Radiomics involves the integration of computer technology, big data analysis, and clinical medicine. Currently, there have been initial advancements in the fields of acute cerebrovascular disease and cardiovascular disease. The objective of radiomics is to extract quantitative features from medical images for analysis to predict the risk or treatment outcome, help in differential diagnosis, and guide clinical decisions and management. Radiomics applied research has reached a more advanced stage yet encounters several obstacles, including the need for standardization of radiomics features and alignment with treatment requirements for acute and severe illnesses. Future research should aim to seamlessly incorporate radiomics with various disciplines, leverage big data and artificial intelligence advancements, cater to the requirements of acute and critical medicine, and enhance the effectiveness of technological innovation and application in diagnosing and treating acute and critical illnesses.
{"title":"Application of radiomics in acute and severe non-neoplastic diseases: A literature review","authors":"Yu Fang , Qiannan Zhang , Jingjun Yan , Shanshan Yu","doi":"10.1016/j.jcrc.2025.155027","DOIUrl":"10.1016/j.jcrc.2025.155027","url":null,"abstract":"<div><div>Radiomics involves the integration of computer technology, big data analysis, and clinical medicine. Currently, there have been initial advancements in the fields of acute cerebrovascular disease and cardiovascular disease. The objective of radiomics is to extract quantitative features from medical images for analysis to predict the risk or treatment outcome, help in differential diagnosis, and guide clinical decisions and management. Radiomics applied research has reached a more advanced stage yet encounters several obstacles, including the need for standardization of radiomics features and alignment with treatment requirements for acute and severe illnesses. Future research should aim to seamlessly incorporate radiomics with various disciplines, leverage big data and artificial intelligence advancements, cater to the requirements of acute and critical medicine, and enhance the effectiveness of technological innovation and application in diagnosing and treating acute and critical illnesses.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"87 ","pages":"Article 155027"},"PeriodicalIF":3.2,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028808","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}
Onco-hematological (OH) patients face significant cardiovascular risks due to malignancy and drug toxicity. Data are limited on the characteristics and outcomes of OH patients with cardiogenic shock (CS) in intensive care units (ICUs).
Methods
This multicenter retrospective study included 214 OH patients with CS across 22 ICUs (2010−2021). The objectives were to (i) identify risk factors for 30-day mortality, (ii) describe early and long-term outcomes, and (iii) assess the prognostic impact of malignancy by comparing OH patients to a control group of CS patients.
Results
The 30-day survival rate was 44.8 %. Multivariate analysis identified previous cardiomyopathy (OR = 1.61), acute kidney injury (OR = 1.62), lactate levels (OR = 1.08 per 1 mmol/L), pulmonary embolism (OR = 3.04), invasive mechanical ventilation (OR = 3.48), and epinephrine use (OR = 2.09) as factors associated with 30-day mortality. Among ICU survivors, 54 % were alive at 1 year with a median left ventricular ejection fraction of 52 %. OH malignancy was significantly associated with 30-day mortality (HR 2.54).
Conclusion
The prognosis for OH patients with CS in the ICU is poor, with epinephrine use associated with worse outcomes. Further research is needed to refine risk stratification and improve treatments for this population.
{"title":"Cardiogenic shock in patients with active onco-hematological malignancies: A multicenter retrospective study","authors":"Mickael Lescroart , Hélène Kemp , Olivier Imauven , Jean Herlé Raphalen , François Bagate , Julien Schmidt , Nahema Issa , Maxens Decavele , Anne-Sophie Moreau , Fabienne Tamion , Bruno Mourvillier , Laure Calvet , Emmanuel Canet , Christine Lebert , Stephanie Pons , Guillaume Lacave , Florent Wallet , Hadrien Winiszewski , Hamid Merdji , Marc Pineton De Chambrun , Lara Zafrani","doi":"10.1016/j.jcrc.2025.155028","DOIUrl":"10.1016/j.jcrc.2025.155028","url":null,"abstract":"<div><h3>Purpose</h3><div>Onco-hematological (OH) patients face significant cardiovascular risks due to malignancy and drug toxicity. Data are limited on the characteristics and outcomes of OH patients with cardiogenic shock (CS) in intensive care units (ICUs).</div></div><div><h3>Methods</h3><div>This multicenter retrospective study included 214 OH patients with CS across 22 ICUs (2010−2021). The objectives were to (i) identify risk factors for 30-day mortality, (ii) describe early and long-term outcomes, and (iii) assess the prognostic impact of malignancy by comparing OH patients to a control group of CS patients.</div></div><div><h3>Results</h3><div>The 30-day survival rate was 44.8 %. Multivariate analysis identified previous cardiomyopathy (OR = 1.61), acute kidney injury (OR = 1.62), lactate levels (OR = 1.08 per 1 mmol/L), pulmonary embolism (OR = 3.04), invasive mechanical ventilation (OR = 3.48), and epinephrine use (OR = 2.09) as factors associated with 30-day mortality. Among ICU survivors, 54 % were alive at 1 year with a median left ventricular ejection fraction of 52 %. OH malignancy was significantly associated with 30-day mortality (HR 2.54).</div></div><div><h3>Conclusion</h3><div>The prognosis for OH patients with CS in the ICU is poor, with epinephrine use associated with worse outcomes. Further research is needed to refine risk stratification and improve treatments for this population.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"87 ","pages":"Article 155028"},"PeriodicalIF":3.2,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028810","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}
The optimal modalities of kidney replacement therapy (KRT) in the ICU remain debated. Intermittent haemodialysis (IHD) and continuous veno-venous haemofiltration (CVVH) are the two main methods. Intermittent haemodialysis requires a water treatment system, which may not be available in all jurisdictions. We report the experience of an innovative strategy of intermittent KRT without water treatment system.
Based on the manufacturer's recommendations, the dialysate flow during “CVVHDF post” (post-dilution continuous veno-venous haemodiafiltration) mode was increased by connecting the substitution pump in parallel with the dialysate pump using a Y-connector. This doubled the flow rate of dialysate, allowing for 9000 mL/h during intermittent KRT sessions at a blood flow rate of 250 mL/min. We called this technique “water treatment-free prolonged intermittent kidney replacement therapy” (WTF-PIKRT).
We report our experience in 18 patients who underwent 88 WTF-PIKRT sessions (median duration 5 h (IQR [4, 6])) between August 2019 and May 2020. The median urea reduction ratio was 38 % (IQR [29,49]). Hypotension occurred during 21.6 % of sessions. Hypokalemia or hypophosphatemia occurred in less than 5 % of sessions.
WTF-PIKRT represents an attractive alternative to conventional IHD when a water treatment system is not available. Despite its lower efficacy compared with IHD, it may have significant organizational and economic impact.
{"title":"Water treatment-free prolonged intermittent kidney replacement therapy: A new approach for kidney replacement therapy in the ICU setting. A retrospective study.","authors":"Noémie Zucman , Fabrice Uhel , Charles Verney , Jean-Damien Ricard , Didier Dreyfuss , Damien Roux","doi":"10.1016/j.jcrc.2025.155014","DOIUrl":"10.1016/j.jcrc.2025.155014","url":null,"abstract":"<div><div>The optimal modalities of kidney replacement therapy (KRT) in the ICU remain debated. Intermittent haemodialysis (IHD) and continuous veno-venous haemofiltration (CVVH) are the two main methods. Intermittent haemodialysis requires a water treatment system, which may not be available in all jurisdictions. We report the experience of an innovative strategy of intermittent KRT without water treatment system.</div><div>Based on the manufacturer's recommendations, the dialysate flow during “CVVHDF post” (post-dilution continuous veno-venous haemodiafiltration) mode was increased by connecting the substitution pump in parallel with the dialysate pump using a Y-connector. This doubled the flow rate of dialysate, allowing for 9000 mL/h during intermittent KRT sessions at a blood flow rate of 250 mL/min. We called this technique “water treatment-free prolonged intermittent kidney replacement therapy” (WTF-PIKRT).</div><div>We report our experience in 18 patients who underwent 88 WTF-PIKRT sessions (median duration 5 h (IQR [4, 6])) between August 2019 and May 2020. The median urea reduction ratio was 38 % (IQR [29,49]). Hypotension occurred during 21.6 % of sessions. Hypokalemia or hypophosphatemia occurred in less than 5 % of sessions.</div><div>WTF-PIKRT represents an attractive alternative to conventional IHD when a water treatment system is not available. Despite its lower efficacy compared with IHD, it may have significant organizational and economic impact.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"87 ","pages":"Article 155014"},"PeriodicalIF":3.2,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970921","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}
Hypernatremia is relatively common in acutely ill patients and associated with mortality. Guidelines recommend a slow rate of correction (≤ 0.5 mmol/L per hour). However, a faster correction rate may be safe and improve outcomes.
Objectives
To evaluate the impact of sodium correction rates on mortality and hospital length of stay and to assess types of hypernatremia treatment and treatment side effects.
Methods
We conducted a systematic review and meta-analysis according to PRISMA guidelines, searching Ovid MEDLINE, Embase, and CENTRAL databases from inception to August 2024. Studies reporting sodium correction rates and clinical outcomes in hospitalized adults were included. A random-effects meta-analysis assessed mortality and hospital length of stay, with subgroup analyses exploring correction timing and severity. Treatment method and side effects were analyzed qualitatively.
Results
We reviewed 4445 articles and included 12 studies. Faster correction rates (> 0.5 mmol/L/h) overall showed no significant change in mortality and a high level of heterogeneity (OR 0.68, 95 % CI: 0.38–1.24, I2 = 95 %). However, subgroup analyses found significantly lower mortality with faster correction of hypernatremia at the time of hospital admission (OR 0.48, 95 % CI: 0.35–0.68, I2 = 2 %), with fast correction within the first 24 h of diagnosis (OR 0.48, 95 % CI: 0.31–0.73, I2 = 65 %), and for severe hypernatremia (OR 0.55, 95 % CI: 0.33–0.92, I2 = 79 %). There was no significant different in hospital length of stay by correction rate. No major neurological complications were reported when the correction rate was < 1 mmol/L/h.
Conclusion
Faster sodium correction appears safe and may benefit patients with severe admission-related hypernatremia, particularly within the first 24 h. Further studies are needed to refine correction protocols.
{"title":"Systematic review and meta-analysis of the treatment of hypernatremia in adult hospitalized patients: impact on mortality, morbidity, and treatment-related side effects","authors":"Nuanprae Kitisin , Nattaya Raykateeraroj , Yukiko Hikasa , Larissa Bianchini , Nuttapol Pattamin , Anis Chaba , Akinori Maeda , Sofia Spano , Glenn Eastwood , Kyle White , Rinaldo Bellomo","doi":"10.1016/j.jcrc.2024.155012","DOIUrl":"10.1016/j.jcrc.2024.155012","url":null,"abstract":"<div><h3>Background</h3><div>Hypernatremia is relatively common in acutely ill patients and associated with mortality. Guidelines recommend a slow rate of correction (≤ 0.5 mmol/L per hour). However, a faster correction rate may be safe and improve outcomes.</div></div><div><h3>Objectives</h3><div>To evaluate the impact of sodium correction rates on mortality and hospital length of stay and to assess types of hypernatremia treatment and treatment side effects.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and meta-analysis according to PRISMA guidelines, searching Ovid MEDLINE, Embase, and CENTRAL databases from inception to August 2024. Studies reporting sodium correction rates and clinical outcomes in hospitalized adults were included. A random-effects meta-analysis assessed mortality and hospital length of stay, with subgroup analyses exploring correction timing and severity. Treatment method and side effects were analyzed qualitatively.</div></div><div><h3>Results</h3><div>We reviewed 4445 articles and included 12 studies. Faster correction rates (> 0.5 mmol/L/h) overall showed no significant change in mortality and a high level of heterogeneity (OR 0.68, 95 % CI: 0.38–1.24, I<sup>2</sup> = 95 %). However, subgroup analyses found significantly lower mortality with faster correction of hypernatremia at the time of hospital admission (OR 0.48, 95 % CI: 0.35–0.68, I<sup>2</sup> = 2 %), with fast correction within the first 24 h of diagnosis (OR 0.48, 95 % CI: 0.31–0.73, I<sup>2</sup> = 65 %), and for severe hypernatremia (OR 0.55, 95 % CI: 0.33–0.92, I<sup>2</sup> = 79 %). There was no significant different in hospital length of stay by correction rate. No major neurological complications were reported when the correction rate was < 1 mmol/L/h.</div></div><div><h3>Conclusion</h3><div>Faster sodium correction appears safe and may benefit patients with severe admission-related hypernatremia, particularly within the first 24 h. Further studies are needed to refine correction protocols.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"87 ","pages":"Article 155012"},"PeriodicalIF":3.2,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143092707","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 : 2025-01-03DOI: 10.1016/j.jcrc.2024.155011
Kamel A. Gharaibeh , Mohammad O. Abdelhafez , Kolman E.B. Guedze , Hussain Siddiqi , Abdurrahman M. Hamadah , Avelino C. Verceles
Purpose
This study evaluated the impact of choosing the right versus left internal jugular vein (IJV) for initial central venous catheter (CVC) placement on hemodialysis catheter-related outcomes in critically ill patients.
Materials and methods
Medical records from the University of Maryland Medical Center were reviewed for adult critical care patients who received an IJV CVC between January 1, 2019, and December 31, 2022, and later required an additional temporary hemodialysis catheter.
Results
The study included 214 patients, with 100 (46.7 %) receiving the primary CVC in the right IJV and 114 (53.3 %) in the left IJV. The right IJV group had higher hemodialysis catheter re-insertion rates (40 % vs. 2.6 % in the left IJV group, P < 0.001) related to using a different site other than the right IJV for the initial hemodialysis catheter (85 % for the right IJV group vs. 1.75 % for the left IJV group). Hemodialysis catheters were exchanged over a guidewire in 23 % of the right IJV group vs. 0.9 % in the left IJV group (P < 0.001). Additionally, 38 % of patients in the right IJV group required three venous access interventions, with 14 % needing four or more, versus only 2.6 % requiring three interventions in the left IJV group.
Conclusions
Initiating CVC placement in the right IJV in critically ill patients is associated with a higher risk of hemodialysis catheter re-catheterization related to the use of veins other than the right IJV for hemodialysis catheter placement and an increased need for venous access interventions compared to placement in the left IJV.
{"title":"Impact of initial jugular vein insertion site selection for central venous catheter placement on hemodialysis catheter complications","authors":"Kamel A. Gharaibeh , Mohammad O. Abdelhafez , Kolman E.B. Guedze , Hussain Siddiqi , Abdurrahman M. Hamadah , Avelino C. Verceles","doi":"10.1016/j.jcrc.2024.155011","DOIUrl":"10.1016/j.jcrc.2024.155011","url":null,"abstract":"<div><h3>Purpose</h3><div>This study evaluated the impact of choosing the right versus left internal jugular vein (IJV) for initial central venous catheter (CVC) placement on hemodialysis catheter-related outcomes in critically ill patients.</div></div><div><h3>Materials and methods</h3><div>Medical records from the University of Maryland Medical Center were reviewed for adult critical care patients who received an IJV CVC between January 1, 2019, and December 31, 2022, and later required an additional temporary hemodialysis catheter.</div></div><div><h3>Results</h3><div>The study included 214 patients, with 100 (46.7 %) receiving the primary CVC in the right IJV and 114 (53.3 %) in the left IJV. The right IJV group had higher hemodialysis catheter re-insertion rates (40 % vs. 2.6 % in the left IJV group, <em>P</em> < 0.001) related to using a different site other than the right IJV for the initial hemodialysis catheter (85 % for the right IJV group vs. 1.75 % for the left IJV group). Hemodialysis catheters were exchanged over a guidewire in 23 % of the right IJV group vs. 0.9 % in the left IJV group (<em>P</em> < 0.001). Additionally, 38 % of patients in the right IJV group required three venous access interventions, with 14 % needing four or more, versus only 2.6 % requiring three interventions in the left IJV group.</div></div><div><h3>Conclusions</h3><div>Initiating CVC placement in the right IJV in critically ill patients is associated with a higher risk of hemodialysis catheter re-catheterization related to the use of veins other than the right IJV for hemodialysis catheter placement and an increased need for venous access interventions compared to placement in the left IJV.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"87 ","pages":"Article 155011"},"PeriodicalIF":3.2,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927251","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 : 2025-01-02DOI: 10.1016/j.jcrc.2024.155010
Xueqi Wang, Jin Tang, Yajing Feng, Cijun Tang, Xuebin Wang
Background
The use of ChatGPT in medical applications is of increasing interest. However, its efficacy in critical care medicine remains uncertain. This study aims to assess ChatGPT-4's performance in critical care examination, providing insights into its potential as a tool for clinical decision-making.
Methods
A dataset from the Chinese Health Professional Technical Qualification Examination for Critical Care Medicine, covering four components—fundamental knowledge, specialized knowledge, professional practical skills, and related medical knowledge—was utilized. ChatGPT-4 answered 600 questions, which were evaluated by critical care experts using a standardized rubric.
Results
ChatGPT-4 achieved a 73.5 % success rate, surpassing the 60 % passing threshold in four components, with the highest accuracy in fundamental knowledge (81.94 %). ChatGPT-4 performed significantly better on single-choice questions than on multiple-choice questions (76.72 % vs. 51.32 %, p < 0.001), while no significant difference was observed between case-based and non-case-based questions.
Conclusion
ChatGPT demonstrated notable strengths in critical care examination, highlighting its potential for supporting clinical decision-making, information retrieval, and medical education. However, caution is required regarding its potential to generate inaccurate responses. Its application in critical care must therefore be carefully supervised by medical professionals to ensure both the accuracy of the information and patient safety.
{"title":"Can ChatGPT-4 perform as a competent physician based on the Chinese critical care examination?","authors":"Xueqi Wang, Jin Tang, Yajing Feng, Cijun Tang, Xuebin Wang","doi":"10.1016/j.jcrc.2024.155010","DOIUrl":"10.1016/j.jcrc.2024.155010","url":null,"abstract":"<div><h3>Background</h3><div>The use of ChatGPT in medical applications is of increasing interest. However, its efficacy in critical care medicine remains uncertain. This study aims to assess ChatGPT-4's performance in critical care examination, providing insights into its potential as a tool for clinical decision-making.</div></div><div><h3>Methods</h3><div>A dataset from the Chinese Health Professional Technical Qualification Examination for Critical Care Medicine, covering four components—fundamental knowledge, specialized knowledge, professional practical skills, and related medical knowledge—was utilized. ChatGPT-4 answered 600 questions, which were evaluated by critical care experts using a standardized rubric.</div></div><div><h3>Results</h3><div>ChatGPT-4 achieved a 73.5 % success rate, surpassing the 60 % passing threshold in four components, with the highest accuracy in fundamental knowledge (81.94 %). ChatGPT-4 performed significantly better on single-choice questions than on multiple-choice questions (76.72 % vs. 51.32 %, <em>p</em> < 0.001), while no significant difference was observed between case-based and non-case-based questions.</div></div><div><h3>Conclusion</h3><div>ChatGPT demonstrated notable strengths in critical care examination, highlighting its potential for supporting clinical decision-making, information retrieval, and medical education. However, caution is required regarding its potential to generate inaccurate responses. Its application in critical care must therefore be carefully supervised by medical professionals to ensure both the accuracy of the information and patient safety.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"86 ","pages":"Article 155010"},"PeriodicalIF":3.2,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143098889","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 : 2024-12-26DOI: 10.1016/j.jcrc.2024.155008
Yudai Iwasaki, Takayuki Ogura
{"title":"Letter to the editor: “Platelet dysfunction in heatstroke-induced coagulopathy: A retrospective observational study”","authors":"Yudai Iwasaki, Takayuki Ogura","doi":"10.1016/j.jcrc.2024.155008","DOIUrl":"10.1016/j.jcrc.2024.155008","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"86 ","pages":"Article 155008"},"PeriodicalIF":3.2,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894949","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}
The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a cardiocirculatory support has tremendously increased in critically ill patients. Although fluid therapy is an essential component of the hemodynamic management of VA-ECMO patients, the optimal fluid resuscitation strategy remains controversial. We performed a scoping review to map out the existing knowledge on fluid management in terms of fluid type, dosing and the impact of fluid balance on VA-ECMO patient outcomes.
Methods
A literature search within PubMed and EMBASE was conducted from database inception to April 2024. We included all studies involving critically ill adult patients, supported by VA-ECMO regardless of clinical indication (cardiogenic shock or extracorporeal cardiopulmonary resuscitation) with or without Renal Replacement Therapy and describing fluid resuscitation strategies or focusing on fluid type or reporting the impact of fluid balance on clinical outcomes and mortality. Details of study population, ECMO indications, fluid types, resuscitation strategies, fluid balance and outcome measures were extracted.
Results
Sixteen studies met inclusion criteria, including 14 clinical studies and two experimental animal studies. We found a lack of studies comparing restrictive and liberal approaches. No study has compared the efficacy and safety of balanced and saline solutions. The place of albumin, as an alternative fluid, should be investigated. Despite their heterogeneity, studies found a negative impact of both early and cumulative fluid overload on survival and renal outcomes.
Conclusions
The available literature on the fluid management in VA-ECMO setting is scarce. More high-quality evidence is needed regarding optimal fluid dosing, type and resuscitation endpoints in order to standardize practice and improve outcomes.
{"title":"Fluid management in adult patients undergoing venoarterial extracorporeal membrane oxygenation: A scoping review","authors":"Ali Jendoubi , Quentin de Roux , Solène Ribot , Aurore Vanden Bulcke , Camille Miard , Bérénice Tiquet , Bijan Ghaleh , Renaud Tissier , Matthias Kohlhauer , Nicolas Mongardon","doi":"10.1016/j.jcrc.2024.155007","DOIUrl":"10.1016/j.jcrc.2024.155007","url":null,"abstract":"<div><h3>Background</h3><div>The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a cardiocirculatory support has tremendously increased in critically ill patients. Although fluid therapy is an essential component of the hemodynamic management of VA-ECMO patients, the optimal fluid resuscitation strategy remains controversial. We performed a scoping review to map out the existing knowledge on fluid management in terms of fluid type, dosing and the impact of fluid balance on VA-ECMO patient outcomes.</div></div><div><h3>Methods</h3><div>A literature search within PubMed and EMBASE was conducted from database inception to April 2024. We included all studies involving critically ill adult patients, supported by VA-ECMO regardless of clinical indication (cardiogenic shock or extracorporeal cardiopulmonary resuscitation) with or without Renal Replacement Therapy and describing fluid resuscitation strategies or focusing on fluid type or reporting the impact of fluid balance on clinical outcomes and mortality. Details of study population, ECMO indications, fluid types, resuscitation strategies, fluid balance and outcome measures were extracted.</div></div><div><h3>Results</h3><div>Sixteen studies met inclusion criteria, including 14 clinical studies and two experimental animal studies. We found a lack of studies comparing restrictive and liberal approaches. No study has compared the efficacy and safety of balanced and saline solutions. The place of albumin, as an alternative fluid, should be investigated. Despite their heterogeneity, studies found a negative impact of both early and cumulative fluid overload on survival and renal outcomes.</div></div><div><h3>Conclusions</h3><div>The available literature on the fluid management in VA-ECMO setting is scarce. More high-quality evidence is needed regarding optimal fluid dosing, type and resuscitation endpoints in order to standardize practice and improve outcomes.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"86 ","pages":"Article 155007"},"PeriodicalIF":3.2,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877225","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号