Critical care science最新文献

Objective: To evaluate the impact of noninvasive ventilation versus bag-valve-mask ventilation preoxygenation on safety and efficacy outcomes.

Methods: PubMed, Embase, and Cochrane databases were searched for randomized controlled trials that compared preoxygenation using noninvasive ventilation and bag-valve-mask ventilation. The reported outcomes were all-cause mortality; hypoxemia during intubation; and regurgitation. We perform frequentist and Bayesian analysis. Heterogeneity was examined with I2 statistics. Statistical analysis was done using RStudio and Review Manager.

Results: We included 3 randomized controlled trials with 1,555 patients, of whom 771 (49.6%) received preoxygenation with noninvasive ventilation (intervention group). Hypoxemia during intubation was significantly lower in the noninvasive ventilation compared to the bag-valve-mask ventilation group in frequentist with a pooled log RR of -0.94 (log RR -0.94; 95%CI -1.61 - -0.28) and Bayesian pooled log risk ratio of -0.32 (log RR -0.32; 95% credible interval -0.91 - 0.40). Regurgitation was a safety outcome that did not present a difference between the groups in the frequentist or Bayesian models, with log RR -0.50 (log RR -0.50; 95% credible interval -2.09 - 1.01). There was no significant difference between groups in all-cause mortality and other secondary outcomes.

Conclusion: Preoxygenation with noninvasive ventilation significantly reduces the risk of hypoxemia during emergency intubation compared to bag-valve-mask ventilation. However, there were no significant differences in all-cause mortality or regurgitation rates.

Objective: To assess the prevalence and evolution of acid-base disturbances at intensive care unit admission and throughout hospitalization and their association with intensive care unit mortality.

Methods: A retrospective epidemiological study was conducted, analyzing consecutive patients admitted to a single intensive care unit.

Results: Metabolic acidosis, either isolated or combined with other disturbances, was the most prevalent disorder (58.0%), followed by respiratory alkalosis (37.6%), respiratory acidosis (25.7%), and metabolic alkalosis (12.8%). Multivariate analysis demonstrated that metabolic alkalosis combined with respiratory alkalosis was independently associated with reduced mortality (OR 0.427, 95%CI 0.194 - 0.869). Higher standard base excess at intensive care unit admission was correlated with lower mortality (OR 0.973, 95%CI 0.956 - 0.990). Maximum pCO2 variation during hospitalization showed no significant association with mortality. However, greater standard base excess improvement was independently linked to reduced mortality in patients with intensive care unit stays exceeding 5 days. Additionally, disease severity markers and younger age were predictive of metabolic acidosis both at admission and during hospitalization.

Conclusion: Metabolic acidosis was the most common acid-base disorder at intensive care unit admission, with lower standard base excess levels associated with increased mortality. Standard base excess improvement during prolonged intensive care unit stays correlated with improved survival. Disease severity indicators were predictive of metabolic acidosis upon admission and throughout hospitalization.

Background: Intensive care unit registries, which aim to improve the quality of intensive care unit care through benchmarking and quality improvement initiatives, are active worldwide, with considerable dishomogeneity. We aimed to map core datasets, additional variables, and research activities of these registries.

Methods: A cross-sectional survey was disseminated to registry leads between October 2023 and June 2024. The survey was structured into four main topics: registry characteristics and coverage, core dataset features, additional modules, and registry-enabled research.

Results: Leads of 34/42 national registries responded (response rate 81%), covering 3,337 intensive care units, with a larger representation from South America. Systematized nomenclature of medicine, clinical terms, and customized categorical classifications were the main nomenclatures used. All registries except one employed a severity of illness score/risk prediction model. The SOFA score was reported by 88% of registries. Organ support measures were often recorded, including mechanical ventilation (97%), vasopressor administration (86%) and renal replacement therapy (86%). Three out of four intensive care unit registries coded interventions such as intubations, intravenous lines and tracheostomies. Additional datasets differed, with many use cases for nosocomial infection burden, bed availability and staffing resources. Over half of intensive care unit registries had current structured quality improvement initiatives. Registry-enabled observational research was reported in 46% of registries, while interventional studies were reported in only 22%.

Conclusion: Over three thousand intensive care units in 35 countries participate in an intensive care unit registry. Despite heterogeneity in coding systems, risk models, and additional datasets, we identify several areas of convergence that may inform a future shared core dataset. There is potential for further intensive care unit registry-based research, particularly interventional.

Objective: To assess the perceptions of intensive care unit health care professionals in Brazil regarding postintensive care syndrome and the importance attributed to it by individuals and institutions.

Methods: A web-based survey was conducted among intensive care unit professionals across all five Brazilian geopolitical regions. The questionnaire was used to collect demographic and professional data and to explore participants' perceptions of postintensive care syndrome, including a focus on patient/family-centered outcomes and long-term intensive care unit consequences.

Results: A total of 1,527 intensive care unit professionals responded, 61.3% of whom were women. The responses represented 12 professional categories, including physicians (51.1%), physiotherapists (16.9%), nurses (12.7%), and psychologists (5.8%). Among the participants, 50.4% had training or certification in critical care, and 59.9% had more than five years of experience. However, 24% had never heard of postintensive care syndrome. Awareness was significantly higher among those with specialized training (85.2% versus 66.6%; p < 0.001). Only 26.4% reported that their institutions had protocols for postintensive care syndrome assessment before hospital discharge. A significant difference emerged between individual and institutional priorities regarding patient/family-centered outcomes and postintensive care unit care (p < 0.001). In 60% of the cases, intensive care unit teams were not involved in patients' hospital discharge.

Conclusion: Despite moderate awareness of postintensive care syndrome among intensive care unit professionals, there is a considerable gap between staff and the institutional prioritization of postintensive care unit care in Brazil. This highlights the need to increase awareness and develop structured postintensive care unit care protocols, ensuring improved long-term outcomes for intensive care unit patients and their families.