Critical care science最新文献

A 26-year-old female with a history of depression was admitted after ingesting 7.5g of bupropion. Her clinical status rapidly deteriorated into a coma and myoclonic status, which was complicated by lung aspiration. Initial treatment with high-dose midazolam and later propofol failed to control her myoclonus. Sevoflurane inhalation therapy (6.5 mg/hour) was initiated, and complete resolution of myoclonus was achieved within hours. Propofol was discontinued, and the sevoflurane dose was gradually tapered over 24 hours without myoclonus recurrence. The patient awoke agitated but neurologically intact, was extubated, and fully recovered by Day 10. This case highlights the efficacy of sevoflurane in managing refractory myoclonic status due to bupropion toxicity, especially when electroencephalogram monitoring is unavailable. Sevoflurane rapid titration and elimination allow precise sedation control and safe neurological assessment. Inhaled anesthetics may also be beneficial in other ICU scenarios, including status epilepticus, severe asthma, and hemodynamic instability. This successful outcome demonstrates the potential of sevoflurane as an alternative therapy in critical toxicological emergencies.

Objective: To assess whether surface disinfection with organosilane in the intensive care unit reduces the occurrence of healthcare-associated infections.

Methods: This multicenter, controlled, cluster-randomized trial includes 14 intensive care units in Brazil from November 2023 to December 2024. The local hygiene team of the included intensive care units will disinfect bed surfaces with organosilane or with usual care for 6 months, followed by a sequential crossover of another 6 months. The primary outcome is the incidence of healthcare-associated infections, specifically ventilator-associated pneumonia, central-line-associated bloodstream infections, and catheter-associated urinary tract infections. The secondary endpoints are the contamination of the environment by multidrug-resistant microorganisms (i.e., oxacillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus faecium, carbapenem-resistant Enterobacter, Pseudomonas, and Acinetobacter), the incidence of specific infections (i.e., ventilator-associated pneumonia, central-line associated bloodstream infection, and catheter-associated urinary tract infection) and the cost of the patient's intensive care unit stay. We will enroll all adult patients admitted after the study begins in each participant's intensive care unit.

Ethics and dissemination: The institutional review board of the coordinator center and each enrolled center approved the study protocol. We will disseminate the results in peer-reviewed journals and at scientific meetings, regardless of the study's outcome.

Critical illnesses such as sepsis and acute respiratory distress syndrome lead to millions of deaths globally, with a higher burden in low- and middle-income countries. Conducting multicentric clinical studies is essential to help minimize the burden of critical illnesses, particularly in areas where their impact is greater. However, conducting large-scale multicentric studies is challenging, and most large multicentric studies in critical care are from high-income countries, which limits their relevance in other contexts. This highlights the need for collaborative research networks in low- and middle-income countries to better address local needs. The Brazilian Research in Intensive Care Network (BRICNet) was created by a group of intensivists and researchers in 2007 and is dedicated to being the leading organization in Brazil for conducting collaborative clinical research to improve care for critically ill patients. BRICNet focuses on investigator-initiated and collaborative studies relevant to global intensive care, with a special emphasis on Brazilian context. Its mission includes advancing research methodology, scientific writing, and conducting large-scale multicenter studies to fill knowledge gaps in critical care. Since its creation, the network has published 71 articles, including 15 randomized controlled trials and 14 observational studies, many of them in collaboration with major Brazilian institutions and international networks. This review aims to critically assess the achievements of BRICNet, highlighting its high-impact publications, international partnerships, and capacity building, which have significantly contributed to the field of intensive care. Looking ahead, we also identify barriers and solutions for sustainable growth.