Pub Date : 2024-01-01DOI: 10.1016/j.jointm.2023.07.006
Nishel M Shah , Esmita Charani , Damien Ming , Fook-Choe Cheah , Mark R Johnson
Pregnant and postnatal women are a high-risk population particularly prone to rapid progression to sepsis with significant morbidity and mortality worldwide. Moreover, severe maternal infections can have a serious detrimental impact on neonates with almost 1 million neonatal deaths annually attributed to maternal infection or sepsis. In this review we discuss the susceptibility of pregnant women and their specific physiological and immunological adaptations that contribute to their vulnerability to sepsis, the implications for the neonate, as well as the issues with antimicrobial stewardship and the challenges this poses when attempting to reach a balance between clinical care and urgent treatment. Finally, we review advancements in the development of pregnancy-specific diagnostic and therapeutic approaches and how these can be used to optimize the care of pregnant women and neonates.
{"title":"Antimicrobial stewardship and targeted therapies in the changing landscape of maternal sepsis","authors":"Nishel M Shah , Esmita Charani , Damien Ming , Fook-Choe Cheah , Mark R Johnson","doi":"10.1016/j.jointm.2023.07.006","DOIUrl":"10.1016/j.jointm.2023.07.006","url":null,"abstract":"<div><p>Pregnant and postnatal women are a high-risk population particularly prone to rapid progression to sepsis with significant morbidity and mortality worldwide. Moreover, severe maternal infections can have a serious detrimental impact on neonates with almost 1 million neonatal deaths annually attributed to maternal infection or sepsis. In this review we discuss the susceptibility of pregnant women and their specific physiological and immunological adaptations that contribute to their vulnerability to sepsis, the implications for the neonate, as well as the issues with antimicrobial stewardship and the challenges this poses when attempting to reach a balance between clinical care and urgent treatment. Finally, we review advancements in the development of pregnancy-specific diagnostic and therapeutic approaches and how these can be used to optimize the care of pregnant women and neonates.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X23000543/pdfft?md5=e2f079ef23a4978f8424cf9a0152fe85&pid=1-s2.0-S2667100X23000543-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135347949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-27DOI: 10.1016/j.jointm.2023.11.005
Sebastian Berger , Pascale Grzonka , Simon A. Amacher , Sabina Hunziker , Anja I. Frei , Raoul Sutter
Physical restraints are widely used and accepted as protective measures during treatment in intensive care unit (ICU). This review of the literature summarizes the adverse events and outcomes associated with physical restraint use, and the risk factors associated with their use during treatment in the ICU. The PubMed, Scopus, and Google Scholar databases were screened using predefined search terms to identify studies pertaining to adverse events and/or outcomes associated with physical restraint use, and the factors associated with their use in adult patients admitted to the ICU. A total of 24 articles (including 6126 patients) that were published between 2006 and 2022 were identified. The described adverse events associated with physical restraint use included skin injuries, subsequent delirium, neurofunctional impairment, and a higher rate of post-traumatic stress disorder. Subsequent delirium was the most frequent adverse event to be reported. No alternative measures to physical restraints were discussed, and only one study reported a standardized protocol for their use. Although physical restraint use has been reported to be associated with adverse events (including neurofunctional impairment) in the literature, the available evidence is limited. Although causality cannot be confirmed, a definite association appears to exist. Our findings suggest that it is essential to improve awareness regarding their adverse impact and optimize approaches for their detection, management, and prevention using protocols or checklists.
{"title":"Adverse events related to physical restraint use in intensive care units: A review of the literature","authors":"Sebastian Berger , Pascale Grzonka , Simon A. Amacher , Sabina Hunziker , Anja I. Frei , Raoul Sutter","doi":"10.1016/j.jointm.2023.11.005","DOIUrl":"https://doi.org/10.1016/j.jointm.2023.11.005","url":null,"abstract":"<div><p>Physical restraints are widely used and accepted as protective measures during treatment in intensive care unit (ICU). This review of the literature summarizes the adverse events and outcomes associated with physical restraint use, and the risk factors associated with their use during treatment in the ICU. The PubMed, Scopus, and Google Scholar databases were screened using predefined search terms to identify studies pertaining to adverse events and/or outcomes associated with physical restraint use, and the factors associated with their use in adult patients admitted to the ICU. A total of 24 articles (including 6126 patients) that were published between 2006 and 2022 were identified. The described adverse events associated with physical restraint use included skin injuries, subsequent delirium, neurofunctional impairment, and a higher rate of post-traumatic stress disorder. Subsequent delirium was the most frequent adverse event to be reported. No alternative measures to physical restraints were discussed, and only one study reported a standardized protocol for their use. Although physical restraint use has been reported to be associated with adverse events (including neurofunctional impairment) in the literature, the available evidence is limited. Although causality cannot be confirmed, a definite association appears to exist. Our findings suggest that it is essential to improve awareness regarding their adverse impact and optimize approaches for their detection, management, and prevention using protocols or checklists.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X23000920/pdfft?md5=7fc5b4b8e0c73afdfdef7e254fa76cae&pid=1-s2.0-S2667100X23000920-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141424195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-15DOI: 10.1016/j.jointm.2023.11.002
Laurent Camous , Samuel Markowicz , Cecile Loraux , Julien Jabot , Jean David Pommier
{"title":"High frequency of severe liver dysfunction in critically ill Dengue patients in the French West Indies","authors":"Laurent Camous , Samuel Markowicz , Cecile Loraux , Julien Jabot , Jean David Pommier","doi":"10.1016/j.jointm.2023.11.002","DOIUrl":"10.1016/j.jointm.2023.11.002","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X23000889/pdfft?md5=60a09f317bb3f5447edd6dc72a0b6b6f&pid=1-s2.0-S2667100X23000889-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139014481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-06DOI: 10.1016/j.jointm.2023.10.003
Qinglin Li , Guanggang Li , Dawei Li , Yan Chen , Feihu Zhou
Background
Emerging evidence suggests that minimal acute kidney injury (stage 1 AKI) is associated with increased hospital mortality rates. However, for those who do not meet the AKI diagnostic criteria, whether a small increase in serum creatinine (SCr) levels is associated with an increased mortality rate in elderly patients is not known. Therefore, we aimed to investigate small elevations in SCr of <26.5 µmol/L within 48 h after invasive mechanical ventilation (MV) on the short-term mortality of critically ill patients in the geriatric population.
Methods
We conducted a retrospective, observational, multicenter cohort study enrolling consecutive elderly patients (≥75 years) who received invasive MV from January 2008 to December 2020. Recursive partitioning was used to calculate the ratio of SCr rise from baseline within 48 h after MV and divided into six groups, (1) <10%, (2) 10%–<20%, (3) 20%–<30%, (4) 30%–<40%, (5) 40%–<50%, and (6) ≥50%, where the reference interval was defined as the ratio <10% based on an analysis, which confirmed that the lowest mortality risk was found in this range. Clinical data and laboratory data were noted. Their general conditions and clinical characteristics were compared between the six groups. Prognostic survival factors were identified using Cox regression analysis. Kaplan–Meier survival analysis was employed for the accumulative survival rate.
Results
A total of 1292 patients (1171 men) with a median age of 89 (interquartile range: 85–92) with MV were suitable for further analysis. In all, 376 patients had any stage of early AKI, and 916 patients had no AKI. Among 916 non-AKI patients, 349 patients were in the ratio <10%, 291 in the 10%–<20% group, 169 in the 20%–<30% group, 68 in the 30%–<40% group, 25 in the 40%–<50% group, and 14 in the ≥50% group. The 28-day mortality rates in the six groups from the lowest (<10%) to the highest (≥50%) were 8.0%, 16.8%, 28.4%, 54.4%, 80.0%, and 85.7%, respectively. In the multivariable-adjusted analysis, patients with a ratio of 10%–<20% (hazard ratio [HR]=2.244; 95% confidence interval [CI]: 1.410 to 3.572; P=0.001), 20%–<30% (HR=3.822; 95% CI: 2.433 to 6.194; P <0.001), 30%–<40% (HR=10.472; 95% CI: 6.379 to 17.190; P <0.001), 40%–<50% (HR=13.887; 95% CI: 7.624 to 25.292; P <0.001), and ≥50% (HR=13.618; 95% CI: 6.832 to 27.144; P <0.001) had relatively higher 28-day mortality rates. The 90-day mortality rates in the six strata were 30.1%, 35.1%, 45.0%, 60.3%, 80.0%, and 85.7%, respectively. Significant interactions were also observed between the ratio and 90-day mortality: patients with a ratio of 10%–<20% (HR=1.322; 95% CI: 1.006 to 1.738; P=0.045), 20%–<30% (HR=1.823; 95% CI: 1.356 to 2.452; P <0.001), 30%–<40% (HR=3.751; 95% CI: 2.601 to 5.410; P <0.001),
{"title":"Early and minimal changes in serum creatinine can predict prognosis in elderly patients receiving invasive mechanical ventilation: A retrospective observational study","authors":"Qinglin Li , Guanggang Li , Dawei Li , Yan Chen , Feihu Zhou","doi":"10.1016/j.jointm.2023.10.003","DOIUrl":"10.1016/j.jointm.2023.10.003","url":null,"abstract":"<div><h3>Background</h3><p>Emerging evidence suggests that minimal acute kidney injury (stage 1 AKI) is associated with increased hospital mortality rates. However, for those who do not meet the AKI diagnostic criteria, whether a small increase in serum creatinine (SCr) levels is associated with an increased mortality rate in elderly patients is not known. Therefore, we aimed to investigate small elevations in SCr of <26.5 µmol/L within 48 h after invasive mechanical ventilation (MV) on the short-term mortality of critically ill patients in the geriatric population.</p></div><div><h3>Methods</h3><p>We conducted a retrospective, observational, multicenter cohort study enrolling consecutive elderly patients (≥75 years) who received invasive MV from January 2008 to December 2020. Recursive partitioning was used to calculate the ratio of SCr rise from baseline within 48 h after MV and divided into six groups, (1) <10%, (2) 10%–<20%, (3) 20%–<30%, (4) 30%–<40%, (5) 40%–<50%, and (6) ≥50%, where the reference interval was defined as the ratio <10% based on an analysis, which confirmed that the lowest mortality risk was found in this range. Clinical data and laboratory data were noted. Their general conditions and clinical characteristics were compared between the six groups. Prognostic survival factors were identified using Cox regression analysis. Kaplan–Meier survival analysis was employed for the accumulative survival rate.</p></div><div><h3>Results</h3><p>A total of 1292 patients (1171 men) with a median age of 89 (interquartile range: 85–92) with MV were suitable for further analysis. In all, 376 patients had any stage of early AKI, and 916 patients had no AKI. Among 916 non-AKI patients, 349 patients were in the ratio <10%, 291 in the 10%–<20% group, 169 in the 20%–<30% group, 68 in the 30%–<40% group, 25 in the 40%–<50% group, and 14 in the ≥50% group. The 28-day mortality rates in the six groups from the lowest (<10%) to the highest (≥50%) were 8.0%, 16.8%, 28.4%, 54.4%, 80.0%, and 85.7%, respectively. In the multivariable-adjusted analysis, patients with a ratio of 10%–<20% (hazard ratio [HR]=2.244; 95% confidence interval [CI]: 1.410 to 3.572; <em>P</em>=0.001), 20%–<30% (HR=3.822; 95% CI: 2.433 to 6.194; <em>P <</em>0.001), 30%–<40% (HR=10.472; 95% CI: 6.379 to 17.190; <em>P <</em>0.001), 40%–<50% (HR=13.887; 95% CI: 7.624 to 25.292; <em>P <</em>0.001), and ≥50% (HR=13.618; 95% CI: 6.832 to 27.144; <em>P <</em>0.001) had relatively higher 28-day mortality rates. The 90-day mortality rates in the six strata were 30.1%, 35.1%, 45.0%, 60.3%, 80.0%, and 85.7%, respectively. Significant interactions were also observed between the ratio and 90-day mortality: patients with a ratio of 10%–<20% (HR=1.322; 95% CI: 1.006 to 1.738; <em>P</em>=0.045), 20%–<30% (HR=1.823; 95% CI: 1.356 to 2.452; <em>P <</em>0.001), 30%–<40% (HR=3.751; 95% CI: 2.601 to 5.410; <em>P <</em>0.001), ","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X2300083X/pdfft?md5=2b80a592cf6a98cf850ff92e4197091c&pid=1-s2.0-S2667100X2300083X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138617300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-31DOI: 10.1016/j.jointm.2023.06.002
John E. Madias
{"title":"A protocol to ascertain whether sepsis-induced cardiomyopathy constitutes a phenotype of Takotsubo syndrome","authors":"John E. Madias","doi":"10.1016/j.jointm.2023.06.002","DOIUrl":"10.1016/j.jointm.2023.06.002","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48242370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-31DOI: 10.1016/j.jointm.2023.07.005
Despoina Koulenti , Marios Karvouniaris , Elisabeth Paramythiotou , Nikolaos Koliakos , Nikolaos Markou , Paschalis Paranos , Joseph Meletiadis , Stijn Blot
The frequency of co-infections with bacterial or fungal pathogens has constantly increased among critically ill patients with coronavirus disease 2019 (COVID-19) during the pandemic. Candidemia was the most frequently reported invasive fungal co-infection. The onset of candidemia in COVID-19 patients was often delayed compared to non-COVID-19 patients. Additionally, Candida invasive infections in COVID-19 patients were more often linked to invasive procedures (e.g., invasive mechanical ventilation or renal replacement therapy) during the intensive care stay and the severity of illness rather than more “classic” risk factors present in patients without COVID-19 (e.g., underlying diseases and prior hospitalization). Moreover, apart from the increased incidence of candidemia during the pandemic, a worrying rise in fluconazole-resistant strains was reported, including a rise in the multidrug-resistant Candida auris. Regarding outcomes, the development of invasive Candida co-infection had a negative impact, increasing morbidity and mortality compared to non-co-infected COVID-19 patients. In this narrative review, we present and critically discuss information on the diagnosis and management of invasive fungal infections caused by Candida spp. in critically ill COVID-19 patients.
{"title":"Severe Candida infections in critically ill patients with COVID-19","authors":"Despoina Koulenti , Marios Karvouniaris , Elisabeth Paramythiotou , Nikolaos Koliakos , Nikolaos Markou , Paschalis Paranos , Joseph Meletiadis , Stijn Blot","doi":"10.1016/j.jointm.2023.07.005","DOIUrl":"10.1016/j.jointm.2023.07.005","url":null,"abstract":"<div><p>The frequency of co-infections with bacterial or fungal pathogens has constantly increased among critically ill patients with coronavirus disease 2019 (COVID-19) during the pandemic. Candidemia was the most frequently reported invasive fungal co-infection. The onset of candidemia in COVID-19 patients was often delayed compared to non-COVID-19 patients. Additionally, <em>Candida</em> invasive infections in COVID-19 patients were more often linked to invasive procedures (e.g., invasive mechanical ventilation or renal replacement therapy) during the intensive care stay and the severity of illness rather than more “classic” risk factors present in patients without COVID-19 (e.g., underlying diseases and prior hospitalization). Moreover, apart from the increased incidence of candidemia during the pandemic, a worrying rise in fluconazole-resistant strains was reported, including a rise in the multidrug-resistant <em>Candida auris</em>. Regarding outcomes, the development of invasive <em>Candida</em> co-infection had a negative impact, increasing morbidity and mortality compared to non-co-infected COVID-19 patients. In this narrative review, we present and critically discuss information on the diagnosis and management of invasive fungal infections caused by <em>Candida</em> spp. in critically ill COVID-19 patients.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47911456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-31DOI: 10.1016/j.jointm.2023.07.003
Yonghao Xu , Yin Xi , Shuijiang Cai , Yuheng Yu , Sibei Chen , Weijie Guan , Weibo Liang , Hongkai Wu , Weiqun He , Xilong Deng , Yuanda Xu , Rong Zhang , Manshu Li , Jieyi Pan , Zhenting Liang , Ya Wang , Shaofeng Kong , Xiaoqing Liu , Zheng Lv , Yimin Li
Background
Venovenous extracorporeal membrane oxygenation (VV-ECMO) has been demonstrated to be effective in treating patients with virus-induced acute respiratory distress syndrome (ARDS). However, whether the management of ECMO is different in treating H1N1 influenza and coronavirus disease 2019 (COVID-19)-associated ARDS patients remains unknown.
Methods
This is a retrospective cohort study. We included 12 VV-ECMO-supported COVID-19 patients admitted to The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Eighth People's Hospital, and Wuhan Union Hospital West Campus between January 23 and March 31, 2020. We retrospectively included VV-ECMO-supported patients with COVID-19 and H1N1 influenza-associated ARDS. Clinical characteristics, respiratory mechanics including plateau pressure, driving pressure, mechanical power, ventilatory ratio (VR) and lung compliance, and outcomes were compared.
Results
Data from 25 patients with COVID-19 (n=12) and H1N1 (n=13) associated ARDS who had received ECMO support were analyzed. COVID-19 patients were older than H1N1 influenza patients (P=0.004). The partial pressure of arterial carbon dioxide (PaCO2) and VR before ECMO initiation were significantly higher in COVID-19 patients than in H1N1 influenza patients (P <0.001 and P=0.004, respectively). COVID-19 patients showed increased plateau and driving pressure compared with H1N1 subjects (P=0.013 and P=0.018, respectively). Patients with COVID-19 remained longer on ECMO support than did H1N1 influenza patients (P=0.015). COVID-19 patients who required ECMO support also had fewer intensive care unit and ventilator-free days than H1N1.
Conclusions
Compared with H1N1 influenza patients, COVID-19 patients were older and presented with increased PaCO2 and VR values before ECMO initiation. The differences between ARDS patients with COVID-19 and influenza on VV-ECMO detailed herein could be helpful for obtaining a better understanding of COVID-19 and for better clinical management.
{"title":"Venovenous extracorporeal membrane oxygenation for COVID-19 and influenza H1N1 associated acute respiratory distress syndrome: A comparative cohort study in China","authors":"Yonghao Xu , Yin Xi , Shuijiang Cai , Yuheng Yu , Sibei Chen , Weijie Guan , Weibo Liang , Hongkai Wu , Weiqun He , Xilong Deng , Yuanda Xu , Rong Zhang , Manshu Li , Jieyi Pan , Zhenting Liang , Ya Wang , Shaofeng Kong , Xiaoqing Liu , Zheng Lv , Yimin Li","doi":"10.1016/j.jointm.2023.07.003","DOIUrl":"https://doi.org/10.1016/j.jointm.2023.07.003","url":null,"abstract":"<div><h3>Background</h3><p>Venovenous extracorporeal membrane oxygenation (VV-ECMO) has been demonstrated to be effective in treating patients with virus-induced acute respiratory distress syndrome (ARDS). However, whether the management of ECMO is different in treating H1N1 influenza and coronavirus disease 2019 (COVID-19)-associated ARDS patients remains unknown.</p></div><div><h3>Methods</h3><p>This is a retrospective cohort study. We included 12 VV-ECMO-supported COVID-19 patients admitted to The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Eighth People's Hospital, and Wuhan Union Hospital West Campus between January 23 and March 31, 2020. We retrospectively included VV-ECMO-supported patients with COVID-19 and H1N1 influenza-associated ARDS. Clinical characteristics, respiratory mechanics including plateau pressure, driving pressure, mechanical power, ventilatory ratio (VR) and lung compliance, and outcomes were compared.</p></div><div><h3>Results</h3><p>Data from 25 patients with COVID-19 (<em>n</em>=12) and H1N1 (<em>n</em>=13) associated ARDS who had received ECMO support were analyzed. COVID-19 patients were older than H1N1 influenza patients (<em>P</em>=0.004). The partial pressure of arterial carbon dioxide (PaCO<sub>2</sub>) and VR before ECMO initiation were significantly higher in COVID-19 patients than in H1N1 influenza patients (<em>P</em> <0.001 and <em>P</em>=0.004, respectively). COVID-19 patients showed increased plateau and driving pressure compared with H1N1 subjects (<em>P</em>=0.013 and <em>P</em>=0.018, respectively). Patients with COVID-19 remained longer on ECMO support than did H1N1 influenza patients (<em>P</em>=0.015). COVID-19 patients who required ECMO support also had fewer intensive care unit and ventilator-free days than H1N1.</p></div><div><h3>Conclusions</h3><p>Compared with H1N1 influenza patients, COVID-19 patients were older and presented with increased PaCO<sub>2</sub> and VR values before ECMO initiation. The differences between ARDS patients with COVID-19 and influenza on VV-ECMO detailed herein could be helpful for obtaining a better understanding of COVID-19 and for better clinical management.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71776729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-31DOI: 10.1016/j.jointm.2023.04.004
Raquel Martinez-Reviejo , Sofia Tejada , Miia Jansson , Alfonsina Ruiz-Spinelli , Sergio Ramirez-Estrada , Duygu Ege , Tarsila Vieceli , Bert Maertens , Stijn Blot , Jordi Rello
Background
Ventilator-associated pneumonia (VAP) represents a common hospital-acquired infection among mechanically ventilated patients. We summarized evidence concerning ventilator care bundles to prevent VAP.
Methods
A systematic review and meta-analysis were performed. Randomized controlled trials and controlled observational studies of adults undergoing mechanical ventilation (MV) for at least 48 h were considered for inclusion. Outcomes of interest were the number of VAP episodes, duration of MV, hospital and intensive care unit (ICU) length of stay, and mortality. A systematic search was conducted in the MEDLINE, the Cochrane Library, and the Web of Science between 1985 and 2022. Results are reported as odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CI). The PROSPERO registration number is CRD42022341780.
Results
Thirty-six studies including 116,873 MV participants met the inclusion criteria. A total of 84,031 participants underwent care bundles for VAP prevention. The most reported component of the ventilator bundle was head-of-bed elevation (n=83,146), followed by oral care (n=80,787). A reduction in the number of VAP episodes was observed among those receiving ventilator care bundles, compared with the non-care bundle group (OR=0.42, 95% CI: 0.33, 0.54). Additionally, the implementation of care bundles decreased the duration of MV (MD=−0.59, 95% CI: −1.03, −0.15) and hospital length of stay (MD=−1.24, 95% CI: −2.30, −0.18) in studies where educational activities were part of the bundle. Data regarding mortality were inconclusive.
Conclusions
The implementation of ventilator care bundles reduced the number of VAP episodes and the duration of MV in adult ICUs. Their application in combination with educational activities seemed to improve clinical outcomes.
{"title":"Prevention of ventilator-associated pneumonia through care bundles: A systematic review and meta-analysis","authors":"Raquel Martinez-Reviejo , Sofia Tejada , Miia Jansson , Alfonsina Ruiz-Spinelli , Sergio Ramirez-Estrada , Duygu Ege , Tarsila Vieceli , Bert Maertens , Stijn Blot , Jordi Rello","doi":"10.1016/j.jointm.2023.04.004","DOIUrl":"10.1016/j.jointm.2023.04.004","url":null,"abstract":"<div><h3>Background</h3><p>Ventilator-associated pneumonia (VAP) represents a common hospital-acquired infection among mechanically ventilated patients. We summarized evidence concerning ventilator care bundles to prevent VAP.</p></div><div><h3>Methods</h3><p>A systematic review and meta-analysis were performed. Randomized controlled trials and controlled observational studies of adults undergoing mechanical ventilation (MV) for at least 48 h were considered for inclusion. Outcomes of interest were the number of VAP episodes, duration of MV, hospital and intensive care unit (ICU) length of stay, and mortality. A systematic search was conducted in the MEDLINE, the Cochrane Library, and the Web of Science between 1985 and 2022. Results are reported as odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CI). The PROSPERO registration number is CRD42022341780.</p></div><div><h3>Results</h3><p>Thirty-six studies including 116,873 MV participants met the inclusion criteria. A total of 84,031 participants underwent care bundles for VAP prevention. The most reported component of the ventilator bundle was head-of-bed elevation (<em>n</em>=83,146), followed by oral care (<em>n</em>=80,787). A reduction in the number of VAP episodes was observed among those receiving ventilator care bundles, compared with the non-care bundle group (OR=0.42, 95% CI: 0.33, 0.54). Additionally, the implementation of care bundles decreased the duration of MV (MD=−0.59, 95% CI: −1.03, −0.15) and hospital length of stay (MD=−1.24, 95% CI: −2.30, −0.18) in studies where educational activities were part of the bundle. Data regarding mortality were inconclusive.</p></div><div><h3>Conclusions</h3><p>The implementation of ventilator care bundles reduced the number of VAP episodes and the duration of MV in adult ICUs. Their application in combination with educational activities seemed to improve clinical outcomes.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46997324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-31DOI: 10.1016/j.jointm.2023.02.001
Jingjing Wang , Daonan Chen , Puyu Deng , Chenchen Zhang , Xue Zhan , Hui Lv , Hui Xie , Dechang Chen , Ruilan Wang
Background
Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, prone positioning has been widely applied for non-intubated, spontaneously breathing patients. However, the efficacy and safety of prone positioning in non-intubated patients with COVID-19-related acute hypoxemic respiratory failure remain unclear. We aimed to systematically analyze the outcomes associated with awake prone positioning (APP).
Methods
We conducted a systematic literature search of PubMed/MEDLINE, Cochrane Library, Embase, and Web of Science from January 1, 2020, to June 3, 2022. This study included adult patients with acute respiratory failure caused by COVID-19. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the study quality was assessed using the Cochrane risk-of-bias tool. The primary outcome was the reported cumulative intubation risk across randomized controlled trials (RCTs), and the effect estimates were calculated as risk ratios (RRs; 95% confidence interval [CI]).
Results
A total of 495 studies were identified, of which 10 fulfilled the selection criteria, and 2294 patients were included. In comparison to supine positioning, APP significantly reduced the need for intubation in the overall population (RR=0.84, 95% CI: 0.74–0.95). The two groups showed no significant differences in the incidence of adverse events (RR=1.16, 95% CI: 0.48–2.76). The meta-analysis revealed no difference in mortality between the groups (RR=0.93, 95% CI: 0.77–1.11).
Conclusions
APP was safe and reduced the need for intubation in patients with respiratory failure associated with COVID-19. However, it did not significantly reduce mortality in comparison to usual care without prone positioning.
{"title":"Efficacy and safety of awake prone positioning in the treatment of non-intubated spontaneously breathing patients with COVID-19-related acute respiratory failure: A systematic review and meta-analysis","authors":"Jingjing Wang , Daonan Chen , Puyu Deng , Chenchen Zhang , Xue Zhan , Hui Lv , Hui Xie , Dechang Chen , Ruilan Wang","doi":"10.1016/j.jointm.2023.02.001","DOIUrl":"10.1016/j.jointm.2023.02.001","url":null,"abstract":"<div><h3>Background</h3><p>Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, prone positioning has been widely applied for non-intubated, spontaneously breathing patients. However, the efficacy and safety of prone positioning in non-intubated patients with COVID-19-related acute hypoxemic respiratory failure remain unclear. We aimed to systematically analyze the outcomes associated with awake prone positioning (APP).</p></div><div><h3>Methods</h3><p>We conducted a systematic literature search of PubMed/MEDLINE, Cochrane Library, Embase, and Web of Science from January 1, 2020, to June 3, 2022. This study included adult patients with acute respiratory failure caused by COVID-19. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the study quality was assessed using the Cochrane risk-of-bias tool. The primary outcome was the reported cumulative intubation risk across randomized controlled trials (RCTs), and the effect estimates were calculated as risk ratios (RRs; 95% confidence interval [CI]).</p></div><div><h3>Results</h3><p>A total of 495 studies were identified, of which 10 fulfilled the selection criteria, and 2294 patients were included. In comparison to supine positioning, APP significantly reduced the need for intubation in the overall population (RR=0.84, 95% CI: 0.74–0.95). The two groups showed no significant differences in the incidence of adverse events (RR=1.16, 95% CI: 0.48–2.76). The meta-analysis revealed no difference in mortality between the groups (RR=0.93, 95% CI: 0.77–1.11).</p></div><div><h3>Conclusions</h3><p>APP was safe and reduced the need for intubation in patients with respiratory failure associated with COVID-19. However, it did not significantly reduce mortality in comparison to usual care without prone positioning.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9699558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-31DOI: 10.1016/j.jointm.2023.06.007
Hui Xiang , Yuqian Zhao , Siqing Ma , Qi Li , Kianoush B. Kashani , Zhiyong Peng , Jianguo Li , Bo Hu
Background
The benefits of early use of norepinephrine in endotoxemic shock remain unknown. We aimed to elucidate the effects of different doses of norepinephrine in early-stage endotoxemic shock using a clinically relevant large animal model.
Methods
Vasodilatory shock was induced by endotoxin bolus in 30 Bama suckling pigs. Treatment included fluid resuscitation and administration of different doses of norepinephrine, to induce return to baseline mean arterial pressure (MAP). Fluid management, hemodynamic, microcirculation, inflammation, and organ function variables were monitored. All animals were supported for 6 h after endotoxemic shock.
Results
Infused fluid volume decreased with increasing norepinephrine dose. Return to baseline MAP was achieved more frequently with doses of 0.8 µg/kg/min and 1.6 µg/kg/min (P <0.01). At the end of the shock resuscitation period, cardiac index was higher in pigs treated with 0.8 µg/kg/min norepinephrine (P <0.01), while systemic vascular resistance was higher in those receiving 0.4 µg/kg/min (P <0.01). Extravascular lung water level and degree of organ edema were higher in animals administered no or 0.2 µg/kg/min norepinephrine (P <0.01), while the percentage of perfused small vessel density (PSVD) was higher in those receiving 0.8 µg/kg/min (P <0.05) and serum lactate was higher in the groups administered no and 1.6 µg/kg/min norepinephrine (P <0.01).
Conclusions
The impact of norepinephrine on the macro- and micro-circulation in early-stage endotoxemic shock is dose-dependent, with very low and very high doses resulting in detrimental effects. Only an appropriate norepinephrine dose was associated with improved tissue perfusion and organ function.
{"title":"Dose-related effects of norepinephrine on early-stage endotoxemic shock in a swine model","authors":"Hui Xiang , Yuqian Zhao , Siqing Ma , Qi Li , Kianoush B. Kashani , Zhiyong Peng , Jianguo Li , Bo Hu","doi":"10.1016/j.jointm.2023.06.007","DOIUrl":"https://doi.org/10.1016/j.jointm.2023.06.007","url":null,"abstract":"<div><h3>Background</h3><p>The benefits of early use of norepinephrine in endotoxemic shock remain unknown. We aimed to elucidate the effects of different doses of norepinephrine in early-stage endotoxemic shock using a clinically relevant large animal model.</p></div><div><h3>Methods</h3><p>Vasodilatory shock was induced by endotoxin bolus in 30 Bama suckling pigs. Treatment included fluid resuscitation and administration of different doses of norepinephrine, to induce return to baseline mean arterial pressure (MAP). Fluid management, hemodynamic, microcirculation, inflammation, and organ function variables were monitored. All animals were supported for 6 h after endotoxemic shock.</p></div><div><h3>Results</h3><p>Infused fluid volume decreased with increasing norepinephrine dose. Return to baseline MAP was achieved more frequently with doses of 0.8 µg/kg/min and 1.6 µg/kg/min (<em>P</em> <0.01). At the end of the shock resuscitation period, cardiac index was higher in pigs treated with 0.8 µg/kg/min norepinephrine (<em>P</em> <0.01), while systemic vascular resistance was higher in those receiving 0.4 µg/kg/min (<em>P</em> <0.01). Extravascular lung water level and degree of organ edema were higher in animals administered no or 0.2 µg/kg/min norepinephrine (<em>P</em> <0.01), while the percentage of perfused small vessel density (PSVD) was higher in those receiving 0.8 µg/kg/min (<em>P</em> <0.05) and serum lactate was higher in the groups administered no and 1.6 µg/kg/min norepinephrine (<em>P</em> <0.01).</p></div><div><h3>Conclusions</h3><p>The impact of norepinephrine on the macro- and micro-circulation in early-stage endotoxemic shock is dose-dependent, with very low and very high doses resulting in detrimental effects. Only an appropriate norepinephrine dose was associated with improved tissue perfusion and organ function.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71776196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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