Different Pathways to the Most Difficult Decisions*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - November 26, 2022 Category: Emergency Medicine Tags: Editorials Source Type: research
Immunomodulators in Mechanically Ventilated Patients With COVID-19: Lessons Learned From Underpowered Trials*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - November 26, 2022 Category: Emergency Medicine Tags: Editorials Source Type: research
The Smoldering Embers of Physician Burnout: The Pandemic Within the Pandemic*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - November 26, 2022 Category: Emergency Medicine Tags: Editorials Source Type: research
Complications Associated With Venovenous Extracorporeal Membrane Oxygenation—What Can Go Wrong?
CONCLUSIONS:
V-V ECMO is associated with a number of complications. ECMO selection, timing of initiation, and management decisions impact the presence and severity of these potential harms. (Source: Critical Care Medicine)
Source: Critical Care Medicine - November 26, 2022 Category: Emergency Medicine Tags: Concise Definitive Review Source Type: research
Functional Recovery Groups in Critically Ill COVID-19 Patients and Their Associated Factors: From ICU to Hospital Discharge*
CONCLUSIONS:
Age, hyperglycemia, and time for patient mobilization out of bed were independent factors associated with becoming physically dependent after their ICU stay. Recovery of physical function at hospital discharge was associated with muscle strength at ICU discharge and length of ICU stay. (Source: Critical Care Medicine)
Source: Critical Care Medicine - November 26, 2022 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research
Avdoralimab (Anti-C5aR1 mAb) Versus Placebo in Patients With Severe COVID-19: Results From a Randomized Controlled Trial (FOR COVID Elimination [FORCE])*
CONCLUSIONS:
In this randomized trial in hospitalized patients with severe COVID-19 pneumonia, avdoralimab did not significantly improve clinical status at days 14 and 28 (funded by Innate Pharma, ClinicalTrials.gov number, NCT04371367). (Source: Critical Care Medicine)
Source: Critical Care Medicine - November 26, 2022 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research
Patient and Caregiver-Derived Health Service Improvements for Better Critical Care Recovery
CONCLUSIONS:
Patients and caregivers reported a range of emotions and experiences across the recovery trajectory from ICU to home. Through end-user engagement strategies many potential solutions were identified that could be implemented by health services and tested to support the delivery of higher-quality care for ICU survivors and their caregivers that extend from tertiary to primary care settings. (Source: Critical Care Medicine)
Source: Critical Care Medicine - November 26, 2022 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research
Low-Flow Duration and Outcomes of Extracorporeal Cardiopulmonary Resuscitation in Adults With In-Hospital Cardiac Arrest: A Nationwide Inpatient Database Study*
CONCLUSIONS:
The estimated survival-to-discharge rate was markedly decreased by approximately 20% during the first 35 minutes of low-flow duration. Whether we should wait for the first 10–20 minutes of cardiac arrest without preparing for ECPR is questionable. (Source: Critical Care Medicine)
Source: Critical Care Medicine - November 26, 2022 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research
Impact of a Nurse-Driven Patient Empowerment Intervention on the Reduction in Patients’ Anxiety and Depression During ICU Discharge: A Randomized Clinical Trial
OBJECTIVES:
To assess the impact of a nurse-driven patient empowerment intervention on anxiety and depression of patients during ICU discharge.
DESIGN:
A prospective, multicenter, randomized clinical trial.
SETTING:
Three ICUs (1 medical, 1 medical and surgical, and 1 coronary) of three tertiary hospitals.
PATIENTS:
Adults admitted to the ICU greater than 18 years old for greater than or equal to 48 hours with preserved consciousness, the ability to communicate and without delirium, who were randomized to receive the nurse-driven patient empowerment intervention (NEI) (intervention group [IG] or st...
Source: Critical Care Medicine - November 26, 2022 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research
Host Gene Expression to Predict Sepsis Progression*
CONCLUSIONS:
Host gene expression was unable to predict sepsis progression when defined by an increase in Sepsis-3 category, suggesting this definition is not a useful framework for transcriptomic prediction methods. However, there was a differential response when progression was defined as ICU admission or death. Validation of previously described signatures predicted 28-day mortality with insufficient accuracy to offer meaningful clinical utility. (Source: Critical Care Medicine)
Source: Critical Care Medicine - November 26, 2022 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research
Variation in Bed-to-Physician Ratios During Weekday Daytime Hours in ICUs in Australia and New Zealand*
CONCLUSIONS:
Weekday bed-to-physician ratios in Australia/New Zealand ICUs are lower than the bed-to-intensivist ratios and have a relatively fixed ratio of less than 3 for units taking care of patients with a higher average severity of illness. These relationships may be different in other countries or healthcare systems. (Source: Critical Care Medicine)
Source: Critical Care Medicine - November 26, 2022 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research
Epidemiology of ICU-Onset Bloodstream Infection: Prevalence, Pathogens, and Risk Factors Among 150,948 ICU Patients at 85 U.S. Hospitals*
OBJECTIVES:
Bloodstream infections (BSIs) acquired in the ICU represent a detrimental yet potentially preventable condition. We determined the prevalence of BSI acquired in the ICU (ICU-onset BSI), pathogen profile, and associated risk factors.
DESIGN:
Retrospective cohort study.
DATA SOURCES:
Eighty-five U.S. hospitals in the Cerner Healthfacts Database.
PATIENT SELECTION:
Adult hospitalizations between January 2009 and December 2015 including a (≥ 3 d) ICU stay.
DATA EXTRACTION AND DATA SYNTHESIS:
Prevalence of ICU-onset BSI (between ICU Day 3 and ICU discharge) and associated pathogen a...
Source: Critical Care Medicine - November 26, 2022 Category: Emergency Medicine Tags: Feature Articles Source Type: research
Preparing for the Worst-Case Scenario in a Pandemic: Intensivists Simulate Prioritization and Triage of Scarce ICU Resources*
CONCLUSIONS:
To mitigate potential bias and to reduce the emotional burden of triage, a consensus-oriented, interdisciplinary, and collaborative approach should be implemented. Prognostic comparative assessment by intensivists is feasible. The combination of long-term ICU stay and consistently high Sequential Organ Failure Assessment scores resulted in a greater risk for triage in patients. It remains challenging to reliably differentiate between patients with very low chances to survive and requires further conceptual and empirical research. (Source: Critical Care Medicine)
Source: Critical Care Medicine - November 26, 2022 Category: Emergency Medicine Tags: Feature Articles Source Type: research
Randomized Phase 3 Trial of Ruxolitinib for COVID-19–Associated Acute Respiratory Distress Syndrome*
OBJECTIVES:
Evaluate the safety and efficacy of the Janus kinase (JAK)1/JAK2 inhibitor ruxolitinib in COVID-19–associated acute respiratory distress syndrome requiring mechanical ventilation.
DESIGN:
Phase 3 randomized, double-blind, placebo-controlled trial Ruxolitinib in Participants With COVID-19–Associated Acute Respiratory Distress Syndrome Who Require Mechanical Ventilation (RUXCOVID-DEVENT; NCT04377620).
SETTING:
Hospitals and community-based private or group practices in the United States (29 sites) and Russia (4 sites).
PATIENTS:
Eligible patients were greater than or equal to 12 years...
Source: Critical Care Medicine - November 26, 2022 Category: Emergency Medicine Tags: Feature Articles Source Type: research
Wellness and Coping of Physicians Who Worked in ICUs During the Pandemic: A Multicenter Cross-Sectional North American Survey*
CONCLUSIONS:
Despite moderate intrapandemic moral distress and burnout, physicians experienced moderate professional fulfilment. However, one in five physicians used at least one maladaptive coping strategy. We highlight potentially modifiable factors at individual, institutional, and regulatory levels to enhance physician wellness. (Source: Critical Care Medicine)
Source: Critical Care Medicine - November 26, 2022 Category: Emergency Medicine Tags: Feature Articles Source Type: research
