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Utilization and outcomes of extracorporeal membrane oxygenation in patients with cirrhosis 肝硬化患者使用体外膜肺氧合的情况和结果
IF 38.9 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-10-29 DOI: 10.1007/s00134-024-07689-w
Spencer R. Goble, Yasmin O. Ali, Thomas M. Leventhal
No Abstract
无摘要
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引用次数: 0
Implementation of a novel retrograde implantation technique for distal limb perfusion during extracorporeal cardiopulmonary resuscitation 在体外心肺复苏过程中采用新型逆行植入技术进行肢体远端灌注
IF 38.9 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-10-28 DOI: 10.1007/s00134-024-07686-z
Yalin Yildirim, Stefan Kluge, Hermann Reichenspurner, Alexander M. Bernhardt, Simon Pecha
Dear Editor,
亲爱的编辑
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引用次数: 0
Critical care admissions and outcomes in pregnant and postpartum women: a systematic review 孕妇和产后妇女接受重症监护的情况和结果:系统综述
IF 38.9 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-10-28 DOI: 10.1007/s00134-024-07682-3
Swagata Tripathy, Neha Singh, Aparajita Panda, Subhasish Nayak, Nivedita Jayanti Bodra, Suma Rabab Ahmad, Madhusmita Parida, Monalisa Sarkar, Soumya Sarkar

Purpose

To synthesise evidence for the incidence of intensive care unit (ICU) admission, characteristics and mortality of pregnant and postpartum women with a focus on differences between high-income countries (HICs) and low-middle-income countries (LMICs) and report changes in reported findings since the last review by Pollock et al. (2010).

Methods

We searched Ovid Medline, EMBASE, and CINAHL (2010–2023), following best practice guidelines for abstract screening for large-evidence systematic reviews. Patient and study characteristics of extracted studies were analysed descriptively. Multivariable meta-regression analysis, employing mixed-effects models, was conducted for assessing ICU admission and mortality. Studies reviewed by Pollock et al. were included to perform an overall analysis, including each study period and geographic region in a model.

Results

Seventy-one eligible studies reported data on 111,601 women admitted to ICU, with 41,291,168 deliveries reported in 65 studies. Fifty-six studies were retrospective. Case definitions, admission criteria, and causes of mortality reported were heterogeneous. The pooled ICU admission rate was 1.6% (95% confidence interval [CI] 1.28–1.99; I2 = 99.8%), 0.4% (95% CI 0.32–0.48, I2 = 99.9%) in HICs versus 2.8% (95% CI 0.65–6.4, I2 = 99.9%) in LMICs (p < 0.0001). The pooled ICU mortality rate among 140,780 admissions reported in 63 studies was 6.5% (95% CI 5.2–7.9; I2 = 98.7%), with mortality in HICs 1.4% (95% CI 0.8–2.1, I2 = 98.04%) lower than LMICs 12.4% (95% CI 8.1–17.5, I2 = 98.9%) (p < 0.0001). Multivariable meta-regression analysis found a significant association between the ICU admission rates (p = 0.0001) and mortality (p = 0.0003) with geographic region (HIC vs LMIC). Compared to the earlier study of Pollock et al. in 2010, there was an increase in reported studies (71 vs 40 in Pollock et al. study) and reported admissions (111,601 vs 7887 Pollock et al. study), particularly from LMICs’.

Conclusions

Mortality for critically ill peripartum women is substantial and the gap in reported ICU admissions and mortality for critically ill peripartum women between HIC and LMICs remains unacceptably high. The reports are often small and heterogeneous using many case definitions. Reporting standards focusing on critical care processes and outcomes and large multinational prospective studies are necessary to better understand and mitigate maternal and child health challenges as sustainable development goals in LMICs and HICs.

目的综述有关孕妇和产后妇女入住重症监护室 (ICU) 的发生率、特征和死亡率的证据,重点关注高收入国家 (HIC) 和中低收入国家 (LMIC) 之间的差异,并报告自 Pollock 等人(2010 年)上一次综述以来报告结果的变化。方法我们按照大型证据系统综述摘要筛选的最佳实践指南检索了 Ovid Medline、EMBASE 和 CINAHL(2010-2023 年)。我们对所提取研究的患者和研究特征进行了描述性分析。采用混合效应模型进行多变量元回归分析,以评估重症监护病房入院率和死亡率。结果71项符合条件的研究报告了111,601名入住ICU的产妇的数据,其中65项研究报告了41,291,168例分娩。其中 56 项研究为回顾性研究。所报告的病例定义、入院标准和死亡原因各不相同。综合 ICU 入院率为 1.6%(95% 置信区间 [CI] 1.28-1.99;I2 = 99.8%),高收入国家为 0.4%(95% CI 0.32-0.48,I2 = 99.9%),低收入国家为 2.8%(95% CI 0.65-6.4,I2 = 99.9%)(p < 0.0001)。在 63 项研究报告的 140,780 例住院患者中,汇总的 ICU 死亡率为 6.5%(95% CI 5.2-7.9;I2 = 98.7%),高收入国家的死亡率为 1.4%(95% CI 0.8-2.1,I2 = 98.04%),低于低收入国家的 12.4%(95% CI 8.1-17.5,I2 = 98.9%)(p <0.0001)。多变量元回归分析发现,ICU 入院率(p = 0.0001)和死亡率(p = 0.0003)与地理区域(高收入国家与低收入国家)之间存在显著关联。与 2010 年 Pollock 等人的早期研究相比,报告的研究(Pollock 等人的研究为 71 例对 40 例)和报告的入院人数(111601 对 7887 Pollock 等人的研究)都有所增加,尤其是来自低收入国家的研究。这些报告通常篇幅较小,使用的病例定义也不尽相同。为了更好地了解和减轻孕产妇和儿童健康方面的挑战,将其作为低收入和中等收入国家以及高收入国家的可持续发展目标,有必要制定侧重于危重症护理流程和结果的报告标准,并开展大型的多国前瞻性研究。
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引用次数: 0
The paracetamol challenge in intensive care: going green with paracetamol 重症监护中的扑热息痛挑战:绿色使用扑热息痛
IF 38.9 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-10-28 DOI: 10.1007/s00134-024-07679-y
Nicole Hunfeld, Dick Tibboel, Diederik Gommers
Paracetamol is one of the most widely prescribed medications in critically ill patients [1]. Our intensive care unit (ICU) administered 50.133 g of paracetamol in 2023 (16.230 intravenous [IV] doses, 33.825 oral doses and 78 rectal doses). Two reports from the Netherlands showed that medication accounts for 40% of the environmental CO2 footprint [2, 3]. Given this high percentage, interventions that decrease the administration of medications result in a direct decrease of the environmental footprint of healthcare.
扑热息痛是重症患者最常用的处方药之一[1]。我们重症监护室(ICU)在 2023 年共使用了 50.133 克扑热息痛(16.230 次静脉注射、33.825 次口服和 78 次直肠给药)。荷兰的两份报告显示,药物占二氧化碳环境足迹的 40%[2,3]。鉴于这一高比例,减少用药的干预措施可直接减少医疗环境足迹。
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引用次数: 0
Spontaneous breathing trials should be adapted for each patient according to the critical illness. A new individualised approach: the GLOBAL WEAN study 自主呼吸试验应根据危重病人的病情进行调整。新的个体化方法:GLOBAL WEAN 研究
IF 38.9 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-10-25 DOI: 10.1007/s00134-024-07657-4
Mathieu Capdevila, Yassir Aarab, Clement Monet, Audrey De Jong, Aurelie Vonarb, Julie Carr, Nicolas Molinari, Xavier Capdevila, Laurent Brochard, Samir Jaber

Purpose

Spontaneous breathing trials (SBT) evaluate the patient's capacity to maintain inspiratory effort after extubation. SBT practices are heterogeneous and not individualised. The objective of this study was to assess which SBT best reproduces inspiratory effort after extubation in five critical illnesses.

Methods

In this multicentre randomized cross-over study, adult intensive care unit patients under invasive mechanical ventilation for at least 24-h and ready for extubation, underwent three 15-min SBTs in random order: pressure support ventilation level of 7-cmH2O with positive end-expiratory pressure (PEEP) level of 0-cmH2O (PSV7PEEP0), PSV 0-cmH2O with PEEP 0-cmH2O (PSV0PEEP0) and T-piece trial. Primary outcome was the variation of pressure–time-product per minute (PTPmin) between each SBT and 20-min after extubation. Five categories of critical illnesses were selected: abdominal surgery, brain injury, chest trauma, chronic obstructive pulmonary disease (COPD) and miscellaneous.

Results

Five hundred measures of effort from 100 patients were analysed. PTPmin (cmH2O s/min, median and interquartile range, IQR) was 256 (208–321) after extubation, 192 (127–281) at the end of PSV7PEEP0 (p < 0.001 in comparison to after extubation), 291 (235–347) at the end of PSV0PEEP0 and 262 (198–338) at the end of T-piece (both no different from after extubation). One method of SBT in patients with brain injury (PSV0PEEP0), two in abdominal surgery (PSV0PEEP0 and T-piece) and miscellaneous patients (PSV7PEEP0 and T-piece) and all three methods in chest trauma and COPD exacerbation patients replicated reasonably accurately the postextubation effort to breathe.

Conclusion

Unassisted SBTs, namely PSV0PEEP0 and T-piece trial, are the most appropriate to replicate the postextubation effort to breathe.

目的自主呼吸试验(SBT)评估患者在拔管后维持吸气的能力。SBT 的做法各不相同,而且没有个性化。本研究的目的是评估哪种 SBT 最能再现五种危重症患者拔管后的吸气努力。方法 在这项多中心随机交叉研究中,接受有创机械通气至少 24 小时并准备拔管的成人重症监护病房患者按随机顺序接受了三种 15 分钟的 SBT:压力支持通气水平为 7-cmH2O,呼气末正压(PEEP)水平为 0-cmH2O(PSV7PEEP0)、压力支持通气水平为 0-cmH2O,呼气末正压(PEEP)水平为 0-cmH2O(PSV0PEEP0)和 T 片试验。主要结果是每次 SBT 和拔管后 20 分钟之间每分钟压力-时间乘积(PTPmin)的变化。选择了五类危重疾病:腹部手术、脑损伤、胸部创伤、慢性阻塞性肺病(COPD)和其他疾病。拔管后的 PTPmin(cmH2O s/min,中位数和四分位数间距,IQR)为 256(208-321),PSV7PEEP0 结束时为 192(127-281)(与拔管后相比 p < 0.001),PSV0PEEP0 结束时为 291(235-347),T-piece 结束时为 262(198-338)(均与拔管后无异)。脑损伤患者的一种 SBT 方法(PSV0PEEP0)、腹部手术患者的两种 SBT 方法(PSV0PEEP0 和 T-piece)和其他患者的三种 SBT 方法(PSV7PEEP0 和 T-piece)以及胸部创伤和慢性阻塞性肺疾病恶化患者的所有三种 SBT 方法都相当准确地复制了拔管后的呼吸努力。
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引用次数: 0
Heart rate control in septic shock with tachycardia 脓毒性休克伴有心动过速时的心率控制
IF 38.9 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-10-25 DOI: 10.1007/s00134-024-07691-2
Ajay Kumar Jha
No Abstract
无摘要
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引用次数: 0
Interventions to reduce low-value care in intensive care settings: a scoping review of impacts on health, resource use, costs, and the environment 减少重症监护环境中低价值护理的干预措施:对健康、资源使用、成本和环境影响的范围界定审查
IF 38.9 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-10-25 DOI: 10.1007/s00134-024-07670-7
Jake T. W. Williams, Florencia Moraga Masson, Forbes McGain, Rachel Stancliffe, Julia K. Pilowsky, Nhi Nguyen, Katy J. L. Bell

Purpose

Low-value care is common in intensive care units (ICUs), unnecessarily exposing patients to risks and harms, incuring costs to the patient and healthcare system, and contributing to healthcare’s carbon footprint. We aimed to identify, collate, and summarise published evidence on the impact of interventions to reduce low-value care in ICUs.

Methods

We searched MEDLINE, Embase, and Cochrane CENTRAL from inception to 22 September 2023 for evaluations of interventions aiming to reduce low-value care, supplemented by reference lists and recently published articles. We recorded impacts on the low-value target, health outcomes, resource use, cost, and the environment.

Results

From 1155 studies screened, 32 eligible studies were identified evaluating interventions to reduce: routine blood testing (n = 13), routine chest X-rays (n = 10), and other types (or multiple types) of low-value care (n = 9). All but 3 of the interventions found reductions in the immediate low-value care target (usually the primary outcome). Although the small sample size of most included studies, limited their ability to detect impacts on other outcomes, many interventions were also associated with improved health outcomes and financial savings. The only study that reported environmental impacts found the intervention was associated with reduced carbon dioxide equivalent (CO2-e) emissions.

Conclusions

Interventions to reduce low-value care in ICUs may have important health, financial, and environmental co-benefits. Further research may inform wider scale-up and sustainability of successful strategies to decrease low-value healthcare. More empirical evidence on potential environmental benefits may inform policies to lower healthcare’s carbon footprint.

目的 低价值护理在重症监护病房(ICU)中很常见,它使患者面临不必要的风险和伤害,给患者和医疗系统带来成本,并增加了医疗保健的碳足迹。我们的目的是识别、整理和总结已发表的有关干预措施对减少重症监护病房低价值护理的影响的证据。方法我们检索了 MEDLINE、Embase 和 Cochrane CENTRAL(从开始到 2023 年 9 月 22 日)中有关旨在减少低价值护理的干预措施的评价,并以参考文献列表和近期发表的文章作为补充。我们记录了对低价值目标、健康结果、资源使用、成本和环境的影响。结果从筛选出的 1155 项研究中,确定了 32 项符合条件的研究,这些研究评估了旨在减少以下低价值护理的干预措施:常规血液检测(13 项)、常规胸部 X 光检查(10 项)和其他类型(或多种类型)的低价值护理(9 项)。除 3 项干预措施外,所有干预措施都发现低价值护理的直接目标(通常是主要结果)有所减少。虽然大多数纳入研究的样本量较小,限制了其检测对其他结果影响的能力,但许多干预措施也与改善健康结果和节省资金有关。结论减少重症监护室低价值护理的干预措施可能会带来重要的健康、经济和环境共同效益。进一步的研究可为更广泛地推广和持续实施减少低价值医疗服务的成功策略提供信息。有关潜在环境效益的更多实证证据可为降低医疗保健碳足迹的政策提供依据。
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引用次数: 0
My echo checklist in venoarterial ECMO patients 静脉动脉 ECMO 患者的回声检查清单
IF 38.9 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-10-25 DOI: 10.1007/s00134-024-07659-2
Ouriel Saura, Alain Combes, Guillaume Hekimian
No Abstract
无摘要
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引用次数: 0
Integrating multidisciplinary expertise in postoperative noninvasive ventilation management. Authors’ reply 在术后无创通气管理中整合多学科专业知识。作者回复
IF 38.9 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-10-25 DOI: 10.1007/s00134-024-07633-y
Audrey De Jong, Joris Pensier, Samir Jaber
No Abstract
无摘要
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引用次数: 0
Terlipressin use in hepatorenal syndrome-acute kidney injury in cirrhosis 肝肾综合征-肝硬化急性肾损伤中使用特利加压素
IF 38.9 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-10-23 DOI: 10.1007/s00134-024-07681-4
Florence Wong, Stephen C. Pappas
No Abstract
无摘要
{"title":"Terlipressin use in hepatorenal syndrome-acute kidney injury in cirrhosis","authors":"Florence Wong, Stephen C. Pappas","doi":"10.1007/s00134-024-07681-4","DOIUrl":"https://doi.org/10.1007/s00134-024-07681-4","url":null,"abstract":"No Abstract","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"41 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142487156","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
期刊
Intensive Care Medicine
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