Paradoxical Positioning: Does “Head Up” Always Improve Mechanics and Lung Protection?*
CONCLUSIONS: In advanced ARDS, bed inclination toward vertical adversely affects Crs and therefore affects the numerical values for plateau and driving tidal pressures commonly targeted in lung protective strategies. These changes are fully reversed with manual loading of the chest wall, suggestive of end-tidal overdistension in the upright position. Body inclination should be considered a modifiable determinant of transpulmonary pressure and lung protection, directionally similar to tidal volume and positive end-expiratory pressure. (Source: Critical Care Medicine)
Source: Critical Care Medicine - October 20, 2022 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Development and Validation of the Medical Emergency Team-Risk Prediction Model for Clinical Deterioration in Acute Hospital Patients, at Time of an Emergency Admission*
CONCLUSIONS: Using only nine predictor variables available to clinicians at the time of admission, the MET-risk model can predict the risk of MET review during the first 48 hours of an emergency admission. Model utility in improving patient outcomes requires further investigation. (Source: Critical Care Medicine)
Source: Critical Care Medicine - October 20, 2022 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Stress Hyperphenylalaninemia Is Associated With Mortality in Cardiac ICU: Clinical Factors, Genetic Variants, and Pteridines*
OBJECTIVES: Hyperphenylalaninemia predicts poor outcomes in patients with cardiovascular disease. However, the prognostic value and factors associated with stress hyperphenylalaninemia (SHP) were unknown in critical patients in the cardiac ICU. DESIGN: Prospective observational study. SETTING: Single-center, cardiac ICU in Taiwan. PATIENTS: Patients over 20 years old with Acute Physiology And Chronic Health Evaluation II scores greater than or equal to 15 and/or ventilatory support in the cardiac ICU. INTERVENTIONS: We measured plasma phenylalanine levels serially during patients’ stays in...
Source: Critical Care Medicine - October 20, 2022 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

A Multiple Baseline Trial of an Electronic ICU Discharge Summary Tool for Improving Quality of Care*
CONCLUSIONS: Implementation of an electronic tool was associated with more timely and complete discharge summaries for patients discharged from the ICU to a hospital ward. (Source: Critical Care Medicine)
Source: Critical Care Medicine - October 20, 2022 Category: Emergency Medicine Tags: Feature Articles Source Type: research

Cardiorespiratory Fitness and Neuromuscular Function of Mechanically Ventilated ICU COVID-19 Patients*
OBJECTIVES: The aim of the current study was to investigate the level of cardiorespiratory fitness and neuromuscular function of ICU survivors after COVID-19 and to examine whether these outcomes are related to ICU stay/mechanical ventilation duration. DESIGN: Prospective nonrandomized study. SETTING: Patients hospitalized in ICU for COVID-19 infection. PATIENTS: Sixty patients hospitalized in ICU (mean duration: 31.9 ± 18.2 d) were recruited 4–8 weeks post discharge from ICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patients visited the laboratory on two separate oc...
Source: Critical Care Medicine - October 20, 2022 Category: Emergency Medicine Tags: Feature Articles Source Type: research

The Use of IV Vasoactive Intestinal Peptide (Aviptadil) in Patients With Critical COVID-19 Respiratory Failure: Results of a 60-Day Randomized Controlled Trial*
CONCLUSIONS: The primary end point did not reach statistical significance, indicating that there was no difference between Aviptadil versus placebo. However, Aviptadil improves the likelihood of survival from respiratory failure at day 60 in critical COVID-19 across all sites of care. Given the absence of drug-related serious adverse events and acceptable safety profile, we believe the benefit versus risk for the use of Aviptadil is favorable for patient treatment. (Source: Critical Care Medicine)
Source: Critical Care Medicine - October 20, 2022 Category: Emergency Medicine Tags: Feature Articles Source Type: research

Epidemiology of Acute Kidney Injury After Neonatal Cardiac Surgery: A Report From the Multicenter Neonatal and Pediatric Heart and Renal Outcomes Network: Erratum
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - September 23, 2022 Category: Emergency Medicine Tags: Online Erratum Source Type: research

The authors reply
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - September 23, 2022 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Potential Confounders in Study Concluding Higher Lactate at Vasopressin Initiation Is Associated With Higher Mortality in Septic Shock
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - September 23, 2022 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

The authors reply
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - September 23, 2022 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Prone Positioning for Patients With COVID-19–Associated Acute Respiratory Distress Syndrome
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - September 23, 2022 Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research

Patient-Important Outcomes Other Than Mortality in Contemporary ICU Trials: A Scoping Review
CONCLUSIONS: In this sample of RCTs, substantial variation in practice and suboptimal methodological choices were observed. This calls for increased focus on standardizing outcome choices and definitions, adequate handling of missing data and deceased patients in analyses, and use of statistical methods quantifying effect sizes. (Source: Critical Care Medicine)
Source: Critical Care Medicine - September 23, 2022 Category: Emergency Medicine Tags: Online Review Article Source Type: research

Association of Renin Angiotensin Aldosterone System Inhibitors and Outcomes of Hospitalized Patients With COVID-19
OBJECTIVES: To determine the association of prior use of renin-angiotensin-aldosterone system inhibitors (RAASIs) with mortality and outcomes in hospitalized patients with COVID-19. DESIGN: Retrospective observational study. SETTING: Multicenter, international COVID-19 registry. Subjects: Adult hospitalized COVID-19 patients on antihypertensive agents (AHAs) prior to admission, admitted from March 31, 2020, to March 10, 2021. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Data were compared between three groups: patients on RAASIs only, other AHAs only, and those on both medicati...
Source: Critical Care Medicine - September 23, 2022 Category: Emergency Medicine Tags: Online Clinical Investigation Source Type: research

Accidental Awareness With Recall During Pharmacologic Neuromuscular Blockade in Emergency Department Settings: Challenges, Opportunities, and Lessons for Intensive Care*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - September 23, 2022 Category: Emergency Medicine Tags: Editorials Source Type: research

Turning Back the Clock: Prehospital Antibiotics for Patients With Septic Shock*
No abstract available (Source: Critical Care Medicine)
Source: Critical Care Medicine - September 23, 2022 Category: Emergency Medicine Tags: Editorials Source Type: research