Pub Date : 2024-12-17DOI: 10.1016/j.jcrc.2024.154991
Lisanne van Berkel , Marnix Kuindersma , Ingrid D. van Iperen , Henk J. Adriaansen , Janine J.J. Hulstein , Peter E. Spronk
Purpose
Low-molecular-weight heparins (LMWHs) are widely used for prevention and treatment of venous thromboembolism (VTE) in critically ill patients. The objective of this study was to assess the dose-response relationship between nadroparin dose and anti-Xa activity in ICU patients.
Materials and methods
Critically ill adult patients who were admitted to the ICU, and received at least three subcutaneous injections of nadroparin were included. The dose-effect relationship between nadroparin dose and anti-Xa level was analysed through a mixed-effects logistic regression model.
Results
In total, 327 ICU patients were included. Median anti-Xa levels ranged from <0.1 IU/mL after nadroparin 0–37 IU/kg/day to 0.6 IU/mL after nadroparin >85 IU/kg/day (p < 0.01). Among all 1520 anti-Xa measurements, 859 (57 %) measurements were in the desired anti-Xa range. The best adequacy of anti-Xa levels was observed in nadroparin doses of 38–85 IU/kg (73 %). No differences in the odds of bleeding events or VTE between different anti-Xa levels were found.
Conclusions
We found a clear dose-response relationship between nadroparin dose and anti-Xa levels. Increasing nadroparin doses led to more adequate anti-Xa levels without a change in the occurrence of VTE or major bleeding events, suggesting that LMWH therapy can be successfully and safely personalized using anti-Xa guided dosing.
{"title":"A retrospective Cohort study on the effect of the LOw-molecular weighT heparin (LMWH) nadroparin dose on anti-XA levels in a mixed medical-surgical ICU population: CLOT-Xa","authors":"Lisanne van Berkel , Marnix Kuindersma , Ingrid D. van Iperen , Henk J. Adriaansen , Janine J.J. Hulstein , Peter E. Spronk","doi":"10.1016/j.jcrc.2024.154991","DOIUrl":"10.1016/j.jcrc.2024.154991","url":null,"abstract":"<div><h3>Purpose</h3><div>Low-molecular-weight heparins (LMWHs) are widely used for prevention and treatment of venous thromboembolism (VTE) in critically ill patients. The objective of this study was to assess the dose-response relationship between nadroparin dose and anti-Xa activity in ICU patients.</div></div><div><h3>Materials and methods</h3><div>Critically ill adult patients who were admitted to the ICU, and received at least three subcutaneous injections of nadroparin were included. The dose-effect relationship between nadroparin dose and anti-Xa level was analysed through a mixed-effects logistic regression model.</div></div><div><h3>Results</h3><div>In total, 327 ICU patients were included. Median anti-Xa levels ranged from <0.1 IU/mL after nadroparin 0–37 IU/kg/day to 0.6 IU/mL after nadroparin >85 IU/kg/day (<em>p</em> < 0.01). Among all 1520 anti-Xa measurements, 859 (57 %) measurements were in the desired anti-Xa range. The best adequacy of anti-Xa levels was observed in nadroparin doses of 38–85 IU/kg (73 %). No differences in the odds of bleeding events or VTE between different anti-Xa levels were found.</div></div><div><h3>Conclusions</h3><div>We found a clear dose-response relationship between nadroparin dose and anti-Xa levels. Increasing nadroparin doses led to more adequate anti-Xa levels without a change in the occurrence of VTE or major bleeding events, suggesting that LMWH therapy can be successfully and safely personalized using anti-Xa guided dosing.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"86 ","pages":"Article 154991"},"PeriodicalIF":3.2,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-16DOI: 10.1016/j.jcrc.2024.155001
Wisam Al-Bassam , Samer Noaman , Rahul Kumar , Neil Glassford , Daryl Jones , Carys Jones , William Chan , David M. Kaye , David Pilcher , Rinaldo Bellomo , Yehya shehabi , Ary Serpa Neto
Purpose
Patients with Cardiogenic shock (CS) admitted to intensive care units (ICUs) have high mortality rates. We aimed to investigate the changes patient characteristics and outcomes over time among patients admitted to the ICU with CS.
Methods
Retrospective study utilizing a large bi-national ICU database from 2003 to 2022. Patient characteristics and outcomes based on the ICU admission diagnosis of CS were evaluated and changes in outcomes over time after adjusting for key baseline variables were assessed.
Results
During the study period, among CS patients, there were significant reductions in severity of illness (APACHE III from 80 to 72 and Australian and New Zealand Risk of Death Scores from 0.34 to 0.30, both p < 0.001). There was also a significant increase in admissions from emergency departments (32 % to 41 %, p < 0.001). Over time, unadjusted hospital mortality decreased from 57 % in 2003 to 41 % in 2022 (P < 0.001). After adjustment for severity of illness, the odds ratios for hospital mortality also decreased to 0.49 (95 % CI, 0.38 to 0.64) compared with 2003 (p < 0.001).
Conclusions
Over twenty years period, among patients with CS admitted to ICU, there has been a significant change in the epidemiological characteristics and a decrease in absolute and adjusted mortality rates.
{"title":"Clinical outcomes of cardiogenic shock among critically ill patients admitted to intensive care units in Australia and New Zealand from 2003 to 2022","authors":"Wisam Al-Bassam , Samer Noaman , Rahul Kumar , Neil Glassford , Daryl Jones , Carys Jones , William Chan , David M. Kaye , David Pilcher , Rinaldo Bellomo , Yehya shehabi , Ary Serpa Neto","doi":"10.1016/j.jcrc.2024.155001","DOIUrl":"10.1016/j.jcrc.2024.155001","url":null,"abstract":"<div><h3>Purpose</h3><div>Patients with Cardiogenic shock (CS) admitted to intensive care units (ICUs) have high mortality rates. We aimed to investigate the changes patient characteristics and outcomes over time among patients admitted to the ICU with CS.</div></div><div><h3>Methods</h3><div>Retrospective study utilizing a large bi-national ICU database from 2003 to 2022. Patient characteristics and outcomes based on the ICU admission diagnosis of CS were evaluated and changes in outcomes over time after adjusting for key baseline variables were assessed.</div></div><div><h3>Results</h3><div>During the study period, among CS patients, there were significant reductions in severity of illness (APACHE III from 80 to 72 and Australian and New Zealand Risk of Death Scores from 0.34 to 0.30, both <em>p</em> < 0.001). There was also a significant increase in admissions from emergency departments (32 % to 41 %, p < 0.001). Over time, unadjusted hospital mortality decreased from 57 % in 2003 to 41 % in 2022 (<em>P</em> < 0.001). After adjustment for severity of illness, the odds ratios for hospital mortality also decreased to 0.49 (95 % CI, 0.38 to 0.64) compared with 2003 (<em>p</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>Over twenty years period, among patients with CS admitted to ICU, there has been a significant change in the epidemiological characteristics and a decrease in absolute and adjusted mortality rates.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"86 ","pages":"Article 155001"},"PeriodicalIF":3.2,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-16DOI: 10.1016/j.jcrc.2024.155002
Akinori Maeda , Alastair Brown , Sofia Spano , Anis Chaba , Atthaphong Phongphithakchai , Yukiko Hikasa , Nuttapol Pattamin , Nuanprae Kitisin , Jonathan Nübel , Bethany Nielsen , Jennifer Holmes , Leah Peck , Helen Young , Glenn Eastwood , Rinaldo Bellomo , Ary Serpa Neto
Purpose
Furosemide is the most commonly used diuretic in intensive care units (ICU). We aimed to evaluate the physiological effects of adjunctive acetazolamide with furosemide on diuresis and the prevention of potential furosemide-induced metabolic alkalosis.
Materials and methods
We performed a two-center, pilot, open-label, randomized trial. Where the treating physicians planned intravenous diuretic therapy, we randomized ICU patients to a bolus of furosemide (40 mg) plus acetazolamide (500 mg) (n = 15) or furosemide alone (40 mg) (n = 15). Urine output, additional furosemide use, acid-base parameters, and electrolytes were compared following a Bayesian framework.
Results
Adjunctive acetazolamide didn't increase urine output in the first six hours (mean difference: −112 ml, credible interval: [−742, 514]). However, compared with furosemide alone, it maintained a greater urine output response to furosemide over 24 h, with 100 % probability. Acetazolamide also acidified plasma (pH difference: −0.045, [−0.081, −0.008]) while alkalinizing urine (1.10, [0.04, 2.11]) at six hours, compared to furosemide alone with >95 % probability. Finally, we didn't observe severe acidosis or electrolyte disturbances over 24 h.
Conclusions
Adjunctive acetazolamide may increase diuretic efficacy and counterbalance furosemide-induced metabolic alkalosis without safety concerns. Larger trials are warranted to verify these findings and assess their impacts on clinical outcomes.
Registration number
ACTRN12623000624684.
Registration title
A pilot trial of single versus dual diuretic therapy in the intensive care unit.
{"title":"Furosemide with adjunctive acetazolamide vs furosemide only in critically ill patients: A pilot two-center randomized controlled trial","authors":"Akinori Maeda , Alastair Brown , Sofia Spano , Anis Chaba , Atthaphong Phongphithakchai , Yukiko Hikasa , Nuttapol Pattamin , Nuanprae Kitisin , Jonathan Nübel , Bethany Nielsen , Jennifer Holmes , Leah Peck , Helen Young , Glenn Eastwood , Rinaldo Bellomo , Ary Serpa Neto","doi":"10.1016/j.jcrc.2024.155002","DOIUrl":"10.1016/j.jcrc.2024.155002","url":null,"abstract":"<div><h3>Purpose</h3><div>Furosemide is the most commonly used diuretic in intensive care units (ICU). We aimed to evaluate the physiological effects of adjunctive acetazolamide with furosemide on diuresis and the prevention of potential furosemide-induced metabolic alkalosis.</div></div><div><h3>Materials and methods</h3><div>We performed a two-center, pilot, open-label, randomized trial. Where the treating physicians planned intravenous diuretic therapy, we randomized ICU patients to a bolus of furosemide (40 mg) plus acetazolamide (500 mg) (<em>n</em> = 15) or furosemide alone (40 mg) (n = 15). Urine output, additional furosemide use, acid-base parameters, and electrolytes were compared following a Bayesian framework.</div></div><div><h3>Results</h3><div>Adjunctive acetazolamide didn't increase urine output in the first six hours (mean difference: −112 ml, credible interval: [−742, 514]). However, compared with furosemide alone, it maintained a greater urine output response to furosemide over 24 h, with 100 % probability. Acetazolamide also acidified plasma (pH difference: −0.045, [−0.081, −0.008]) while alkalinizing urine (1.10, [0.04, 2.11]) at six hours, compared to furosemide alone with >95 % probability. Finally, we didn't observe severe acidosis or electrolyte disturbances over 24 h.</div></div><div><h3>Conclusions</h3><div>Adjunctive acetazolamide may increase diuretic efficacy and counterbalance furosemide-induced metabolic alkalosis without safety concerns. Larger trials are warranted to verify these findings and assess their impacts on clinical outcomes.</div></div><div><h3>Registration number</h3><div>ACTRN12623000624684.</div></div><div><h3>Registration title</h3><div>A pilot trial of single versus dual diuretic therapy in the intensive care unit.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"86 ","pages":"Article 155002"},"PeriodicalIF":3.2,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-15DOI: 10.1016/j.jcrc.2024.155003
Chen Zhou , Chenglong Liang
{"title":"Letter to the editor: “Malnutrition in survivors of critical illness and long-term survival outcomes: A cohort study”","authors":"Chen Zhou , Chenglong Liang","doi":"10.1016/j.jcrc.2024.155003","DOIUrl":"10.1016/j.jcrc.2024.155003","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"86 ","pages":"Article 155003"},"PeriodicalIF":3.2,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142835958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-14DOI: 10.1016/j.jcrc.2024.155004
Hailey A. Thompson , Hannah M. Brinkman , Kianoush B. Kashani , Kristin C. Cole , Erica D. Wittwer , Patrick M. Wieruszewski
Purpose
Septic shock refractory to high-dose vasopressors confers unacceptably high mortality, however, the impact of timing of peak vasopressor dose exposure on outcomes is unknown.
Methods
This retrospective cohort study included adults who required a vasopressor dose ≥0.5 μg/kg/min norepinephrine-equivalents in the first 24 h of septic shock. We used the median time to peak vasopressor dose to stratify patients into ‘early’ and ‘late’ groups. Multivariable Cox proportional hazards regression was used to assess the impact of time to peak vasopressor exposure on mortality.
Results
The median time to peak vasopressor dose exposure was 6 (3,13) hours, defining the early (n = 351) and late (n = 351) groups. In the severity-adjusted multivariable analysis, the early group was less likely to die within 28 days (HR 0.76, 95 % CI 0.58–0.99). The early group experienced significantly more days alive and free from renal replacement therapy, vasopressors, mechanical ventilation, and quicker independence from vasopressors (HR 1.40, 95 % CI 1.17–1.69). Mesenteric ischemia and arrhythmias were more frequent in the late group.
Conclusions
In vasopressor-refractory septic shock, achieving the peak vasopressor dose within the first six hours of shock onset was associated with reduced mortality and more days alive and free from organ-support therapies.
目的：大剂量血管加压药难治性脓毒性休克会导致不可接受的高死亡率，但血管加压药剂量达到峰值的时间对预后的影响尚不清楚：这项回顾性队列研究纳入了在脓毒性休克最初 24 小时内需要血管加压药剂量≥0.5 μg/kg/min 去甲肾上腺素当量的成年人。我们使用血管加压药剂量达到峰值的中位时间将患者分为 "早期 "和 "晚期 "两组。采用多变量考克斯比例危险回归评估血管加压药剂量达到峰值的时间对死亡率的影响：血管加压药剂量达到峰值的中位时间为6（3,13）小时，分为早期组（351人）和晚期组（351人）。在严重程度调整后的多变量分析中，早期组在 28 天内死亡的可能性较低（HR 0.76，95 % CI 0.58-0.99）。早期组的存活天数明显更多，且无需接受肾脏替代治疗、血管加压、机械通气，并能更快地脱离血管加压（HR 1.40，95 % CI 1.17-1.69）。肠系膜缺血和心律失常在晚期组更为常见：结论：在血管加压药难治性脓毒性休克患者中，在休克发生后六小时内达到血管加压药峰值与死亡率降低、存活天数增加以及无需器官支持疗法有关。
{"title":"Early high-dose vasopressors in refractory septic shock: A cohort study","authors":"Hailey A. Thompson , Hannah M. Brinkman , Kianoush B. Kashani , Kristin C. Cole , Erica D. Wittwer , Patrick M. Wieruszewski","doi":"10.1016/j.jcrc.2024.155004","DOIUrl":"10.1016/j.jcrc.2024.155004","url":null,"abstract":"<div><h3>Purpose</h3><div>Septic shock refractory to high-dose vasopressors confers unacceptably high mortality, however, the impact of timing of peak vasopressor dose exposure on outcomes is unknown.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included adults who required a vasopressor dose ≥0.5 μg/kg/min norepinephrine-equivalents in the first 24 h of septic shock. We used the median time to peak vasopressor dose to stratify patients into ‘early’ and ‘late’ groups. Multivariable Cox proportional hazards regression was used to assess the impact of time to peak vasopressor exposure on mortality.</div></div><div><h3>Results</h3><div>The median time to peak vasopressor dose exposure was 6 (3,13) hours, defining the early (<em>n</em> = 351) and late (n = 351) groups. In the severity-adjusted multivariable analysis, the early group was less likely to die within 28 days (HR 0.76, 95 % CI 0.58–0.99). The early group experienced significantly more days alive and free from renal replacement therapy, vasopressors, mechanical ventilation, and quicker independence from vasopressors (HR 1.40, 95 % CI 1.17–1.69). Mesenteric ischemia and arrhythmias were more frequent in the late group.</div></div><div><h3>Conclusions</h3><div>In vasopressor-refractory septic shock, achieving the peak vasopressor dose within the first six hours of shock onset was associated with reduced mortality and more days alive and free from organ-support therapies.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"86 ","pages":"Article 155004"},"PeriodicalIF":3.2,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-12DOI: 10.1016/j.jcrc.2024.154989
Arnaud Robert , Julien Moury , Emily Perriens , Sydney Blackman , Patrick M. Honore
{"title":"What Every Intensivist Should Know About Medullary Renal Perfusion","authors":"Arnaud Robert , Julien Moury , Emily Perriens , Sydney Blackman , Patrick M. Honore","doi":"10.1016/j.jcrc.2024.154989","DOIUrl":"10.1016/j.jcrc.2024.154989","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"86 ","pages":"Article 154989"},"PeriodicalIF":3.2,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-11DOI: 10.1016/j.jcrc.2024.154990
Jorge A. Ortega-Hernández , Héctor González-Pacheco , Mauricio García-Ruiz , Daniel Manzur-Sandoval , Rodrigo Gopar-Nieto , Daniel Sierra-Lara-Martínez , Diego Araiza-Garaygordobil , Salvador Mendoza-García , Arturo Arzate-Ramírez , Álvaro Montañez-Orozco , Luis Augusto Baeza-Herrera , Alfredo Altamirano-Castillo , Adrian Aquiles Valdespino Trejo , Jaime Hernández-Montfort , Alexandra Arias-Mendoza
Introduction
Lactate clearance(LC) is critical in managing critically ill patients. We hypothesized that treatment allocation with different vasoactive drugs or the presence of a pulmonary artery catheter (PAC) could affect the behavior of lactate dynamics and, ultimately, the mortality in AMI-CS.
Materials and methods
In 651 patients with AMI-CS, we examined the relationship of LC time with clinical, laboratory, and CS-management variables. Complete LC time was defined as serum lactate levels less than <2 mmol/L. We explore the impact of vasoactive drugs and PAC with LC. The CART method defined the vasoactive combinations (permutations) in relation with early (<96 h) complete LC.
Results
PAC presence correlated with faster LC (−17.54 h) and was independently associated with lower mortality (HR = 0.61). Levosimendan and dobutamine were associated with lower lactate levels and faster LC (−8.82 & -8.77 h), while vasopressin was linked to slower LC (9.16 h). Slow LC (>96 h) was associated with increased mortality. CART analysis identified specific vasoactive drug combinations associated lactate clearance and mortality, without dobutamine, with vasopressin having higher mortality (80.6 %, HR = 5.53), and with dobutamine, with norepinephrine, without vasopressin, with levosimendan the lowest (35 %) and higher complete LC and a trend for higher %LC.
Conclusion
The right combination of vasoactive medications and the probable use of a PAC could significantly impact the achievement of complete LC in <96 h. The findings support the need for further research and the development of strategies to optimize lactate clearance and improve overall patient survival in this high-risk population.
{"title":"Effect of pulmonary artery catheter, type & combination of vasoactives for optimizing lactate clearance in acute myocardial infarction complicated by cardiogenic shock","authors":"Jorge A. Ortega-Hernández , Héctor González-Pacheco , Mauricio García-Ruiz , Daniel Manzur-Sandoval , Rodrigo Gopar-Nieto , Daniel Sierra-Lara-Martínez , Diego Araiza-Garaygordobil , Salvador Mendoza-García , Arturo Arzate-Ramírez , Álvaro Montañez-Orozco , Luis Augusto Baeza-Herrera , Alfredo Altamirano-Castillo , Adrian Aquiles Valdespino Trejo , Jaime Hernández-Montfort , Alexandra Arias-Mendoza","doi":"10.1016/j.jcrc.2024.154990","DOIUrl":"10.1016/j.jcrc.2024.154990","url":null,"abstract":"<div><h3>Introduction</h3><div>Lactate clearance(LC) is critical in managing critically ill patients. We hypothesized that treatment allocation with different vasoactive drugs or the presence of a pulmonary artery catheter (PAC) could affect the behavior of lactate dynamics and, ultimately, the mortality in AMI-CS.</div></div><div><h3>Materials and methods</h3><div>In 651 patients with AMI-CS, we examined the relationship of LC time with clinical, laboratory, and CS-management variables. Complete LC time was defined as serum lactate levels less than <2 mmol/L. We explore the impact of vasoactive drugs and PAC with LC. The CART method defined the vasoactive combinations (permutations) in relation with early (<96 h) complete LC.</div></div><div><h3>Results</h3><div>PAC presence correlated with faster LC (−17.54 h) and was independently associated with lower mortality (HR = 0.61). Levosimendan and dobutamine were associated with lower lactate levels and faster LC (−8.82 & -8.77 h), while vasopressin was linked to slower LC (9.16 h). Slow LC (>96 h) was associated with increased mortality. CART analysis identified specific vasoactive drug combinations associated lactate clearance and mortality, without dobutamine, with vasopressin having higher mortality (80.6 %, HR = 5.53), and with dobutamine, with norepinephrine, without vasopressin, with levosimendan the lowest (35 %) and higher complete LC and a trend for higher %LC.</div></div><div><h3>Conclusion</h3><div>The right combination of vasoactive medications and the probable use of a PAC could significantly impact the achievement of complete LC in <96 h. The findings support the need for further research and the development of strategies to optimize lactate clearance and improve overall patient survival in this high-risk population.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"86 ","pages":"Article 154990"},"PeriodicalIF":3.2,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-10DOI: 10.1016/j.jcrc.2024.154983
Jie Zhang , Qian Xie , Rong Jiang , Yang Yang , Yuting Yang , Chaoqi Zhou , Wei Zhang , Tian Zhang , Yixin Liu , Huiming Yao
Purpose
This study aims to evaluate the role of diaphragmatic dysfunction in extubation failure among patients at high risk of reintubation.
Material and methods
This prospective cohort study was carried out at a intensive care unit in China. Adult patients who had been intubated for more than 24 h and ready for extubation were included in the study if they exhibited a high risk of extubation failure. Diaphragm dysfunction was defined as a diaphragmatic thickening fraction <30 % or diaphragmatic excursion <10 mm. The primary outcome was defined as extubation failure, which includes either reintubation or death within the initial 7 days following extubation.
Results
Out of the 113 patients, 27 (23.89 %) experienced extubation failure, with diaphragm dysfunction diagnosed in 63 (55.75 %) individuals. Patients who failed extubation were significantly more likely to have diaphragm dysfunction (85.19 % vs. 46.51 %, p < 0.01). In the Cox-proportional hazards regression analysis, diaphragm dysfunction and the Medical Research Council score were found to be associated with extubation failure. The adjusted hazard ratios were 4.56 [95 % CI: 1.56–13.33] and 0.93 [95 % CI: 0.88–0.99]. Both variables were closely correlated with extubation failure showing statistical significance.
Conclusion
Diaphragm dysfunction could contribute to an elevated extubation failure rate.
目的：本研究旨在评估膈功能障碍在高危再插管患者拔管失败中的作用。材料和方法：本前瞻性队列研究在中国的重症监护病房进行。已插管超过24小时并准备拔管的成年患者，如果他们表现出拔管失败的高风险，则纳入研究。结果：113例患者中，27例（23.89%）出现拔管失败，63例（55.75%）诊断为膈功能障碍。拔管失败的患者更容易出现膈功能障碍（85.19% vs. 46.51%）。结论：膈功能障碍可能导致拔管失败率升高。
{"title":"Role of diaphragmatic dysfunction in extubation failure among patients at high risk of reintubation: A prospective cohort study","authors":"Jie Zhang , Qian Xie , Rong Jiang , Yang Yang , Yuting Yang , Chaoqi Zhou , Wei Zhang , Tian Zhang , Yixin Liu , Huiming Yao","doi":"10.1016/j.jcrc.2024.154983","DOIUrl":"10.1016/j.jcrc.2024.154983","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aims to evaluate the role of diaphragmatic dysfunction in extubation failure among patients at high risk of reintubation.</div></div><div><h3>Material and methods</h3><div>This prospective cohort study was carried out at a intensive care unit in China. Adult patients who had been intubated for more than 24 h and ready for extubation were included in the study if they exhibited a high risk of extubation failure. Diaphragm dysfunction was defined as a diaphragmatic thickening fraction <30 % or diaphragmatic excursion <10 mm. The primary outcome was defined as extubation failure, which includes either reintubation or death within the initial 7 days following extubation.</div></div><div><h3>Results</h3><div>Out of the 113 patients, 27 (23.89 %) experienced extubation failure, with diaphragm dysfunction diagnosed in 63 (55.75 %) individuals. Patients who failed extubation were significantly more likely to have diaphragm dysfunction (85.19 % vs. 46.51 %, <em>p</em> < 0.01). In the Cox-proportional hazards regression analysis, diaphragm dysfunction and the Medical Research Council score were found to be associated with extubation failure. The adjusted hazard ratios were 4.56 [95 % CI: 1.56–13.33] and 0.93 [95 % CI: 0.88–0.99]. Both variables were closely correlated with extubation failure showing statistical significance.</div></div><div><h3>Conclusion</h3><div>Diaphragm dysfunction could contribute to an elevated extubation failure rate.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"86 ","pages":"Article 154983"},"PeriodicalIF":3.2,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-10DOI: 10.1016/j.jcrc.2024.154975
Michael Hill-Oliva , Srinivas Medavarapu MBBS , Deeksha Chada MPH , Maggie Keogh MEd , Errol Gordon MD , Stephan A. Mayer MD , Neha S. Dangayach MD MSCR
Background
Surrogates often provide substituted judgement for neurologically critically ill patients. Resilience and spirituality are understudied constructs in this patient population.
In this study we examine how accurately surrogates estimate measures of resilience and spirituality for neurologically critically ill patients.
Methods
A convenience sample of English/Spanish speaking neurologically critically ill patient-surrogate dyads was enrolled from March 2016 to 2018. Questionnaires related to resilience (CD-RISC-10), spiritual wellbeing (positive Brief R-COPE), and spiritual turmoil (negative Brief R-cope) were completed by patients for themselves and surrogates on behalf of patients while in the Neurosciences Intensive Care Unit. Responses were evaluated by Spearman's rank-order correlation, Bland-Altman analysis and Cohen's weighted kappa.
Results
51 dyads were included. No correlation was found between patient and surrogate CD-RISC-10 (0.17, p = 0.238); moderate, positive correlations for positive (0.47, p < 0.001) and negative (0.33, p = 0.021) Brief R-COPE. Mean differences between patient and surrogate scores were low for CD-RISC-10 (−1.0 point), positive R-COPE (− 0.14 point), and negative R-COPE (0.02 point) suggesting lack of bias towards over/under-estimation. Kappa scores demonstrate fair inter-rater agreement for positive/negative R-COPE and no agreement for CD-RISC-10.
Conclusion
Surrogate evaluations lack systematic bias, but may not estimate resilience and spirituality reliably for neurologically critically ill patients.
{"title":"Surrogates may not accurately estimate resilience and spirituality in neurologically critically ill patients","authors":"Michael Hill-Oliva , Srinivas Medavarapu MBBS , Deeksha Chada MPH , Maggie Keogh MEd , Errol Gordon MD , Stephan A. Mayer MD , Neha S. Dangayach MD MSCR","doi":"10.1016/j.jcrc.2024.154975","DOIUrl":"10.1016/j.jcrc.2024.154975","url":null,"abstract":"<div><h3>Background</h3><div>Surrogates often provide substituted judgement for neurologically critically ill patients. Resilience and spirituality are understudied constructs in this patient population.</div><div>In this study we examine how accurately surrogates estimate measures of resilience and spirituality for neurologically critically ill patients.</div></div><div><h3>Methods</h3><div>A convenience sample of English/Spanish speaking neurologically critically ill patient-surrogate dyads was enrolled from March 2016 to 2018. Questionnaires related to resilience (CD-RISC-10), spiritual wellbeing (positive Brief R-COPE), and spiritual turmoil (negative Brief R-cope) were completed by patients for themselves and surrogates on behalf of patients while in the Neurosciences Intensive Care Unit. Responses were evaluated by Spearman's rank-order correlation, Bland-Altman analysis and Cohen's weighted kappa.</div></div><div><h3>Results</h3><div>51 dyads were included. No correlation was found between patient and surrogate CD-RISC-10 (0.17, <em>p</em> = 0.238); moderate, positive correlations for positive (0.47, <em>p</em> < 0.001) and negative (0.33, <em>p</em> = 0.021) Brief R-COPE. Mean differences between patient and surrogate scores were low for CD-RISC-10 (−1.0 point), positive R-COPE (− 0.14 point), and negative R-COPE (0.02 point) suggesting lack of bias towards over/under-estimation. Kappa scores demonstrate fair inter-rater agreement for positive/negative R-COPE and no agreement for CD-RISC-10.</div></div><div><h3>Conclusion</h3><div>Surrogate evaluations lack systematic bias, but may not estimate resilience and spirituality reliably for neurologically critically ill patients.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"86 ","pages":"Article 154975"},"PeriodicalIF":3.2,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-07DOI: 10.1016/j.jcrc.2024.154988
Liran Statlender , Tzippy Shochat , Pierre Singer
{"title":"Authors response: “Urea to creatinine ratio as a predictor of persistent critical illness”","authors":"Liran Statlender , Tzippy Shochat , Pierre Singer","doi":"10.1016/j.jcrc.2024.154988","DOIUrl":"10.1016/j.jcrc.2024.154988","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"86 ","pages":"Article 154988"},"PeriodicalIF":3.2,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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