2013 Feb - Augmented renal clearance in septic and traumatized patients with normal plasma creatinine concentrations: Identifying at-risk patients
Introduction: Improved methods to optimize drug dosing in the critically ill are urgently needed. Traditional prescribing culture involves recognition of factors that mandate dose reduction (such as renal impairment), although optimizing drug exposure, through more frequent or augmented dosing, represents an evolving strategy. Elevated creatinine clearance (CLCR) has been associated with sub-therapeutic antibacterial concentrations in the critically ill, a concept termed augmented renal clearance (ARC). We aimed to determine the prevalence of ARC in a cohort of septic and traumatized critically ill patients, while also examining demographic, physiological and illness severity characteristics that may help identify this phenomenon.
2013 Feb - Analysis of ventilatory ratio as a novel method to monitor ventilatory adequacy at the bedside
Introduction: Due to complexities in its measurement, adequacy of ventilation is seldom used to categorize disease severity and guide ventilatory strategies. Ventilatory ratio (VR) is a novel index to monitor ventilatory adequacy at the bedside. VR = (expired measured minute ventilation [VEmeasured] x measured arterial partial pressure of carbon dioxide [PaCO2measured])/(expired predicted minute ventilation [VEpredicted] x ideal arterial partial pressure of carbon dioxide [PaCO2ideal]). VEpredicted is 100 mL.Kg-1.min-1 and PaCO2ideal is 5 kPa. Physiological analysis shows that VR is influenced by dead space (VD/VT) and CO2 production (VCO2). Two studies were conducted to explore the physiological properties of VR and assess its use in clinical practice.
2013 Feb - Rule out of acute aortic dissection with plasma matrix metalloproteinase 8 in the emergency department
Introduction: Matrix metalloproteinases (MMPs) are involved in aortic pathophysiology. Preliminary studies have detected increased plasma levels of MMP8 and MMP9 in patients with acute aortic dissection (AAD). However, the performance of plasma MMP8 and MMP9 for the diagnosis of AAD in the emergency department is presently unknown.
2013 Feb - Automated peritoneal lavage: an extremely rapid and safe way to induce hypothermia in post-resuscitation patients
Introduction: Mild therapeutic hypothermia (MTH) is a worldwide used therapy to improve neurological outcome in patients successfully resuscitated after cardiac arrest (CA). Preclinical data suggest that timing and speed of induction are related to reduction of secondary brain damage and improved outcome.
2013 Feb - Practical approach to hyponatraemia and hypernatraemia in critically ill patients [Review]
Disturbances in sodium concentration are common in the critically ill patient and associated with increased mortality. The key principle in treatment and prevention is that plasma [Na+] (P-[Na+]) is determined by external water and cation balances. P-[Na+] determines plasma tonicity. An important exception is hyperglycaemia, where P-[Na+] may be reduced despite plasma hypertonicity...
2013 Feb - Early patient mobilization in the ICU [Review]
Early mobilization (EM) of ICU patients is a physiologically logical intervention to attenuate critical illness-associated muscle weakness. However, its long-term value remains controversial...
2013 Jan - Pro/con debate: Should PaCO2 be tightly controlled in all patients with acute brain injuries?
You are the attending intensivist in a neurointensive care unit caring for a woman five days post-rupture of a cerebral aneurysm (World Federation of Neurological Surgeons Grade 4 and Fisher Grade 3). She is intubated for airway protection and mild hypoxemia related to an aspiration event at the time of aneurysm rupture, but is breathing spontaneously on the ventilator. Your patient is spontaneously hyperventilating with high tidal volumes despite minimal support and has developed significant hypocapnia...
2013 Feb - Extracorporeal membrane oxygenation (ECMO) in patients with H1N1 influenza infection: a systematic review and meta-analysis including 8 studies and 266 patients receiving ECMO
Introduction: H1N1 influenza can cause severe acute lung injury (ALI). Extracorporeal membrane oxygenation (ECMO) can support gas exchange in patients failing conventional mechanical ventilation, but its role is still controversial. We conducted a systematic review and meta-analysis on ECMO for H1N1-associated ALI.
2013 Feb - Additive value of blood neutrophil gelatinase-associated lipocalin to clinical judgement in acute kidney injury diagnosis and mortality prediction in patients hospitalized from the emergency department
Introduction: Acute kidney injury (AKI) is a common complication among hospitalized patients. The aim of this study was to evaluate the utility of blood neutrophil gelatinase-associated lipocalin (NGAL) assessment as an aid in the early risk evaluation for AKI development in admitted patients.
2013 Feb - Functional changes of the myocardium in survivors of high-voltage electrical injury
Introduction: There are limited long-term follow-up data on functional changes in the myocardium after high-voltage electrical injury (HVEI).
2013 Feb - Evaluation of early mini- bronchoalveolar lavage in the diagnosis of health-care associated pneumonia: a prospective study
Introduction: Health care-associated pneumonia (HCAP) has been proposed as a new category of respiratory infection to identify patients at risk of multidrug-resistant (MDR) pathogens. The American Thoracic Society's recommendation for HCAP treatment is to use broad-spectrum and multiple antibiotics. However, this strategy may be economically expensive and promote antimicrobial resistance when a multisensible pathogen is not identified.
2013 Feb - A Retrospective Review of the Use of Regional Citrate Anticoagulation in Continuous Venovenous Hemofiltration for Critically Ill Patients
Background. The emergence of a commercially prepared citrate solution has revolutionized the use of RCA in the intensive care unit (ICU). The aim of this study was to evaluate the safety profile of a commercially prepared citrate solution.
2013 Jan - Fluid balance and urine volume are independent predictors of mortality in acute kidney injury
Teixeira C, Garzotto F, Piccinni P, Brienza N, Iannuzzi M, Gramaticopolo S, Forfori F, Rocco M, Ronco C, Belluomo Anello C, Bove T, Carlini M, Michetti V, Pelaia P, Cruz DN, Nefroint NE.; Crit Care. 2013 Jan 24;17(1):R14. [Epub ahead of print]
INTRODUCTION: Both fluid overload and oliguria are common complications in intensive care units (ICU) associated with increased mortality among critically ill patients, particularly in acute kidney injury (AKI). Although fluid overload is an expected complication of oliguria, it remains unclear whether their effects on mortality are independent of each other. The aim of this study is to evaluate the impact of both fluid balance and urine volume on outcomes and determine whether they behave as independent predictors of mortality in adult ICU patients with AKI.
2013 Jan - Lower tidal volume at initiation of mechanical ventilation may reduce progression to acute respiratory distress syndrome - a systematic review
Introduction: The most appropriate tidal volume in patients without acute respiratory distress syndrome (ARDS) is controversial, and has not been rigorously examined. The objective was to determine whether a mechanical ventilation strategy using lower tidal volume is associated with a decreased incidence of progression to ARDS when compared to a higher tidal volume strategy.
2013 Jan - Haloperidol prophylaxis in critically ill patients with a high risk for delirium
Introduction: Delirium is associated with increased morbidity and mortality. We implemented a delirium prevention policy in intensive care unit (ICU) patients with a high risk to develop delirium, and evaluated if our policy resulted in quality improvement of relevant delirium outcome measures.
2013 Feb - Do-not-resuscitate order: a view throughout the world
Santonocito C, Ristagno G, Gullo A, Weil MH.; J Crit Care. 2013 Feb;28(1):14-21
Resuscitation has the ability to reverse premature death. It can also prolong terminal illness, increase discomfort, and consume resources. The do-not-resuscitate (DNR) order and advance directives are still a debated issue in critical care. This review will focus on several aspects, regarding withholding and/or withdrawing therapies and advance directives in different continents...
2013 Feb - Interobserver agreement rate of the spontaneous breathing trial
Cappati KR, Tonella RM, Damascena AS, Pereira CA, Caruso P.; J Crit Care. 2013 Feb;28(1):62-8.
PURPOSE: During the mechanical ventilation weaning process, the spontaneous breathing trial (SBT) is the confirmatory test of patients' capability to breathe unassisted. However, the SBT interobserver agreement rate (its reliability) is unknown, and our objective was to evaluate it.
2013 Jan - A French multicenter randomised trial comparing two dose-regimens of Prothrombin Complex Concentrates in urgent anticoagulation reversal
Introduction: Prothrombin complex concentrates (PCC) are haemostatic blood preparations indicated for urgent anticoagulation reversal, though the optimal dose for effective reversal is still under debate. The latest generation of PCCs include four coagulation factors, the so-called 4-factor PCC. The aim of this study was to compare the efficacy and safety of two doses, 25 and 40 IU/kg, of 4-factor PCC in vitamin K antagonist (VKA) associated intracranial haemorrhage.
2013 Jan - Small studies may overestimate the effect sizes in critical care meta-analyses: a meta-epidemiological study
Introduction: Small study effects refer to the fact that trials with limited sample sizes are more likely to report larger beneficial effects than large trials. However, this has never been investigated in critical care medicine. Thus, the present study aimed to examine the presence and extent of small study effects in critical care medicine.
2012 Dec - Use of 2-hour creatinine clearance to guide cessation of continuous renal replacement therapy
Fröhlich S, Donnelly A, Solymos O, Conlon N. J Crit Care. 2012 Dec;27(6):744.e1-5.
PURPOSE: A simple test that could guide successful cessation of continuous renal replacement therapy (CRRT) in critically ill patients would be clinically useful. This study aimed to investigate whether a 2-hour creatinine clearance (2h-CrCl) measurement could more accurately predict successful cessation of CRRT than serum creatinine or urine output alone.