High versus low blood pressure target in patients with septic shock. New Eng J Med 2014; 370:1583-93.
Asfar, P., et al.
http://www.nejm.org/doi/full/10.1056/NEJMoa1312173
The Surviving Sepsis Campaign recommends targeting a mean arterial pressure of at least 65 mm Hg during initial resuscitation of patients with septic shock. However, whether this blood-pressure target is more or less effective than a higher target is unknown.
Thursday, 7 August 2014
Early prediction of new-onset physical disability after intensive care unit stay
Early prediction of new-onset physical disability after intensive care unit stay: preliminary instrument. Critical Care 2014, 18: 455.
Schandl, A., et al.
http://ccforum.com/content/pdf/s13054-014-0455-7.pdf
Many intensive care unit (ICU) survivors suffer from physical disability for months after ICU
stay. There is no structured method to identify patients at risk for such problems. The purpose
of the study was to develop a method for early in-ICU prediction of the patient’s individual
risk for new-onset physical disability two months after ICU stay.
Schandl, A., et al.
http://ccforum.com/content/pdf/s13054-014-0455-7.pdf
Many intensive care unit (ICU) survivors suffer from physical disability for months after ICU
stay. There is no structured method to identify patients at risk for such problems. The purpose
of the study was to develop a method for early in-ICU prediction of the patient’s individual
risk for new-onset physical disability two months after ICU stay.
Early sedation and clinical outcomes of mechanically ventilated patients
Early sedation and clinical outcomes of mechanically ventilated patients: a prospective multicenter cohort study. Critical Care 2014, 18: R156.
Tanaka, L.M.S, et al.
http://ccforum.com/content/pdf/cc13995.pdf
Sedation overuse is frequent and possibly associated with poor outcomes in the intensive care
unit (ICU) patients. However, the association of early over-sedation with clinical outcomes
has not been thoroughly evaluated. The aim of this study was to assess the association of
early sedation strategies with outcomes of critically ill adult patients under mechanical
ventilation.
Tanaka, L.M.S, et al.
http://ccforum.com/content/pdf/cc13995.pdf
Sedation overuse is frequent and possibly associated with poor outcomes in the intensive care
unit (ICU) patients. However, the association of early over-sedation with clinical outcomes
has not been thoroughly evaluated. The aim of this study was to assess the association of
early sedation strategies with outcomes of critically ill adult patients under mechanical
ventilation.
One year mortality in patients requiring prolonged mechanical ventilation
One year mortality in patients requiring prolonged mechanical ventilation: multicenter evaluation of the ProVent score. Critical Care 2014, 18:R155.
Leroy, G., et al.
http://ccforum.com/content/18/4/R155
Current severity-of-illness indexes are unable to assess the long-term prognosis of patients requiring prolonged mechanical ventilation. A prognostic scoring system (Prognosis for Prolonged Ventilation score - ProVent - score) seems able to evaluate one-year mortality of such patients. However, testing of the model outside the developers' centers has not been reported. So, it is unclear how the ProVent score performs in non-US and non-tertiary ICUs. The goal of our study was to evaluate its performances in a French multicenter, community hospital-based setting.
Leroy, G., et al.
http://ccforum.com/content/18/4/R155
Current severity-of-illness indexes are unable to assess the long-term prognosis of patients requiring prolonged mechanical ventilation. A prognostic scoring system (Prognosis for Prolonged Ventilation score - ProVent - score) seems able to evaluate one-year mortality of such patients. However, testing of the model outside the developers' centers has not been reported. So, it is unclear how the ProVent score performs in non-US and non-tertiary ICUs. The goal of our study was to evaluate its performances in a French multicenter, community hospital-based setting.
Experimental and clinical evidences for glucose control in intensive care
Experimental and clinical evidences for glucose control in intensive care: is infused glucose the key point for study interpretation? Critical Care 2014, 18: 232.
Mazeraud, A., et al.
http://ccforum.com/content/18/4/232
Stress-induced hyperglycemia has been considered an adaptive mechanism to stress up to the first intensive insulin therapy trial, which showed a 34% reduction in relative risk of in-hospital mortality when normalizing blood glucose levels. Further trials had conflicting results and, at present, stress-induced hyperglycemia management remains non-consensual. These findings could be explained by discrepancies in trials, notably regarding the approach to treat hyperglycemia: high versus restrictive caloric intake. Stress-induced hyperglycemia is a frequent complication during intensive care unit stay and is associated with a higher mortality. It results from an imbalance between insulin and counter-regulatory hormones, increased neoglucogenesis, and the cytokine-induced insulin-resistant state of tissues. In this review, we summarize detrimental effects of hyperglycemia on organs in the critically ill (peripheric and central nervous, liver, immune system, kidney, and cardiovascular system). Finally, we show clinical and experimental evidence of potential benefits from glucose and insulin administration, notably on metabolism, immunity, and the cardiovascular system.
Mazeraud, A., et al.
http://ccforum.com/content/18/4/232
Stress-induced hyperglycemia has been considered an adaptive mechanism to stress up to the first intensive insulin therapy trial, which showed a 34% reduction in relative risk of in-hospital mortality when normalizing blood glucose levels. Further trials had conflicting results and, at present, stress-induced hyperglycemia management remains non-consensual. These findings could be explained by discrepancies in trials, notably regarding the approach to treat hyperglycemia: high versus restrictive caloric intake. Stress-induced hyperglycemia is a frequent complication during intensive care unit stay and is associated with a higher mortality. It results from an imbalance between insulin and counter-regulatory hormones, increased neoglucogenesis, and the cytokine-induced insulin-resistant state of tissues. In this review, we summarize detrimental effects of hyperglycemia on organs in the critically ill (peripheric and central nervous, liver, immune system, kidney, and cardiovascular system). Finally, we show clinical and experimental evidence of potential benefits from glucose and insulin administration, notably on metabolism, immunity, and the cardiovascular system.
Psychometric comparison of three behavioural scales for the assessment of pain in critically ill patients unable to self-report
Psychometric comparison of three behavioural scales for the assessment of pain in patients unable to self-report. Critical Care 2014, 18:R160.
Chanques, G., et al.
http://ccforum.com/content/pdf/cc14000.pdf
Pain assessment is associated with important outcomes in ICU patients but remains
challenging, particularly in non-communicative patients. Use of a reliable tool is paramount
to allow any implementation of sedation/analgesia protocols in a multidisciplinary team. This
study compared psychometric properties (inter-rater agreement primarily; validity, responsiveness and feasibility secondarily) of three pain scales: Behavioural Pain Scale (BPS/BPS-NI, that is BPS for Non-Intubated patients), Critical Care Pain Observation Tool (CPOT) and Non-Verbal Pain Scale (NVPS), the pain tool routinely used in this 16-bed medical ICU.
Chanques, G., et al.
http://ccforum.com/content/pdf/cc14000.pdf
Pain assessment is associated with important outcomes in ICU patients but remains
challenging, particularly in non-communicative patients. Use of a reliable tool is paramount
to allow any implementation of sedation/analgesia protocols in a multidisciplinary team. This
study compared psychometric properties (inter-rater agreement primarily; validity, responsiveness and feasibility secondarily) of three pain scales: Behavioural Pain Scale (BPS/BPS-NI, that is BPS for Non-Intubated patients), Critical Care Pain Observation Tool (CPOT) and Non-Verbal Pain Scale (NVPS), the pain tool routinely used in this 16-bed medical ICU.
A comparison of different diagnostic criteria of acute kidney injury in critically ill patients
A comparison of different diagnostic criteria of acute kidney injury in critically ill patients. Critical Care 2014, 18: R144.
Luo, X., et al.
http://ccforum.com/content/18/4/R144
Recently, the Kidney Disease: Improving Global Outcomes (KDIGO) proposed a new definition and classification of acute kidney injury (AKI) on the basis of the RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage renal failure) and AKIN (Acute Kidney Injury Network) criteria, but comparisons of the three criteria in critically ill patients are rare.
Luo, X., et al.
http://ccforum.com/content/18/4/R144
Recently, the Kidney Disease: Improving Global Outcomes (KDIGO) proposed a new definition and classification of acute kidney injury (AKI) on the basis of the RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage renal failure) and AKIN (Acute Kidney Injury Network) criteria, but comparisons of the three criteria in critically ill patients are rare.
ICU-acquired weakness and recovery from critical illness
ICU-acquired weakness and recovery from critical illness. N Engl J of Med, 2014, 371:287-288
Kress, JP and Hall, JB.
http://www.nejm.org/doi/pdf/10.1056/NEJMra1209390
Kress, JP and Hall, JB.
http://www.nejm.org/doi/pdf/10.1056/NEJMra1209390
Feasibility of a multiple-choice mini mental state examination for chronically critically ill patients
Feasibility of a multiple-choice mini mental state examination for chronically critically ill patients. Critical Care Medicine, Aug 2014, Vol.42(8), p.1874-81.
Miguélez, M., et al.
http://journals.lww.com/ccmjournal/Abstract/2014/08000/Feasibility_of_a_Multiple_Choice_Mini_Mental_State.15.aspx
Following treatment in an ICU, up to 70% of chronically critically ill patients present neurocognitive impairment that can have negative effects on their quality of life, daily activities, and return to work. The Mini Mental State Examination is a simple, widely used tool for neurocognitive assessment. Although of interest when evaluating ICU patients, the current version is restricted to patients who are able to speak. This study aimed to evaluate the feasibility of a visual, multiple-choice Mini Mental State Examination for ICU patients who are unable to speak.
Miguélez, M., et al.
http://journals.lww.com/ccmjournal/Abstract/2014/08000/Feasibility_of_a_Multiple_Choice_Mini_Mental_State.15.aspx
Following treatment in an ICU, up to 70% of chronically critically ill patients present neurocognitive impairment that can have negative effects on their quality of life, daily activities, and return to work. The Mini Mental State Examination is a simple, widely used tool for neurocognitive assessment. Although of interest when evaluating ICU patients, the current version is restricted to patients who are able to speak. This study aimed to evaluate the feasibility of a visual, multiple-choice Mini Mental State Examination for ICU patients who are unable to speak.
Use of a daily goals checklist for morning ICU rounds
Use of a daily goals checklist for morning ICU rounds: a mixed-methods study. Critical Care Medicine, Aug 2014, Vol. 42(8), p.1797-1803.
Centofanti, J.E., et al.
http://journals.lww.com/ccmjournal/Abstract/2014/08000/Use_of_a_Daily_Goals_Checklist_for_Morning_ICU.6.aspx
Centofanti, J.E., et al.
http://journals.lww.com/ccmjournal/Abstract/2014/08000/Use_of_a_Daily_Goals_Checklist_for_Morning_ICU.6.aspx
Objective: To understand the perspectives and attitudes of ICU clinicians about use of a daily goals checklist on rounds. Design: Our three data collection methods were as follows: 1) Field observations: two investigators conducted field observations to understand how and by whom the daily goals checklist was used for 80 ICU patient rounds over 6 days. 2) Document analysis: The 72 completed daily goals checklists from observed rounds were analyzed using mixed methods. 3) Interviews: With 56 clinicians, we conducted semistructured individual and focus-group interviews, analyzing transcripts using a qualitative descriptive approach and content analysis. Triangulation was achieved by a multidisciplinary investigative team using two research methods and three data sources.
Statins and delirium during critical illness
Statins and delirium during critical illness: A multicenter, prospective cohort study. Critical Care Medicine Aug. 2014, Vol. 42(8), p.1899-1909.
Morandi, A., et al.
http://journals.lww.com/ccmjournal/Abstract/2014/08000/Statins_and_Delirium_During_Critical_Illness___A.18.aspx
Since statins have pleiotropic effects on inflammation and coagulation that may interrupt delirium pathogenesis, we tested the hypotheses that statin exposure is associated with reduced delirium during critical illness, whereas discontinuation of statin therapy is associated with increased delirium.
Morandi, A., et al.
http://journals.lww.com/ccmjournal/Abstract/2014/08000/Statins_and_Delirium_During_Critical_Illness___A.18.aspx
Since statins have pleiotropic effects on inflammation and coagulation that may interrupt delirium pathogenesis, we tested the hypotheses that statin exposure is associated with reduced delirium during critical illness, whereas discontinuation of statin therapy is associated with increased delirium.
A randomized trial of protocol-based care for early septic shock
A randomized trial of protocol-based care for early septic shock. N E Jnl Med 2014; 370:1683-93.
The ProCESS Investigators
http://www.nejm.org/doi/full/10.1056/NEJMoa1401602
In a single-center study published more than a decade ago involving patients presenting to the emergency department with severe sepsis and septic shock, mortality was markedly lower among those who were treated according to a 6-hour protocol of early goal-directed therapy (EGDT), in which intravenous fluids, vasopressors, inotropes, and blood transfusions were adjusted to reach central hemodynamic targets, than among those receiving usual care. We conducted a trial to determine whether these findings were generalizable and whether all aspects of the protocol were necessary.
The ProCESS Investigators
http://www.nejm.org/doi/full/10.1056/NEJMoa1401602
In a single-center study published more than a decade ago involving patients presenting to the emergency department with severe sepsis and septic shock, mortality was markedly lower among those who were treated according to a 6-hour protocol of early goal-directed therapy (EGDT), in which intravenous fluids, vasopressors, inotropes, and blood transfusions were adjusted to reach central hemodynamic targets, than among those receiving usual care. We conducted a trial to determine whether these findings were generalizable and whether all aspects of the protocol were necessary.
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