(PICS)的长期身体、心理和认知障碍。康复效果不佳的可能原因包括获得护理的机会和治疗延迟。我们的综述旨在评估电子医疗干预对 PICS 结果的有效性。综述纳入了 2010 年 1 月 30 日至 2024 年 2 月 12 日期间在 Medline、CINAHL、PsycINFO、Embase 和 Scopus 上发表的针对重症监护后综合症疗效的电子健康干预措施的研究报告。研究资格由两名审稿人进行评估,如有分歧,则由两人讨论,或由第三名审稿人解决。研究质量和偏倚风险采用混合方法评估工具进行评估。除确定有效策略外,我们的综述还旨在明确所考虑的康复时间表以及干预措施所针对的结果或领域。我们的综述共纳入了 13 项研究。研究的持续时间、电子健康干预的实施形式和结果衡量标准差异很大。没有研究报告了行为改变理论,只有一项研究是与患者或护理人员共同完成的。大多数研究都是在出院后的早期阶段(即小于 3 个月)进行的,并将可行性作为主要结果。针对认知领域的干预最少,也没有针对所有三个领域的干预。以心理领域为目标的干预措施普遍具有积极的效果。然而,这些结果都是初步性的。虽然所有研究都被认为是可行的,但大多数研究都没有评估可接受性。在评估了可接受性的研究中,可接受性的主要促进因素是可用性和感知有用性,主要障碍是对心理健康和认知问题的敏感性。我们的系统性综述强调了电子保健的巨大贡献,并初步支持在重症监护后康复的早期阶段采取干预措施的可行性。未来的研究应侧重于证明有效性、可接受性、认知领域和多成分干预措施。
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引用次数: 0
Relationship between SARS-CoV-2 infection and ICU-acquired candidemia in critically ill medical patients: a multicenter prospective cohort study 重症内科病人 SARS-CoV-2 感染与重症监护室获得性念珠菌血症之间的关系:一项多中心前瞻性队列研究
IF 15.1 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-09-27 DOI: 10.1186/s13054-024-05104-w
Florian Reizine, Nicolas Massart, Alexandre Mansour, Yannick Fedun, Anaïs Machut, Charles-Hervé Vacheron, Anne Savey, Arnaud Friggeri, Alain Lepape
While SARS-CoV2 infection has been shown to be a significant risk-factor for several secondary bacterial, viral and Aspergillus infections, its impact on intensive care unit (ICU)-acquired candidemia (ICAC) remains poorly explored. Using the REA-REZO network (French surveillance network of ICU-acquired infections), we included all adult patients hospitalized for a medical reason of admission in participating ICUs for at least 48 h from January 2020 to January 2023. To account for confounders, a non-parsimonious propensity score matching was performed. Rates of ICAC according to SARS-CoV2 status were compared in matched patients. Factors associated with ICAC in COVID-19 patients were also assessed using a Fine-Gray model. A total of 55,268 patients hospitalized at least 48 h for a medical reason in 101 ICUs were included along the study period. Of those, 13,472 were tested positive for a SARS-CoV2 infection while 284 patients developed an ICAC. ICAC rate was higher in COVID-19 patients in both the overall population and the matched patients’ cohort (0.8% (107/13,472) versus 0.4% (173/41,796); p < 0.001 and 0.8% (93/12,241) versus 0.5% (57/12,241); p = 0.004, respectively). ICAC incidence rate was also higher in those patients (incidence rate 0.51 per 1000 patients-days in COVID-19 patients versus 0.32 per 1000 patients-days; incidence rate ratio: 1.58 [95% CI:1.08–2.35]; p = 0.018). Finally, patients with ICAC had a higher ICU mortality rate (49.6% versus 20.2%; p < 0.001). In this large multicenter cohort of ICU patients, although remaining low, the rate of ICAC was higher among COVID-19 patients.
SARS-CoV2感染已被证明是多种继发性细菌、病毒和曲霉菌感染的重要风险因素,但其对重症监护病房(ICU)获得性念珠菌血症(ICAC)的影响仍未得到充分探讨。我们利用 REA-REZO 网络(法国重症监护病房获得性感染监测网络),纳入了 2020 年 1 月至 2023 年 1 月期间因医疗原因在参与网络的重症监护病房住院至少 48 小时的所有成人患者。为了考虑混杂因素,我们进行了非拟合倾向评分匹配。根据 SARS-CoV2 状态比较了匹配患者的 ICAC 发生率。还使用 Fine-Gray 模型评估了与 COVID-19 患者 ICAC 相关的因素。在研究期间,共有 55268 名患者因医疗原因在 101 个重症监护病房住院至少 48 小时。其中,13,472 名患者的 SARS-CoV2 感染检测呈阳性,284 名患者出现了 ICAC。在总体人群和匹配患者队列中,COVID-19 患者的 ICAC 发生率较高(分别为 0.8%(107/13,472)对 0.4%(173/41,796);p < 0.001 和 0.8%(93/12,241)对 0.5%(57/12,241);p = 0.004)。这些患者的 ICAC 发病率也更高(COVID-19 患者的发病率为每 1000 个患者日 0.51 例,而 COVID-19 患者的发病率为每 1000 个患者日 0.32 例;发病率比:1.58 [95% CI:1.08-2.35]; p = 0.018)。最后,ICAC 患者的 ICU 死亡率更高(49.6% 对 20.2%;P < 0.001)。在这一大型多中心 ICU 患者队列中,COVID-19 患者的 ICAC 发生率虽然仍然较低,但却较高。
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