2017 Dec - Are high nurse workload/staffing ratios associated with decreased survival in critically ill patients? A cohort study
Lee A, Cheung YSL, Joynt GM, Leung CCH, Wong WT, Gomersall CD.; Ann Intensive Care. 2017 Dec;7(1):46. doi: 10.1186/s13613-017-0269-2. Epub 2017 May 2.
BACKGROUND: Despite the central role of nurses in intensive care, a relationship between intensive care nurse workload/staffing ratios and survival has not been clearly established. We determined whether there is a threshold workload/staffing ratio above which the probability of hospital survival is reduced and then modeled the relationship between exposure to inadequate staffing at any stage of a patient's ICU stay and risk-adjusted hospital survival.
2017 Apr - Diagnostic accuracy of quantitative neuromuscular ultrasound for the diagnosis of intensive care unit-acquired weakness: a cross-sectional observational study
Witteveen E, Sommers J, Wieske L, Doorduin J, van Alfen N, Schultz MJ, van Schaik IN, Horn J, Verhamme C.; Ann Intensive Care. 2017 Dec;7(1):40. doi: 10.1186/s13613-017-0263-8. Epub 2017 Apr 5.
BACKGROUND: Neuromuscular ultrasound is a noninvasive investigation, which can be easily performed at the bedside on the ICU. A reduction in muscle thickness and increase in echo intensity over time have been described in ICU patients, but the relation to ICU-acquired weakness (ICU-AW) is unknown. We hypothesized that quantitative assessment of muscle and nerve parameters with ultrasound can differentiate between patients with and without ICU-AW. The aim of this cross-sectional study was to investigate the diagnostic accuracy of neuromuscular ultrasound for diagnosing ICU-AW.
2017 Apr - Earlier versus later initiation of renal replacement therapy among critically ill patients with acute kidney injury: a systematic review and meta-analysis of randomized controlled trials
Lai TS, Shiao CC, Wang JJ, Huang CT, Wu PC, Chueh E, Chueh SJ, Kashani K, Wu VC.; Ann Intensive Care. 2017 Dec;7(1):38. doi: 10.1186/s13613-017-0265-6. Epub 2017 Apr 5.
BACKGROUND: Although the optimal timing of initiation of renal replacement therapy (RRT) in critically ill patients with acute kidney injury has been extensively studied in the past, it is still unclear.
2017 May - A Multicenter, Randomized Trial of Ramped Position versus Sniffing Position during Endotracheal Intubation of Critically Ill Adults
Semler MW, Janz DR, Russell DW, Casey JD, Lentz RJ, Zouk AN, deBoisblanc BP, Santanilla JI, Khan YA, Joffe AM, Stigler WS, Rice TW; Check-UP Investigators.; Pragmatic Critical Care Research Group..; Chest. 2017 May 6. pii: S0012-3692(17)30881-4.
BACKGROUND: Hypoxemia is the most common complication during endotracheal intubation of critically ill adults. Intubation in the ramped position has been hypothesized to prevent hypoxemia by increasing functional residual capacity and decreasing the duration of intubation, but has never been studied outside of the operating room.
2017 May - Decision-making on withholding or withdrawing life-support in the ICU: A worldwide perspective
Lobo SM, Barros de Simoni FH, Jakob SM, Estella A, Vadi S, Bluethgen A, Martin-Loeches I, Sakr Y, Vincent JL; ICON investigators..; Chest. 2017 May 5. pii: S0012-3692(17)30820-6
BACKGROUND: Many critically ill patients who die will do so after a decision has been made to withhold/withdraw life-sustaining therapy. Our objective was to document the characteristics of intensive care unit (ICU) patients with a decision to withhold/withdraw life-sustaining treatment, including the types of supportive treatments used, patterns of organ dysfunction, and international differences, including gross national income (GNI).
Martinell L, Nielsen N, Herlitz J, Karlsson T, Horn J, Wise MP, Undén J, Rylander C.; Crit Care. 2017 Apr 13;21(1):96.
BACKGROUND: Early identification of predictors for a poor long-term outcome in patients who survive the initial phase of out-of-hospital cardiac arrest (OHCA) may facilitate future clinical research, the process of care and information provided to relatives. The aim of this study was to determine the association between variables available from the patient's history and status at intensive care admission with outcome in unconscious survivors of OHCA.
2017 May - New drugs, new toxicities: severe side effects of modern targeted and immunotherapy of cancer and their management
Kroschinsky F, Stölzel F, von Bonin S, Beutel G, Kochanek M, Kiehl M, Schellongowski P; Intensive Care in Hematological and Oncological Patients (iCHOP) Collaborative Group..; Crit Care. 2017 Apr 14;21(1):89.
Pharmacological and cellular treatment of cancer is changing dramatically with benefits for patient outcome and comfort, but also with new toxicity profiles. The majority of adverse events can be classified as mild or moderate, but severe and life-threatening complications requiring ICU admission also occur. This review will focus on pathophysiology, symptoms, and management of these events based on the available literature.
2017 Feb - Timing, method and discontinuation of hydrocortisone administration for septic shock patients
Ibarra-Estrada MA, Chávez-Peña Q, Reynoso-Estrella CI, Rios-Zermeño J, Aguilera-González PE, García-Soto MA, Aguirre-Avalos G.; World J Crit Care Med. 2017 Feb 4;6(1):65-73.
AIM: To characterize the prescribing patterns for hydrocortisone for patients with septic shock and perform an exploratory analysis in order to identify the variables associated with better outcomes.
Weinberg L, Collins N, Van Mourik K, Tan C, Bellomo R. ;World J Crit Care Med. 2016 Nov 4;5(4):235-250.
AIM: To outline the physiochemical properties and specific clinical uses of Plasma-Lyte 148 as choice of solution for fluid intervention in critical illness, surgery and perioperative medicine.
2016 Dec - Outcomes and survival prediction models for severe adult acute respiratory distress syndrome treated with extracorporeal membrane oxygenation
Rozencwajg S, Pilcher D, Combes A, Schmidt M.; Crit Care. 2016 Dec 5;20(1):392. Review.
Extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS) has known a growing interest over the last decades with promising results during the 2009 A(H1N1) influenza epidemic. Targeting populations that can most benefit from this therapy is now of major importance.Survival has steadily improved for a decade, reaching up to 65% at hospital discharge in the most recent cohorts. However, ECMO is still marred by frequent and significant complications such as bleeding and nosocomial infections. In addition, physiological and psychological symptoms are commonly described in long-term follow-up of ECMO-treated ARDS survivors. Because this therapy is costly and exposes patients to significant complications, seven prediction models have been developed recently to help clinicians identify patients most likely to survive once ECMO has been initiated and to facilitate appropriate comparison of risk-adjusted outcomes between centres and over time. Higher age, immunocompromised status, associated extra-pulmonary organ dysfunction, low respiratory compliance and non-influenzae diagnosis seem to be the main determinants of poorer outcome.
2017 Jan - The association of findings on brain computed tomography with neurologic outcomes following extracorporeal cardiopulmonary resuscitation
Ryu JA, Chung CR, Cho YH, Sung K, Suh GY, Park TK, Song YB, Hahn JY, Choi JH, Gwon HC, Choi SH, Yang JH.; Crit Care. 2017 Jan 25;21(1):15.
Background: Limited data are available on imaging predictors of neurological outcomes after extracorporeal cardiopulmonary resuscitation (ECPR). We investigated the association of initial brain computed tomography (CT) findings with neurological outcomes following ECPR.
2017 Jan - Whole-body vibration to prevent intensive care unit-acquired weakness: safety, feasibility, and metabolic response
Wollersheim T, Haas K, Wolf S, Mai K, Spies C, Steinhagen-Thiessen E, Wernecke KD, Spranger J, Weber-Carstens S.: Crit Care. 2017 Jan 9;21(1):9.
Background:Intensive care unit (ICU)-acquired weakness in critically ill patients is a common and significant complication affecting the course of critical illness. Whole-body vibration is known to be effective muscle training and may be an option in diminishing weakness and muscle wasting. Especially, patients who are immobilized and not available for active physiotherapy may benefit. Until now whole-body vibration was not investigated in mechanically ventilated ICU patients. We investigated the safety, feasibility, and metabolic response of whole-body vibration in critically ill patients.
2016 Dec - Passive leg raise testing effectively reduces fluid administration in septic shock after correction of non-compliance to test results
Rameau A, de With E, Boerma EC.; Ann Intensive Care. 2017 Dec;7(1):2.
Background: Fluid resuscitation is considered a cornerstone of shock treatment, but recent data have underlined the potential hazards of fluid overload. The passive leg raise (PLR) test has been introduced as one of many strategies to predict ‘fluid responsiveness.’ The use of PLR testing is applicable to a wide range of clinical situations and has the potential to reduce fluid administration, since PLR testing is based upon (reversible) autotransfusion. Despite these theoretical advantages, data on the net effect on fluid balance as a result of PLR testing remain scarce.
Hekimian G, Kharcha F, Bréchot N, Schmidt M, Ghander C, Lebreton G, Girerd X, Tresallet C, Trouillet JL, Leprince P, Chastre J, Combes A, Luyt CE.; Ann Intensive Care. 2016 Dec;6(1):117.
Background: Pheochromocytoma, a rare catecholamine-producing tumor, might provoke stress-induced Takotsubo-like cardiomyopathy and severe cardiogenic shock. Because venoarterial-extracorporeal membrane oxygenation (VA-ECMO) rescue of pheochromocytoma-induced refractory cardiogenic shock has rarely been reported, we reviewed our ICU patients’ presentations and outcomes.
Lewis SJ, Mueller BA.; J Intensive Care Med. 2016 Mar;31(3):164-76.
Increasing evidence suggests that antibiotic dosing in critically ill patients with acute kidney injury (AKI) often does not achieve pharmacodynamic goals, and the continued high mortality rate due to infectious causes appears to confirm these findings. Although there are compelling reasons why clinicians should use more aggressive antibiotic dosing, particularly in patients receiving aggressive renal replacement therapies, concerns for toxicity associated with higher doses are real. The presence of multisystem organ failure and polypharmacy predispose these patients to drug toxicity. This article examines the pharmacokinetic and pharmacodynamic consequences of critical illness, AKI, and renal replacement therapy and describes potential solutions to help clinicians give “enough but not too much” in these very complicated patients.