Hidehiko Nakano, Hiromu Naraba, Hideki Hashimoto, Masaki Mochizuki, Yuji Takahashi, Tomohiro Sonoo, Yasuhiro Ogawa, Yujiro Matsuishi, Nobutake Shimojo, Yoshiaki Inoue & Kensuke Nakamura
doi : 10.1186/s13054-021-03827-8
Critical Care volume 25, Article number: 415 (2021)
Although the combination of rehabilitation and nutrition may be important for the prevention of intensive care unit (ICU)-acquired weakness, a protocolized intervention of this combination has not yet been reported. We herein developed an original combined protocol and evaluated its efficacy.
Ichiro Hirayama, Toshifumi Asada, Miyuki Yamamoto, Naoki Hayase, Takahiro Hiruma & Kent Doi
doi : 10.1186/s13054-021-03830-z
Critical Care volume 25, Article number: 416 (2021)
Several clinical guidelines recommend monitoring blood lactate levels and central venous oxygen saturation for hemodynamic management of patients with sepsis. We hypothesized that carbon dioxide production (VCO2) and oxygen extraction (VO2) evaluated using indirect calorimetry (IC) might provide additional information to understand the dynamic metabolic changes in sepsis.
Antoine Meyer, Niccolò Buetti, Nadhira Houhou-Fidouh, Juliette Patrier, Moustafa Abdel-Nabey, Pierre Jaquet, Simona Presente, Tiphaine Girard, Faiza Sayagh, Stephane Ruckly, Paul-Henri Wicky, Etienne de Montmollin, Lila Bouadma, Romain Sonneville, Diane Descamps & Jean-Francois Timsit
doi : 10.1186/s13054-021-03843-8
Critical Care volume 25, Article number: 417 (2021)
Data in the literature about HSV reactivation in COVID-19 patients are scarce, and the association between HSV-1 reactivation and mortality remains to be determined. Our objectives were to evaluate the impact of Herpes simplex virus (HSV) reactivation in patients with severe SARS-CoV-2 infections primarily on mortality, and secondarily on hospital-acquired pneumonia/ventilator-associated pneumonia (HAP/VAP) and intensive care unit-bloodstream infection (ICU-BSI).
Antonio Riccardo Buonomo, Giulio Viceconte & Ivan Gentile
doi : 10.1186/s13054-021-03836-7
Critical Care volume 25, Article number: 418 (2021)
Dong Huang, Dingxiu He, Linjing Gong, Wen Wang, Lei Yang, Zhongwei Zhang, Yujun Shi & Zongan Liang
doi : 10.1186/s13054-021-03841-w
Critical Care volume 25, Article number: 419 (2021)
The present study was performed to investigate the impacts of type 2 diabetes mellitus (T2DM) on severe community-acquired pneumonia (SCAP) and to develop a novel prediction model for mortality in SCAP patients with T2DM.
Luis Serviá, Juan Antonio Llompart-Pou, Mario Chico-Fernández, Neus Montserrat, Mariona Badia, Jesús Abelardo Barea-Mendoza, María Ángeles Ballesteros-Sanz, Javier Trujillano on behalf of the Neurointensive Care and Trauma Working Group of the Spanish Society of Intensive Care Medicine (SEMICYUC)
doi : 10.1186/s13054-021-03845-6
Critical Care volume 25, Article number: 420 (2021)
Severity scores are commonly used for outcome adjustment and benchmarking of trauma care provided. No specific models performed only with critically ill patients are available. Our objective was to develop a new score for early mortality prediction in trauma ICU patients.
COVID-ICU group, for the REVA network, COVID-ICU investigators
doi : 10.1186/s13054-021-03784-2
Critical Care volume 25, Article number: 421 (2021)
To evaluate the respective impact of standard oxygen, high-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) on oxygenation failure rate and mortality in COVID-19 patients admitted to intensive care units (ICUs).
Vijo Poulose
doi : 10.1186/s13054-021-03838-5
Critical Care volume 25, Article number: 422 (2021)
Maddalena Alessandra Wu, Gianluca Lopez, Manuela Nebuloni, Davide Ottolina, Jonathan Montomoli, Luca Carsana, Tommaso Fossali, Antonio Castelli, Roberto Rech, Chiara Cogliati, Emanuele Catena & Riccardo Colombo
doi : 10.1186/s13054-021-03846-5
Critical Care volume 25, Article number: 423 (2021)
Autoptic pulmonary findings have been described in severe COVID-19 patients, but evidence regarding the correlation between clinical picture and lung histopathologic patterns is still weak.
Jean-Charles Preiser, Yaseen M. Arabi, Mette M. Berger, Michael Casaer, Stephen McClave, Juan C. Montejo-González, Sandra Peake, Annika Reintam Blaser, Greet Van den Berghe, Arthur van Zanten, Jan Wernerman & Paul Wischmeyer
doi : 10.1186/s13054-021-03847-4
Critical Care volume 25, Article number: 424 (2021)
The preferential use of the oral/enteral route in critically ill patients over gut rest is uniformly recommended and applied. This article provides practical guidance on enteral nutrition in compliance with recent American and European guidelines. Low-dose enteral nutrition can be safely started within 48 h after admission, even during treatment with small or moderate doses of vasopressor agents. A percutaneous access should be used when enteral nutrition is anticipated for???4 weeks. Energy delivery should not be calculated to match energy expenditure before day 4–7, and the use of energy-dense formulas can be restricted to cases of inability to tolerate full-volume isocaloric enteral nutrition or to patients who require fluid restriction. Low-dose protein (max 0.8 g/kg/day) can be provided during the early phase of critical illness, while a protein target of?>?1.2 g/kg/day could be considered during the rehabilitation phase. The occurrence of refeeding syndrome should be assessed by daily measurement of plasma phosphate, and a phosphate drop of 30% should be managed by reduction of enteral feeding rate and high-dose thiamine. Vomiting and increased gastric residual volume may indicate gastric intolerance, while sudden abdominal pain, distension, gastrointestinal paralysis, or rising abdominal pressure may indicate lower gastrointestinal intolerance.
Patrick M. Honore, Sebastien Redant, Thierry Preseau, Bogdan Vasile Cismas, Keitiane Kaefer, Leonel Barreto Gutierrez, Sami Anane, Rachid Attou, Andrea Gallerani & David De Bels
doi : 10.1186/s13054-021-03850-9
Critical Care volume 25, Article number: 425 (2021)
Kay Choong See
doi : 10.1186/s13054-021-03852-7
Critical Care volume 25, Article number: 426 (2021)
Filippo Albani, Federica Fusina, Gianni Ciabatti, Luigi Pisani, Valeria Lippolis, Maria Elena Franceschetti, Alessia Giovannini, Rossella di Mussi, Francesco Murgolo, Antonio Rosano, Salvatore Grasso & Giuseppe Natalini
doi : 10.1186/s13054-021-03855-4
Critical Care volume 25, Article number: 427 (2021)
Flow Index, a numerical expression of the shape of the inspiratory flow-time waveform recorded during pressure support ventilation, is associated with patient inspiratory effort. The aim of this study was to assess the accuracy of Flow Index in detecting high or low inspiratory effort during pressure support ventilation and to establish cutoff values for the Flow index to identify these conditions. The secondary aim was to compare the performance of Flow index,of breathing pattern parameters and of airway occlusion pressure (P0.1) in detecting high or low inspiratory effort during pressure support ventilation.
Andrew R. Mayer, Andrew B. Dodd, Julie G. Rannou-Latella, David D. Stephenson, Rebecca J. Dodd, Josef M. Ling, Carissa J. Mehos, Cidney R. Robertson-Benta, Sharvani Pabbathi Reddy, Rachel E. Kinsler, Meghan S. Vermillion, Andrew P. Gigliotti, Veronik Sicard, Amy L. Lloyd, Erik B. Erhardt, Jessica M. Gill, Chen Lai, Vivian A. Guedes & Irshad H. Chaudry
doi : 10.1186/s13054-021-03844-7
Critical Care volume 25, Article number: 428 (2021)
Traumatic brain injury (TBI) and severe blood loss resulting in hemorrhagic shock (HS) represent leading causes of trauma-induced mortality, especially when co-occurring in pre-hospital settings where standard therapies are not readily available. The primary objective of this study was to determine if 17?-ethinyl estradiol-3-sulfate (EE-3-SO4) increases survival, promotes more rapid cardiovascular recovery, or confers neuroprotection relative to Placebo following TBI?+?HS.
Lorenzo Giosa, Didier Payen, Mattia Busana, Alessio Mattei, Luca Brazzi & Pietro Caironi
doi : 10.1186/s13054-021-03859-0
Critical Care volume 25, Article number: 429 (2021)
Ilse Vanhorebeek, Inge Derese, Jan Gunst, Pieter J. Wouters, Greet Hermans & Greet Van den Berghe
doi : 10.1186/s13054-021-03858-1
Critical Care volume 25, Article number: 430 (2021)
Critical illness is hallmarked by neuroendocrine alterations throughout ICU stay. We investigated whether the neuroendocrine axes recover after ICU discharge and whether any residual abnormalities associate with physical functional impairments assessed 5 years after critical illness.
Davide Chiumello, Matteo Bonifazi, Tommaso Pozzi, Paolo Formenti, Giuseppe Francesco Sferrazza Papa, Gabriele Zuanetti & Silvia Coppola
doi : 10.1186/s13054-021-03839-4
Critical Care volume 25, Article number: 431 (2021)
We hypothesized that as CARDS may present different pathophysiological features than classic ARDS, the application of high levels of end-expiratory pressure is questionable. Our first aim was to investigate the effects of 5–15 cmH2O of PEEP on partitioned respiratory mechanics, gas exchange and dead space; secondly, we investigated whether respiratory system compliance and severity of hypoxemia could affect the response to PEEP on partitioned respiratory mechanics, gas exchange and dead space, dividing the population according to the median value of respiratory system compliance and oxygenation. Thirdly, we explored the effects of an additional PEEP selected according to the Empirical PEEP-FiO2 table of the EPVent-2 study on partitioned respiratory mechanics and gas exchange in a subgroup of patients.
A. Ceccato, A. Russo, E. Barbeta, P. Oscanoa, G. Tiseo, A. Gabarrus, P. Di Giannatale, S. Nogas, C. Cilloniz, F. Menichetti, M. Ferrer, M. Niederman, M. Falcone & A. Torres
doi : 10.1186/s13054-021-03840-x
Critical Care volume 25, Article number: 432 (2021)
Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide despite correct antibiotic use. Corticosteroids have long been evaluated as a treatment option, but heterogeneous effects on survival have precluded their widespread implementation. We aimed to evaluate whether corticosteroids might improve clinical outcomes in patients with severe CAP and high inflammatory responses.
Patrick M. Honore, Sebastien Redant, Thierry Preseau, Bogdan Vasile Cismas, Keitiane Kaefer, Leonel Barreto Gutierrez, Sami Anane, Rachid Attou, Andrea Gallerani & David De Bels
doi : 10.1186/s13054-021-03854-5
Critical Care volume 25, Article number: 433 (2021)
Jean-Baptiste Lascarrou, Elie Guichard, Jean Reignier, Amélie Le Gouge, Caroline Pouplet, Stéphanie Martin, Jean-Claude Lacherade, Gwenhael Colin & AfterROSC network
doi : 10.1186/s13054-021-03842-9
Critical Care volume 25, Article number: 434 (2021)
While targeted temperature management (TTM) has been recommended in patients with shockable cardiac arrest (CA) and suggested in patients with non-shockable rhythms, few data exist regarding the impact of the rewarming rate on systemic inflammation. We compared serum levels of the proinflammatory cytokine interleukin-6 (IL6) measured with two rewarming rates after TTM at 33 °C in patients with shockable out-of-hospital cardiac arrest (OHCA).
Antoni Torres, Anna Motos, Jordi Riera, Laia Fernández-Barat, Adrián Ceccato, Raquel Pérez-Arnal, Dario García-Gasulla, Oscar Peñuelas, José Angel Lorente, Alejandro Rodriguez, David de Gonzalo-Calvo, Raquel Almansa, Albert Gabarrús, Rosario Menéndez, Jesús F. Bermejo-Martin, Ricard Ferrer, Rosario Amaya Villar, José M. Añón, Carme Barberà, José Barberán, Aaron Blandino Ortiz, Elena Bustamante-Munguira, Jesús Caballero, Cristina Carbajales, Nieves Carbonell, Mercedes Catalán-González, Cristóbal Galbán, Víctor D. Gumucio-Sanguino, Maria del Carmen de la Torre, Emili Díaz, Ángel Estella, Elena Gallego, José Luis García Garmendia, José Garnacho-Montero, José M. Gómez, Arturo Huerta, Ruth Noemí Jorge García, Ana Loza-Vázquez, Judith Marin-Corral, Amalia Martínez de la Gándara, Ignacio Martínez Varela, Juan López Messa, Guillermo M. Albaiceta, Mariana Andrea Novo, Yhivian Peñasco, Juan Carlos Pozo-Laderas, Pilar Ricart, Inmaculada Salvador-Adell, Angel Sánchez-Miralles, Susana Sancho Chinesta, Lorenzo Socias, Jordi Solé-Violan, Fernando Suares Sipmann, Luis Tamayo Lomas, José Trenado, Ferran Barbé on behalf of CIBERESUCICOVID Project (COV20/00110, ISCIII)
doi : 10.1186/s13054-021-03849-2
Critical Care volume 25, Article number: 435 (2021)
Keisuke Omiya, Hiroaki Sato, Tamaki Sato, Linda Wykes, Mengyin Hong, Roupen Hatzakorzian, Arnold S. Kristof & Thomas Schricker
doi : 10.1186/s13054-021-03860-7
Critical Care volume 25, Article number: 436 (2021)
The measurement of circulating substrate concentrations does not provide information about substrate kinetics. It, therefore, remains unclear if a decrease in plasma concentration of albumin, as seen during critical illness, is a consequence of suppressed production in the liver or increased peripheral clearance. In this study, using stable isotope tracer infusions, we measured albumin and fibrinogen kinetics in septic patients and in a control group of non-septic subjects.
Lies Langouche, Greet Van den Berghe & Jan Gunst
doi : 10.1186/s13054-021-03861-6
Critical Care volume 25, Article number: 437 (2021)
Hyperglycemia frequently develops in patients with severe COVID-19, regardless of preadmission diabetes status, as in non-COVID critically ill patients [1, 2]. In non-COVID patients, stress hyperglycemia has been attributed to insulin resistance due to elevated counterregulatory hormones, cytokines, and drugs including steroids, although beta-cell dysfunction through prolonged hyperglycemia, poor beta-cell reserve, hypoperfusion and inflammation may co-exist in some patients (Fig. 1) [3]. As in non-COVID patients, numerous observational studies have associated more severe hyperglycemia and increased glucose variability with poor outcome in COVID-19 patients [1, 2, 4, 5]. However, causality remains unclear, since insulin resistance and resultant hyperglycemia closely relate to illness severity [1, 6]. In this regard, a recent observational study also associated insulin treatment with increased mortality of COVID-19 [7]. Evidently, observational studies have an inherent risk of residual confounding, whereby the ideal glucose target can only be derived from adequately powered randomized controlled trials (RCTs).
Kara M. Plotnikoff, Karla D. Krewulak, Laura Hernández, Krista Spence, Nadine Foster, Shelly Longmore, Sharon E. Straus, Daniel J. Niven, Jeanna Parsons Leigh, Henry T. Stelfox & Kirsten M. Fiest
doi : 10.1186/s13054-021-03857-2
Critical Care volume 25, Article number: 438 (2021)
Critically ill patients require complex care and experience unique needs during and after their stay in the intensive care unit (ICU). Discharging or transferring a patient from the ICU to a hospital ward or back to community care (under the care of a general practitioner) includes several elements that may shape patient outcomes and overall experiences. The aim of this study was to answer the question: what elements facilitate a successful, high-quality discharge from the ICU?
Erika Dabricot, Inès Seqat, Frédéric Dailler, Sylvain Rheims, Sebastien Boulogne & Baptiste Balança
doi : 10.1186/s13054-021-03851-8
Critical Care volume 25, Article number: 439 (2021)
Mervyn Singer, Paul J. Young, John G. Laffey, Pierre Asfar, Fabio Silvio Taccone, Markus B. Skrifvars, Christian S. Meyhoff & Peter Radermacher
doi : 10.1186/s13054-021-03815-y
Critical Care volume 25, Article number: 440 (2021)
Oxygen (O2) toxicity remains a concern, particularly to the lung. This is mainly related to excessive production of reactive oxygen species (ROS). Supplemental O2, i.e. inspiratory O2 concentrations (FIO2)?>?0.21 may cause hyperoxaemia (i.e. arterial (a) PO2?>?100 mmHg) and, subsequently, hyperoxia (increased tissue O2 concentration), thereby enhancing ROS formation. Here, we review the pathophysiology of O2 toxicity and the potential harms of supplemental O2 in various ICU conditions. The current evidence base suggests that PaO2?>?300 mmHg (40 kPa) should be avoided, but it remains uncertain whether there is an “optimal level” which may vary for given clinical conditions. Since even moderately supra-physiological PaO2 may be associated with deleterious side effects, it seems advisable at present to titrate O2 to maintain PaO2 within the normal range, avoiding both hypoxaemia and excess hyperoxaemia.
Jan Graßhoff, Eike Petersen, Franziska Farquharson, Max Kustermann, Hans-Joachim Kabitz, Philipp Rostalski & Stephan Walterspacher
doi : 10.1186/s13054-021-03833-w
Critical Care volume 25, Article number: 441 (2021)
Inspiratory patient effort under assisted mechanical ventilation is an important quantity for assessing patient–ventilator interaction and recognizing over and under assistance. An established clinical standard is respiratory muscle pressure
Sergio Lassola, Sara Miori, Andrea Sanna, Rocco Pace, Sandra Magnoni, Luigi Vetrugno & Michele Umbrello
doi : 10.1186/s13054-021-03865-2
Critical Care volume 25, Article number: 442 (2021)
Marcus Kirwan, Reema Munshi, Hannah O’Keeffe, Conor Judge, Mary Coyle, Evelyn Deasy, Yvelynne P. Kelly, Peter J. Lavin, Maria Donnelly & Deirdre M. D’Arcy
doi : 10.1186/s13054-021-03863-4
Critical Care volume 25, Article number: 443 (2021)
Therapeutic antibiotic dose monitoring can be particularly challenging in septic patients requiring renal replacement therapy. Our aim was to conduct an exploratory population pharmacokinetic (PK) analysis on PK of vancomycin following intermittent infusion in critically ill patients receiving continuous venovenous haemodiafiltration (CVVHDF); focussing on the influence of dialysis-related covariates.
Ming Zheng
doi : 10.1186/s13054-021-03871-4
Critical Care volume 25, Article number: 444 (2021)
Sinta B. van der Meer, Grace Figaroa, Peter H. J. van der Voort, Maarten W. Nijsten & Janesh Pillay
doi : 10.1186/s13054-021-03869-y
Critical Care volume 25, Article number: 445 (2021)
Lioudmila V. Karnatovskaia, Katalin Varga, Alexander S. Niven, Phillip J. Schulte, Midhat Mujic, Ognjen Gajic, Brent A. Bauer, Matthew M. Clark, Roberto P. Benzo & Kemuel L. Philbrick
doi : 10.1186/s13054-021-03856-3
Critical Care volume 25, Article number: 446 (2021)
Over a third of critical illness survivors suffer from mental health problems following hospitalization. Memories of delusional experiences are a major risk factor. In this project, ICU doulas delivered a unique positive suggestion intervention targeting the vulnerable time period during critical illness when these memories are formed.
J. M. Smit, M. E. van Genderen, M. J. T. Reinders, D. A. M. P. J. Gommers, J. H. Krijthe & J. Van Bommel
doi : 10.1186/s13054-021-03868-z
Critical Care volume 25, Article number: 447 (2021)
Lucas M. Fleuren, Tariq A. Dam, Michele Tonutti, Daan P. de Bruin, Robbert C. A. Lalisang, Diederik Gommers, Olaf L. Cremer, Rob J. Bosman, Sander Rigter, Evert-Jan Wils, Tim Frenzel, Dave A. Dongelmans, Remko de Jong, Marco Peters, Marlijn J. A. Kamps, Dharmanand Ramnarain, Ralph Nowitzky, Fleur G. C. A. Nooteboom, Wouter de Ruijter, Louise C. Urlings-Strop, Ellen G. M. Smit, D. Jannet Mehagnoul-Schipper, Tom Dormans, Cornelis P. C. de Jager, Stefaan H. A. Hendriks, Sefanja Achterberg, Evelien Oostdijk, Auke C. Reidinga, Barbara Festen-Spanjer, Gert B. Brunnekreef, Alexander D. Cornet, Walter van den Tempel, Age D. Boelens, Peter Koetsier, Judith Lens, Harald J. Faber, A. Karakus, Robert Entjes, Paul de Jong, Thijs C. D. Rettig, Sesmu Arbous, Sebastiaan J. J. Vonk, Mattia Fornasa, Tomas Machado, Taco Houwert, Hidde Hovenkamp, Roberto Noorduijn Londono, Davide Quintarelli, Martijn G. Scholtemeijer, Aletta A. de Beer, Giovanni Cinà, Adam Kantorik, Tom de Ruijter, Willem E. Herter, Martijn Beudel, Armand R. J. Girbes, Mark Hoogendoorn, Patrick J. Thoral, Paul W. G. Elbers & the Dutch ICU Data Sharing Against Covid-19 Collaborators
doi : 10.1186/s13054-021-03864-3
Critical Care volume 25, Article number: 448 (2021)
Determining the optimal timing for extubation can be challenging in the intensive care. In this study, we aim to identify predictors for extubation failure in critically ill patients with COVID-19.
Basang Xiao, Yuntao Zhang, Zhuoga Ci, Dandan Shi & Hangyong He
doi : 10.1186/s13054-021-03866-1
Critical Care volume 25, Article number: 449 (2021)
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