Pub Date : 2024-12-03DOI: 10.1016/j.jcrc.2024.154984
Raphael Romano Bruno , Bernhard Wernly , Antonio Artigas , Kristina Fuest , Stefan J. Schaller , Lisa Dannenberg , Detlef Kindgen-Milles , Malte Kelm , Michael Beil , Sigal Sviri , Muhammed Elhadi , Michael Joannidis , Sandra Oeyen , Eumorfia Kondili , Rui Moreno , Susannah Leaver , Bertrand Guidet , Dylan W. De Lange , Hans Flaatten , Wojciech Szczeklik , Christian Jung
Purpose
There are limited data about the outcome of old intensive care (ICU) patients suffering from Covid-19 in the post-vaccination era. This study distinguishes the pre- and post-acute illness living conditions of ICU survivors from non-survivors.
Methods
This prospective international multicenter study included 642 old (≥ 70 years) ICU patients, including data ranging from pre-illness condition to functional 90-days follow-up. The primary endpoint was the difference of living conditions of ICU-survivors before ICU admission and 90-days after ICU discharge. Secondary outcomes were 90-days mortality, and quality of life.
Results
A total of 642 patients were included. Significantly more ICU survivors lived at their own homes without support before ICU admission than non-survivors (p = 0.016), while more non-survivors resided in nursing homes (p = 0.016). ICU mortality was 39 %, 30-days and 90 days mortality were 47 %and 55 %. After 90 days, only 22 % maintained the same living conditions. Surviving patients viewed ICU admission positively after 90 days, while relatives were more uncertain. Quality of life indicated a self-reported average score of 60 (50–75).
Conclusion
Living conditions influence the outcome of critically ill old patients suffering from Covid-19. Only a minority returned to their initial habitat after ICU survival.
{"title":"Contemporary assessment of short- and functional 90-days outcome in old intensive care patients suffering from COVID-19","authors":"Raphael Romano Bruno , Bernhard Wernly , Antonio Artigas , Kristina Fuest , Stefan J. Schaller , Lisa Dannenberg , Detlef Kindgen-Milles , Malte Kelm , Michael Beil , Sigal Sviri , Muhammed Elhadi , Michael Joannidis , Sandra Oeyen , Eumorfia Kondili , Rui Moreno , Susannah Leaver , Bertrand Guidet , Dylan W. De Lange , Hans Flaatten , Wojciech Szczeklik , Christian Jung","doi":"10.1016/j.jcrc.2024.154984","DOIUrl":"10.1016/j.jcrc.2024.154984","url":null,"abstract":"<div><h3>Purpose</h3><div>There are limited data about the outcome of old intensive care (ICU) patients suffering from Covid-19 in the post-vaccination era. This study distinguishes the pre- and post-acute illness living conditions of ICU survivors from non-survivors.</div></div><div><h3>Methods</h3><div>This prospective international multicenter study included 642 old (≥ 70 years) ICU patients, including data ranging from pre-illness condition to functional 90-days follow-up. The primary endpoint was the difference of living conditions of ICU-survivors before ICU admission and 90-days after ICU discharge. Secondary outcomes were 90-days mortality, and quality of life.</div></div><div><h3>Results</h3><div>A total of 642 patients were included. Significantly more ICU survivors lived at their own homes without support before ICU admission than non-survivors (<em>p</em> = 0.016), while more non-survivors resided in nursing homes (p = 0.016). ICU mortality was 39 %, 30-days and 90 days mortality were 47 %and 55 %. After 90 days, only 22 % maintained the same living conditions. Surviving patients viewed ICU admission positively after 90 days, while relatives were more uncertain. Quality of life indicated a self-reported average score of 60 (50–75).</div></div><div><h3>Conclusion</h3><div>Living conditions influence the outcome of critically ill old patients suffering from Covid-19. Only a minority returned to their initial habitat after ICU survival.</div><div><strong>Trial registration number</strong> <span><span>NCT04321265</span><svg><path></path></svg></span></div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"86 ","pages":"Article 154984"},"PeriodicalIF":3.2,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-28DOI: 10.1016/j.jcrc.2024.154978
Marcela de Almeida Lopes , Aurelie Gouel-Cheron , Saad Nseir
{"title":"Challenges and opportunities in antibiotic allergy de-labeling in intensive care units: The time is now!","authors":"Marcela de Almeida Lopes , Aurelie Gouel-Cheron , Saad Nseir","doi":"10.1016/j.jcrc.2024.154978","DOIUrl":"10.1016/j.jcrc.2024.154978","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154978"},"PeriodicalIF":3.2,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142744000","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}
Severe heatstroke is often complicated by disseminated intravascular coagulation (DIC). The aim of this study was to evaluate platelet function assessed through thromboelastography (TEG) at the emergency department (ED) and DIC severity among patients with heatstroke.
Materials and methods
We performed a retrospective single-tertiary hospital cohort study. Patients admitted to an intensive care unit (ICU) with heatstroke were enrolled. Platelet function was evaluated as the difference between citrated functional fibrinogen-maximum amplitude (CFF-MA) and citrated rapid TEG-maximum amplitude (CRT-MA) at the ED. DIC was defined as a score ≥ 4 points based on the Japanese Association of Acute Medicine score.
Results
A total of 31 patients with heatstroke were enrolled. The median platelet count was 18.1 × 104/μL, (interquartile range [IQR]: 12.6–25.0 × 104/μL), and the median platelet function evaluated as CFF-MA-CRT-MA was 34.4 mm (IQR: 27.8–37.8 mm). Among several clinical and TEG-related parameters, the platelet function was strongly correlated with the DIC score (R = −0.63, p < 0.001) and significantly associated with DIC development (area under the receiver operating characteristic curve 0.87 [95 % confidence interval: 0.72–0.99]).
Conclusions
These results suggested that platelet dysfunction occurs in heatstroke-induced DIC, indicating that platelet function evaluation by TEG can provide complementary information and enhance our understanding about the subtypes of heatstroke.
{"title":"Platelet dysfunction in heatstroke-induced coagulopathy: A retrospective observational study","authors":"Yuri Endo , Ryota Inokuchi , Miyuki Yamamoto , Ryohei Horie , Toshifumi Asada , Koichi Kashiwa , Kazuki Fujishiro , Masao Iwagami , Kent Doi","doi":"10.1016/j.jcrc.2024.154982","DOIUrl":"10.1016/j.jcrc.2024.154982","url":null,"abstract":"<div><h3>Purpose</h3><div>Severe heatstroke is often complicated by disseminated intravascular coagulation (DIC). The aim of this study was to evaluate platelet function assessed through thromboelastography (TEG) at the emergency department (ED) and DIC severity among patients with heatstroke.</div></div><div><h3>Materials and methods</h3><div>We performed a retrospective single-tertiary hospital cohort study. Patients admitted to an intensive care unit (ICU) with heatstroke were enrolled. Platelet function was evaluated as the difference between citrated functional fibrinogen-maximum amplitude (CFF-MA) and citrated rapid TEG-maximum amplitude (CRT-MA) at the ED. DIC was defined as a score ≥ 4 points based on the Japanese Association of Acute Medicine score.</div></div><div><h3>Results</h3><div>A total of 31 patients with heatstroke were enrolled. The median platelet count was 18.1 × 10<sup>4</sup>/μL, (interquartile range [IQR]: 12.6–25.0 × 10<sup>4</sup>/μL), and the median platelet function evaluated as CFF-MA-CRT-MA was 34.4 mm (IQR: 27.8–37.8 mm). Among several clinical and TEG-related parameters, the platelet function was strongly correlated with the DIC score (<em>R</em> = −0.63, <em>p</em> < 0.001) and significantly associated with DIC development (area under the receiver operating characteristic curve 0.87 [95 % confidence interval: 0.72–0.99]).</div></div><div><h3>Conclusions</h3><div>These results suggested that platelet dysfunction occurs in heatstroke-induced DIC, indicating that platelet function evaluation by TEG can provide complementary information and enhance our understanding about the subtypes of heatstroke.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154982"},"PeriodicalIF":3.2,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142743993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-28DOI: 10.1016/j.jcrc.2024.154979
Wei-Zhen Tang, Wei-Ze Xu, Tai-Hang Liu
{"title":"Letter to the Editor: “Outcomes of continuous renal replacement therapy versus peritoneal dialysis as a renal replacement therapy modality in patients undergoing venoarterial 72 extracorporeal membrane oxygenation”","authors":"Wei-Zhen Tang, Wei-Ze Xu, Tai-Hang Liu","doi":"10.1016/j.jcrc.2024.154979","DOIUrl":"10.1016/j.jcrc.2024.154979","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154979"},"PeriodicalIF":3.2,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142744001","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 : 2024-11-27DOI: 10.1016/j.jcrc.2024.154977
Salma Alamin , Rachel Egan , Barbara Cusack , Amanda Sherwin , Emily Naylor , Fiona Carroll , Marie E. Ward , Mary Kelly , Deirdre Doyle , Ignacio Martin-Loeches , Niall Conlon , Sean Keane
Purpose
Critically ill patients in the intensive care unit (ICU) are frequently prescribed antibiotics, with many reporting an antibiotic allergy label, predominantly to penicillin. Mislabeling contributes to suboptimal antibiotic use, increasing multidrug-resistant organisms and Clostridium difficile infections, and increased hospital length of stay. This prospective study implemented an antibiotic allergy assessment and testing program in the ICU, independently of clinical immunology/allergy services.
Materials and methods
Trained ICU staff prospectively identified and risk assessed eligible patients as having a non-immune mediated drug reaction, or a low, intermediate or high risk antibiotic allergy. Non-immune mediated reactions were directly de-labeled. Low-risk allergies underwent direct drug provocation testing, while intermediate-risk allergies included skin testing followed by drug provocation testing. High-risk allergies were confirmed without testing.
Results
Of 71 eligible patients, 62 underwent assessment. Antibiotic allergy de-labeling occurred in 48 of 51 patients (94 %) with a non-immune, low or intermediate risk allergy. High risk allergies were confirmed in 11 patients (18 %). The study resulted in increased penicillin use and decreased broad-spectrum antibiotic use. No adverse events occurred from testing.
Conclusions
This study shows the feasibility of ICU led antibiotic allergy assessment and testing, highlighting a potential model for implementation in settings lacking immunology/allergy services.
{"title":"Antibiotic allergy de-labeling in the intensive care unit: The prospective ADE-ICU study","authors":"Salma Alamin , Rachel Egan , Barbara Cusack , Amanda Sherwin , Emily Naylor , Fiona Carroll , Marie E. Ward , Mary Kelly , Deirdre Doyle , Ignacio Martin-Loeches , Niall Conlon , Sean Keane","doi":"10.1016/j.jcrc.2024.154977","DOIUrl":"10.1016/j.jcrc.2024.154977","url":null,"abstract":"<div><h3>Purpose</h3><div>Critically ill patients in the intensive care unit (ICU) are frequently prescribed antibiotics, with many reporting an antibiotic allergy label, predominantly to penicillin. Mislabeling contributes to suboptimal antibiotic use, increasing multidrug-resistant organisms and <em>Clostridium difficile</em> infections, and increased hospital length of stay. This prospective study implemented an antibiotic allergy assessment and testing program in the ICU, independently of clinical immunology/allergy services.</div></div><div><h3>Materials and methods</h3><div>Trained ICU staff prospectively identified and risk assessed eligible patients as having a non-immune mediated drug reaction, or a low, intermediate or high risk antibiotic allergy. Non-immune mediated reactions were directly de-labeled. Low-risk allergies underwent direct drug provocation testing, while intermediate-risk allergies included skin testing followed by drug provocation testing. High-risk allergies were confirmed without testing.</div></div><div><h3>Results</h3><div>Of 71 eligible patients, 62 underwent assessment. Antibiotic allergy de-labeling occurred in 48 of 51 patients (94 %) with a non-immune, low or intermediate risk allergy. High risk allergies were confirmed in 11 patients (18 %). The study resulted in increased penicillin use and decreased broad-spectrum antibiotic use. No adverse events occurred from testing.</div></div><div><h3>Conclusions</h3><div>This study shows the feasibility of ICU led antibiotic allergy assessment and testing, highlighting a potential model for implementation in settings lacking immunology/allergy services.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154977"},"PeriodicalIF":3.2,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-27DOI: 10.1016/j.jcrc.2024.154981
Niek Kok , Cornelia Hoedemaekers , Malaika Fuchs , Alexander D. Cornet , Esther Ewalds , Harold Hom , Esther Meijer , Iwan Meynaar , Margo van Mol , Walther van Mook , Mariëlle van der Steen-Dieperink , Arthur van Zanten , Hans van der Hoeven , Jelle van Gurp , Marieke Zegers
Purpose
Organizational culture is considered a protective factor against burnout among ICU professionals. The aim of this study is to study the association between organizational culture as a potential antecedent to previously found mediating risk factors for burnout, namely, work-life balance and moral distress.
Materials and methods
Multicenter cross sectional study in eleven Dutch ICUs. The primary outcome measure was the core symptom of burnout, emotional exhaustion, measured using the validated Dutch version of the Maslach Burnout Inventory. Organizational culture was assessed using the Culture of Care Barometer, which measures five aspects of organizational culture. Moral distress and work-life balance were measured with validated questionnaires.
Results
696 ICU professionals (39.7 %) responded. All aspects of the CoCB were negatively associated with the emotional exhaustion component of burnout, both in univariable and multivariable models. Four aspects of organizational culture were significantly associated to the serial association between moral distress, work-to-home spillovers, and emotional exhaustion. For these aspects, the total indirect association was equal or larger than the total direct association.
Conclusions
Multiple aspects of organizational culture reduce burnout among ICU professionals in a largely indirect manner, via moral distress and work-life balance. Improving organizational culture can mitigate burnout symptoms among ICU clinicians.
{"title":"The interplay between organizational culture and burnout among ICU professionals: A cross-sectional multicenter study","authors":"Niek Kok , Cornelia Hoedemaekers , Malaika Fuchs , Alexander D. Cornet , Esther Ewalds , Harold Hom , Esther Meijer , Iwan Meynaar , Margo van Mol , Walther van Mook , Mariëlle van der Steen-Dieperink , Arthur van Zanten , Hans van der Hoeven , Jelle van Gurp , Marieke Zegers","doi":"10.1016/j.jcrc.2024.154981","DOIUrl":"10.1016/j.jcrc.2024.154981","url":null,"abstract":"<div><h3>Purpose</h3><div>Organizational culture is considered a protective factor against burnout among ICU professionals. The aim of this study is to study the association between organizational culture as a potential antecedent to previously found mediating risk factors for burnout, namely, work-life balance and moral distress.</div></div><div><h3>Materials and methods</h3><div>Multicenter cross sectional study in eleven Dutch ICUs. The primary outcome measure was the core symptom of burnout, emotional exhaustion, measured using the validated Dutch version of the Maslach Burnout Inventory. Organizational culture was assessed using the Culture of Care Barometer, which measures five aspects of organizational culture. Moral distress and work-life balance were measured with validated questionnaires.</div></div><div><h3>Results</h3><div>696 ICU professionals (39.7 %) responded. All aspects of the CoCB were negatively associated with the emotional exhaustion component of burnout, both in univariable and multivariable models. Four aspects of organizational culture were significantly associated to the serial association between moral distress, work-to-home spillovers, and emotional exhaustion. For these aspects, the total indirect association was equal or larger than the total direct association.</div></div><div><h3>Conclusions</h3><div>Multiple aspects of organizational culture reduce burnout among ICU professionals in a largely indirect manner, via moral distress and work-life balance. Improving organizational culture can mitigate burnout symptoms among ICU clinicians.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154981"},"PeriodicalIF":3.2,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-21DOI: 10.1016/j.jcrc.2024.154976
Rodolpho Augusto de Moura Pedro , Guilherme Bittar Cunha , Igor Pietrobom , Bruna Carla Scharanch , Daniel Caraca Cubos , Rafael Alves Franco , Fernando Zampieri , Thiago Gomes Romano
Introduction
Oliguria is commonly used as a cutoff for acute kidney injury (AKI), however, a decrease in urine output is common during surgery and may represent an adaptative response in the perioperative setting rather than a reduction in glomerular filtration rate, leading to a possible overestimation of postoperative AKI incidence. Although this dilemma has been addressed in the intraoperative scenario, the incidence and impact of oliguria in the first postoperative day represents a gap in the current literature. Our main goal is to describe the incidence, risk factors and clinical outcomes related to postoperative oliguria.
Methods
This was a retrospective cohort conducted in four intensive care units (ICUs) across two private Brazilian hospitals, analyzing patients admitted after intermediate and high-risk surgeries between January 1, 2018 and December 31, 2022.
Results
1476 patients were included in the final analysis. Overall, 656 (44,5 %) were males, and the median age was 61,7 years. Oliguria was identified in 508 (34,4 %) patients within the first 24 h after surgery. Vasopressor requirement at admission, non-elective procedures, male sex and baseline serum creatinine were higher among oliguric patients. Among oliguric patients, age and basal serum creatine were higher among those who experienced AKI. Although only 12,4 % of oliguric patients developed AKI according to serum creatinine criterion, this incidence was significantly higher than in non-oliguric group (3,6 %), RR 3.42, IC 95 % 2.3–5.1 (p < 0.01). AKI recovery, RRT, ICU and hospital free days, and mortality were similar between the groups.
Conclusions
Postoperative oliguria is common after intermediate and high-risk surgical procedures and increases the risk of AKI. However, oliguria was largely unrelated with kidney disfunction measured by serum creatinine (87,6 %), raising doubts on whether diuresis overestimates AKI incidence in the postoperative setting.
导言：少尿通常被用作急性肾损伤（AKI）的临界值，但尿量减少在手术过程中很常见，可能是围手术期的一种适应性反应，而不是肾小球滤过率的降低，从而可能导致术后 AKI 发生率被高估。尽管这一难题已在术中得到解决，但术后第一天少尿的发生率和影响仍是目前文献中的空白。我们的主要目标是描述与术后少尿相关的发生率、风险因素和临床结果：这是一项回顾性队列研究，在巴西两家私立医院的四个重症监护病房（ICU）进行，分析了2018年1月1日至2022年12月31日期间中高危手术后入院的患者：最终分析共纳入了 1476 名患者。其中 656 人（44.5%）为男性，年龄中位数为 61.7 岁。508名患者（34.4%）在术后24小时内出现少尿症状。入院时需要使用血管加压药、非选择性手术、男性和基线血清肌酐在少尿患者中的比例较高。在少尿患者中，出现 AKI 的患者年龄和基础血清肌酸酐较高。虽然根据血清肌酐标准，只有 12.4% 的少尿患者发生了 AKI，但这一发生率明显高于非少尿患者组（3.6%），RR 为 3.42，IC 95 % 为 2.3-5.1（p 结论：少尿患者中，年龄和基础血清肌酐较低的患者发生 AKI 的比例较高：术后少尿在中高风险外科手术后很常见，会增加发生 AKI 的风险。然而，少尿在很大程度上与以血清肌酐测量的肾功能失调无关（87.6%），这让人怀疑利尿是否会高估术后 AKI 的发生率。
{"title":"Postoperative oliguria after intermediate and high-risk surgeries in critical care, A cohort analysis","authors":"Rodolpho Augusto de Moura Pedro , Guilherme Bittar Cunha , Igor Pietrobom , Bruna Carla Scharanch , Daniel Caraca Cubos , Rafael Alves Franco , Fernando Zampieri , Thiago Gomes Romano","doi":"10.1016/j.jcrc.2024.154976","DOIUrl":"10.1016/j.jcrc.2024.154976","url":null,"abstract":"<div><h3>Introduction</h3><div>Oliguria is commonly used as a cutoff for acute kidney injury (AKI), however, a decrease in urine output is common during surgery and may represent an adaptative response in the perioperative setting rather than a reduction in glomerular filtration rate, leading to a possible overestimation of postoperative AKI incidence. Although this dilemma has been addressed in the intraoperative scenario, the incidence and impact of oliguria in the first postoperative day represents a gap in the current literature. Our main goal is to describe the incidence, risk factors and clinical outcomes related to postoperative oliguria.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort conducted in four intensive care units (ICUs) across two private Brazilian hospitals, analyzing patients admitted after intermediate and high-risk surgeries between January 1, 2018 and December 31, 2022.</div></div><div><h3>Results</h3><div>1476 patients were included in the final analysis. Overall, 656 (44,5 %) were males, and the median age was 61,7 years. Oliguria was identified in 508 (34,4 %) patients within the first 24 h after surgery. Vasopressor requirement at admission, non-elective procedures, male sex and baseline serum creatinine were higher among oliguric patients. Among oliguric patients, age and basal serum creatine were higher among those who experienced AKI. Although only 12,4 % of oliguric patients developed AKI according to serum creatinine criterion, this incidence was significantly higher than in non-oliguric group (3,6 %), RR 3.42, IC 95 % 2.3–5.1 (<em>p</em> < 0.01). AKI recovery, RRT, ICU and hospital free days, and mortality were similar between the groups.</div></div><div><h3>Conclusions</h3><div>Postoperative oliguria is common after intermediate and high-risk surgical procedures and increases the risk of AKI. However, oliguria was largely unrelated with kidney disfunction measured by serum creatinine (87,6 %), raising doubts on whether diuresis overestimates AKI incidence in the postoperative setting.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154976"},"PeriodicalIF":3.2,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692897","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 : 2024-11-14DOI: 10.1016/j.jcrc.2024.154950
Laurence W. Busse MD, MBA, FCCM , J. Pedro Teixeira MD , Christopher L. Schaich PhD , Caitlin C. ten Lohuis ACNP-BC , Nathan D. Nielsen MD, MSc , Jeffrey M. Sturek MD, PhD , Lisa H. Merck MD, MPH , Wesley H. Self MD, MPH , Michael A. Puskarich MD, MSCR , Akram Khan MBBS , Matthew W. Semler MD, MSc , Ari Moskowitz MD, MPH , David N. Hager MD, PhD , Abhijit Duggal MD, MPH, MSc , Todd W. Rice MD, MSc , Adit A. Ginde MD, MPH , Brian R. Tiffany MD, PhD , Nicole M. Iovine MD , Peter Chen MD , Basmah Safdar MD, MSc , Sean P. Collins MD, MSc
Background
Plasma dipeptidyl peptidase-3 (DPP3) and renin levels are associated with organ dysfunction and mortality. However, whether these biomarkers are associated with the subsequent onset of shock in at-risk patients is unknown.
Methods
Using plasma samples collected from participants enrolled in the fourth Accelerating COVID-19 Therapeutic Interventions and Vaccines Host Tissue platform trial, we measured DPP3 and renin in 184 subjects hospitalized with acute hypoxemia from COVID-19 without baseline vasopressor requirement. We calculated the odds ratio of development of shock (defined as the initiation of vasopressor therapy) by Day 28 based on Day 0 DPP3 and renin levels.
Results
Subjects with DPP3 above the median had a significantly higher incidence of vasopressor initiation within 28 days (28.4 % vs. 16.7 %, p = 0.031) and higher 28-day mortality (25.0 % vs. 6.7 %, p < 0.001). After adjusting for covariables, DPP3 above the median was associated with shorter time to vasopressor initiation, greater 28-day mortality, fewer vasopressor-free days, and greater odds of a hypotensive event over 7 days. Significant associations were not observed for renin.
Conclusions
In patients hospitalized with COVID-19 and hypoxemia without baseline hypotension, higher baseline plasma levels of DPP3 but not renin were associated with increased risk of subsequent shock and death.
背景：血浆二肽基肽酶-3（DPP3）和肾素水平与器官功能障碍和死亡率有关。然而，这些生物标志物是否与高危患者随后发生休克有关尚不清楚：我们使用从参加第四次加速 COVID-19 治疗干预和疫苗宿主组织平台试验的参与者处收集的血浆样本，测量了 184 名因 COVID-19 急性低氧血症住院且无基线血管加压需求的受试者的 DPP3 和肾素。我们根据第 0 天的 DPP3 和肾素水平计算了第 28 天发生休克（定义为开始使用血管加压疗法）的几率：结果：DPP3高于中位数的受试者在28天内启动血管加压疗法的发生率明显更高（28.4% vs. 16.7%，p = 0.031），28天死亡率也更高（25.0% vs. 6.7%，p 结论：DPP3高于中位数的受试者在28天内启动血管加压疗法的发生率明显更高（28.4% vs. 16.7%，p = 0.031），28天死亡率也更高（25.0% vs. 6.7%，p = 0.031）：在因 COVID-19 和低氧血症住院但无基线低血压的患者中，DPP3（而非肾素）的基线血浆水平越高，随后发生休克和死亡的风险就越高。
{"title":"Shock prediction with dipeptidyl peptidase-3 and renin (SPiDeR) in hypoxemic patients with COVID-19","authors":"Laurence W. Busse MD, MBA, FCCM , J. Pedro Teixeira MD , Christopher L. Schaich PhD , Caitlin C. ten Lohuis ACNP-BC , Nathan D. Nielsen MD, MSc , Jeffrey M. Sturek MD, PhD , Lisa H. Merck MD, MPH , Wesley H. Self MD, MPH , Michael A. Puskarich MD, MSCR , Akram Khan MBBS , Matthew W. Semler MD, MSc , Ari Moskowitz MD, MPH , David N. Hager MD, PhD , Abhijit Duggal MD, MPH, MSc , Todd W. Rice MD, MSc , Adit A. Ginde MD, MPH , Brian R. Tiffany MD, PhD , Nicole M. Iovine MD , Peter Chen MD , Basmah Safdar MD, MSc , Sean P. Collins MD, MSc","doi":"10.1016/j.jcrc.2024.154950","DOIUrl":"10.1016/j.jcrc.2024.154950","url":null,"abstract":"<div><h3>Background</h3><div>Plasma dipeptidyl peptidase-3 (DPP3) and renin levels are associated with organ dysfunction and mortality. However, whether these biomarkers are associated with the subsequent onset of shock in at-risk patients is unknown.</div></div><div><h3>Methods</h3><div>Using plasma samples collected from participants enrolled in the fourth Accelerating COVID-19 Therapeutic Interventions and Vaccines Host Tissue platform trial, we measured DPP3 and renin in 184 subjects hospitalized with acute hypoxemia from COVID-19 without baseline vasopressor requirement. We calculated the odds ratio of development of shock (defined as the initiation of vasopressor therapy) by Day 28 based on Day 0 DPP3 and renin levels.</div></div><div><h3>Results</h3><div>Subjects with DPP3 above the median had a significantly higher incidence of vasopressor initiation within 28 days (28.4 % vs. 16.7 %, <em>p</em> = 0.031) and higher 28-day mortality (25.0 % vs. 6.7 %, <em>p</em> < 0.001). After adjusting for covariables, DPP3 above the median was associated with shorter time to vasopressor initiation, greater 28-day mortality, fewer vasopressor-free days, and greater odds of a hypotensive event over 7 days. Significant associations were not observed for renin.</div></div><div><h3>Conclusions</h3><div>In patients hospitalized with COVID-19 and hypoxemia without baseline hypotension, higher baseline plasma levels of DPP3 but not renin were associated with increased risk of subsequent shock and death.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154950"},"PeriodicalIF":3.2,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638899","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 : 2024-11-11DOI: 10.1016/j.jcrc.2024.154945
Benjamin Assouline , Gianlucca Belli , Karim Dorgham , Quentin Moyon , Alexandre Coppens , Marc Pineton de Chambrun , Juliette Chommeloux , David Levy , Ouriel Saura , Guillaume Hekimian , Matthieu Schmidt , Alain Combes , Charles-Edouard Luyt
Purpose
Fever is frequent after extracorporeal membrane oxygenation (ECMO) decannulation. We aimed to evaluate the incidence of post-decannulation fever and describe its causes.
Methods
Adult ECMO patients who were successfully weaned from ECMO were retrospectively included. Minimal and maximal core temperatures were collected daily for each patient from 48 h before decannulation up to 5 days after. Patients were grouped according to the cause of fever (infection, thrombosis, or no evident cause) and compared. Plasma cytokine profile was obtained, each day from decannulation to 5 days after for 20 patients.
Results
Between January 2021 and December 2022, 123 patients successfully weaned from ECMO were included. Post-decannulation fever occurred in 54 patients (44 %). It was associated with an infection in 39 patients (72 %) and with a thrombosis in 6 patients (11 %), and no cause was identified in the remaining 9 (17 %). Prolonged ECMO duration, extended ICU length-of-stay, diabetes and vascular comorbidities were significantly associated with a higher risk of infection. Finally, the pro-inflammatory cytokine profiles did not differ between febrile and afebrile patients.
Conclusion
Post-decannulation fever was common, and was mainly due to infections or thrombosis. Fever should therefore not be considered as a benign inflammatory reaction until proven otherwise.
{"title":"Fever following extracorporeal membrane oxygenation decannulation: Infection, thrombosis or just physiology?","authors":"Benjamin Assouline , Gianlucca Belli , Karim Dorgham , Quentin Moyon , Alexandre Coppens , Marc Pineton de Chambrun , Juliette Chommeloux , David Levy , Ouriel Saura , Guillaume Hekimian , Matthieu Schmidt , Alain Combes , Charles-Edouard Luyt","doi":"10.1016/j.jcrc.2024.154945","DOIUrl":"10.1016/j.jcrc.2024.154945","url":null,"abstract":"<div><h3>Purpose</h3><div>Fever is frequent after extracorporeal membrane oxygenation (ECMO) decannulation. We aimed to evaluate the incidence of post-decannulation fever and describe its causes.</div></div><div><h3>Methods</h3><div>Adult ECMO patients who were successfully weaned from ECMO were retrospectively included. Minimal and maximal core temperatures were collected daily for each patient from 48 h before decannulation up to 5 days after. Patients were grouped according to the cause of fever (infection, thrombosis, or no evident cause) and compared. Plasma cytokine profile was obtained, each day from decannulation to 5 days after for 20 patients.</div></div><div><h3>Results</h3><div>Between January 2021 and December 2022, 123 patients successfully weaned from ECMO were included. Post-decannulation fever occurred in 54 patients (44 %). It was associated with an infection in 39 patients (72 %) and with a thrombosis in 6 patients (11 %), and no cause was identified in the remaining 9 (17 %). Prolonged ECMO duration, extended ICU length-of-stay, diabetes and vascular comorbidities were significantly associated with a higher risk of infection. Finally, the pro-inflammatory cytokine profiles did not differ between febrile and afebrile patients.</div></div><div><h3>Conclusion</h3><div>Post-decannulation fever was common, and was mainly due to infections or thrombosis. Fever should therefore not be considered as a benign inflammatory reaction until proven otherwise.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154945"},"PeriodicalIF":3.2,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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