Inflammation biomarkers and delirium in critically ill patients: new insights? Critical Care 2014, 18:153
Sobbi, S.C. and van den Boogaard, M.
http://ccforum.com/content/18/3/153
The pathophysiological mechanism of the serious and frequently occurring disorder delirium is poorly understood. Inflammation and sepsis are known risk factors for ICU delirium and therefore these patients are highly susceptible to delirium. Several studies have been performed to determine which cytokines are most associated with delirium but the results are inconclusive. Also, new biomarkers associated with brain dysfunction and cognitive impairment are still recognized and need to be studied to determine their relation with delirium. In this commentary we address some limitations concerning an interesting new study that warrants directions for future studies.
Monday, 30 June 2014
Tight glycemic control in the ICU
Tight glycemic control in the ICU - is the earth flat? Critical Care 2014, 18: 159
Steil, G.M. and Agus, M.S.D.
http://ccforum.com/content/18/3/159
Tight glycemic control in the ICU has been shown to reduce mortality in some but not all prospective randomized control trials. Confounding the interpretation of these studies are differences in how the control was achieved and underlying incidence of hypoglycemia, which can be expected to be affected by the introduction of continuous glucose monitoring (CGM). In this issue of Critical Care, a consensus panel provides a list of the research priorities they believe are needed for CGM to become routine practice in the ICU. We reflect on these recommendations and consider the implications for using CGM today.
Steil, G.M. and Agus, M.S.D.
http://ccforum.com/content/18/3/159
Tight glycemic control in the ICU has been shown to reduce mortality in some but not all prospective randomized control trials. Confounding the interpretation of these studies are differences in how the control was achieved and underlying incidence of hypoglycemia, which can be expected to be affected by the introduction of continuous glucose monitoring (CGM). In this issue of Critical Care, a consensus panel provides a list of the research priorities they believe are needed for CGM to become routine practice in the ICU. We reflect on these recommendations and consider the implications for using CGM today.
Persistent inflammation and T cell exhaustion in severe sepsis in the elderly
Persistent inflammation and T cell exhaustion in severe sepsis in the elderly. Critical Care 2014, 18: R130
Inoue, S., et al.
http://ccforum.com/content/pdf/cc13941.pdf
Sepsis is known as a complex immunological response with hyperinflammation in the acute
phase followed by immunosuppression. Although aging is crucial in sepsis, the impact of
aging on inflammation and immunosuppression is still unclear. The purpose of this study was
to investigate the relationship between inflammation and immunosuppression in aged patients
and mice after sepsis.
Inoue, S., et al.
http://ccforum.com/content/pdf/cc13941.pdf
Sepsis is known as a complex immunological response with hyperinflammation in the acute
phase followed by immunosuppression. Although aging is crucial in sepsis, the impact of
aging on inflammation and immunosuppression is still unclear. The purpose of this study was
to investigate the relationship between inflammation and immunosuppression in aged patients
and mice after sepsis.
Monday, 28 April 2014
Continuous endotracheal tube cuff pressure control system protects against ventilator-associated pneumonia
Continuous endotracheal tube cuff pressure control system protects against ventilator-associated pneumonia. Critical Care, 2014, 18:R77
Lorente, L., et al.
http://ccforum.com/content/pdf/cc13837.pdf
The use of a system for continuous control of endotracheal tube cuff pressure reduced the
incidence of ventilator-associated pneumonia (VAP) in one randomized controlled trial
(RCT) with 112 patients but not in another RCT with 142 patients. In several guidelines on
the prevention of VAP, the use of a system for continuous or intermittent control of
endotracheal cuff pressure is not reviewed. The objective of this study was to compare the incidence of VAP in a large sample of patients (n=284) treated with either continuous or intermittent control of endotracheal tube cuff pressure.
Lorente, L., et al.
http://ccforum.com/content/pdf/cc13837.pdf
The use of a system for continuous control of endotracheal tube cuff pressure reduced the
incidence of ventilator-associated pneumonia (VAP) in one randomized controlled trial
(RCT) with 112 patients but not in another RCT with 142 patients. In several guidelines on
the prevention of VAP, the use of a system for continuous or intermittent control of
endotracheal cuff pressure is not reviewed. The objective of this study was to compare the incidence of VAP in a large sample of patients (n=284) treated with either continuous or intermittent control of endotracheal tube cuff pressure.
Parenteral glutamine supplementation in critical illness: a systematic review
Parenteral glutamine supplementation in critical illness: a systematic review. Critical Care, 2014, 18:R76.
Wischmeyer, P.E. et al.
http://ccforum.com/content/pdf/cc13836.pdf
The potential benefit of parenteral glutamine (GLN) supplementation has been one of the most commonly studied nutritional interventions in the critical care setting. The aim of this systematic review was to incorporate recent trials of traditional parenteral GLN supplementation in critical illness with previously existing data.
Wischmeyer, P.E. et al.
http://ccforum.com/content/pdf/cc13836.pdf
The potential benefit of parenteral glutamine (GLN) supplementation has been one of the most commonly studied nutritional interventions in the critical care setting. The aim of this systematic review was to incorporate recent trials of traditional parenteral GLN supplementation in critical illness with previously existing data.
Do heart rate and respiratory rate variability improve prediction of extubation outcomes in critically ill patients?
Do heart rate and respiratory rate variability improve prediction of extubation outcomes in critically ill patients? Critical Care, 2014, 18:R65
Seely, AJE, et al.
http://ccforum.com/content/pdf/cc13822.pdf
Prolonged ventilation and failed extubation are associated with increased harm and cost. The
added value of heart and respiratory rate variability (HRV and RRV) during spontaneous
breathing trials (SBTs) to predict extubation failure remains unknown.
Seely, AJE, et al.
http://ccforum.com/content/pdf/cc13822.pdf
Prolonged ventilation and failed extubation are associated with increased harm and cost. The
added value of heart and respiratory rate variability (HRV and RRV) during spontaneous
breathing trials (SBTs) to predict extubation failure remains unknown.
Ventriculo-arterial decoupling in human septic shock
Ventriculo-arterial decoupling in human septic shock. Critical Care 2014, 18:R80
Guarracino, F., et al.
http://ccforum.com/content/pdf/cc13842.pdf
Septic shock is the most severe manifestation of sepsis. It is characterized as a hypotensive
cardiovascular state associated with multiorgan dysfunction and metabolic disturbances.
Management of septic shock is targeted to preserve an adequate organ perfusion pressure
without precipitating pulmonary edema or massive volume overload. Cardiac dysfunction
often occurs in septic shock patients and can significantly affect outcome; one physiologic
approach to disclose the interaction between the heart and the circulation when both are
affected is to examine ventriculo-arterial coupling defined by the ratio of arterial elastance
(Ea) and left ventricular elastance (Ees). We aimed to analyze ventriculo-arterial coupling in
a cohort of patients admitted to ICUs presenting or not with septic shock.
Guarracino, F., et al.
http://ccforum.com/content/pdf/cc13842.pdf
Septic shock is the most severe manifestation of sepsis. It is characterized as a hypotensive
cardiovascular state associated with multiorgan dysfunction and metabolic disturbances.
Management of septic shock is targeted to preserve an adequate organ perfusion pressure
without precipitating pulmonary edema or massive volume overload. Cardiac dysfunction
often occurs in septic shock patients and can significantly affect outcome; one physiologic
approach to disclose the interaction between the heart and the circulation when both are
affected is to examine ventriculo-arterial coupling defined by the ratio of arterial elastance
(Ea) and left ventricular elastance (Ees). We aimed to analyze ventriculo-arterial coupling in
a cohort of patients admitted to ICUs presenting or not with septic shock.
A systematic review of therapeutic hypothermia for adult patients following traumatic brain injury
A systematic review of therapeutic hypothermia for adult patients following traumatic brain injury. Critical Care 2014, 18:R75
Crossley, S., et al.
http://ccforum.com/content/pdf/cc13835.pdf
Research into therapeutic hypothermia following traumatic brain injury has been
characterised by small trials of poor methodological quality, producing variable results. The
Cochrane review, published in 2009, now requires updating. The aim of this systematic
review is to assess the effectiveness of the application of therapeutic hypothermia to reduce
death and disability when administered to adult patients who have been admitted to hospital
following traumatic brain injury.
Crossley, S., et al.
http://ccforum.com/content/pdf/cc13835.pdf
Research into therapeutic hypothermia following traumatic brain injury has been
characterised by small trials of poor methodological quality, producing variable results. The
Cochrane review, published in 2009, now requires updating. The aim of this systematic
review is to assess the effectiveness of the application of therapeutic hypothermia to reduce
death and disability when administered to adult patients who have been admitted to hospital
following traumatic brain injury.
Effect of statin therapy on mortality from infection and sepsis
Effect of statin therapy on mortality from infection and sepsis: a meta-analysis of randomized and observational studies. Critical Care 2014, 18:R71
You-Dong Wan, et al.
http://ccforum.com/content/pdf/cc13828.pdf
Observational data have suggested that statin therapy may reduce mortality in patients with
infection and sepsis; however, results from randomized studies are contradictory and do not
support the use of statins in this context. Here, we performed a meta-analysis to investigate
the effects of statin therapy on mortality from infection and sepsis.
You-Dong Wan, et al.
http://ccforum.com/content/pdf/cc13828.pdf
Observational data have suggested that statin therapy may reduce mortality in patients with
infection and sepsis; however, results from randomized studies are contradictory and do not
support the use of statins in this context. Here, we performed a meta-analysis to investigate
the effects of statin therapy on mortality from infection and sepsis.
Intensive care unit depth of sleep
Intensive care unit depth of sleep: proof of concept of a simple electroencephalography index in the non-sedated. Critical Care 2014, 18:R66
Reinke, L., et al.
http://ccforum.com/content/pdf/cc13823.pdf
Intensive care unit (ICU) patients are known to experience severely disturbed sleep, with
possible detrimental effects on short- and long- term outcomes. Investigation into the exact
causes and effects of disturbed sleep has been hampered by cumbersome and time consuming
methods of measuring and staging sleep. We introduce a novel method for ICU depth of sleep
analysis, the ICU depth of sleep index (IDOS index), using single channel
electroencephalography (EEG) and apply it to outpatient recordings. A proof of concept is
Reinke, L., et al.
http://ccforum.com/content/pdf/cc13823.pdf
Intensive care unit (ICU) patients are known to experience severely disturbed sleep, with
possible detrimental effects on short- and long- term outcomes. Investigation into the exact
causes and effects of disturbed sleep has been hampered by cumbersome and time consuming
methods of measuring and staging sleep. We introduce a novel method for ICU depth of sleep
analysis, the ICU depth of sleep index (IDOS index), using single channel
electroencephalography (EEG) and apply it to outpatient recordings. A proof of concept is
shown in non-sedated ICU patients.
Impact of critical care nursing on 30-day mortality of mechanically ventilated older adults
Impact of critical care nursing on 30-day mortality of mechanically ventilated older adults. Critical Care Medicine, May 2014, Vol. 42(5), p.1089-95.
Kelly, D.M., et al.
http://journals.lww.com/ccmjournal/Abstract/2014/05000/Impact_of_Critical_Care_Nursing_on_30_Day.9.aspx
The mortality rate for mechanically ventilated older adults in ICUs is high. A robust research literature shows a significant association between nurse staffing, nurses’ education, and the quality of nurse work environments and mortality following common surgical procedures. A distinguishing feature of ICUs is greater investment in nursing care. The objective of this study is to determine the extent to which variation in ICU nursing characteristics—staffing, work environment, education, and experience—is associated with mortality, thus potentially illuminating strategies for improving patient outcomes.
Kelly, D.M., et al.
http://journals.lww.com/ccmjournal/Abstract/2014/05000/Impact_of_Critical_Care_Nursing_on_30_Day.9.aspx
The mortality rate for mechanically ventilated older adults in ICUs is high. A robust research literature shows a significant association between nurse staffing, nurses’ education, and the quality of nurse work environments and mortality following common surgical procedures. A distinguishing feature of ICUs is greater investment in nursing care. The objective of this study is to determine the extent to which variation in ICU nursing characteristics—staffing, work environment, education, and experience—is associated with mortality, thus potentially illuminating strategies for improving patient outcomes.
The highs and lows of blood pressure
The highs and lows of blood pressure: toward meaningful clinical targets in patients with shock. Critical Care Medicine, May 2014, Vol. 42(5), p.1241-51.
Magder, S.A.
http://journals.lww.com/ccmjournal/Abstract/2014/05000/The_Highs_and_Lows_of_Blood_Pressure__Toward.26.aspx
Measurement of blood pressure is fundamental for the management of patients in shock, yet the physiological basis and meaning of blood pressure measurements are complex and often not well understood. This article is in two parts: part 1 deals with the mechanical and physiological aspects of blood pressure and its measurement and part 2 deals with the role of changes in regional resistances in the determination of tissue perfusion and bedside approaches to management of shock.
Magder, S.A.
http://journals.lww.com/ccmjournal/Abstract/2014/05000/The_Highs_and_Lows_of_Blood_Pressure__Toward.26.aspx
Measurement of blood pressure is fundamental for the management of patients in shock, yet the physiological basis and meaning of blood pressure measurements are complex and often not well understood. This article is in two parts: part 1 deals with the mechanical and physiological aspects of blood pressure and its measurement and part 2 deals with the role of changes in regional resistances in the determination of tissue perfusion and bedside approaches to management of shock.
Rehabilitation interventions for postintensive care syndrome
Rehabilitation interventions for postintensive care syndrome: A systematic review. Critical Care Medicine, May 2014, Vol. 42(5), p.1263-71.
Mehlhorn, J., et al.
http://journals.lww.com/ccmjournal/Abstract/2014/05000/Rehabilitation_Interventions_for_Postintensive.28.aspx
An increasing number of ICU patients survive and develop mental, cognitive, or physical impairments. Various interventions support recovery from this postintensive care syndrome. Physicians in charge of post-ICU patients need to know which interventions are effective.
Mehlhorn, J., et al.
http://journals.lww.com/ccmjournal/Abstract/2014/05000/Rehabilitation_Interventions_for_Postintensive.28.aspx
An increasing number of ICU patients survive and develop mental, cognitive, or physical impairments. Various interventions support recovery from this postintensive care syndrome. Physicians in charge of post-ICU patients need to know which interventions are effective.
Family presence during brain death evaluation
Family presence during brain death evaluation: A randomized controlled trial. Critical Care Medicine, April 2014, Vol. 42(4), p.934-42.
Tawil, I., et al.
http://journals.lww.com/ccmjournal/Abstract/2014/04000/Family_Presence_During_Brain_Death_Evaluation__A.21.aspx
To evaluate if a family presence educational intervention during brain death evaluation improves understanding of brain death without affecting psychological distress.
Tawil, I., et al.
http://journals.lww.com/ccmjournal/Abstract/2014/04000/Family_Presence_During_Brain_Death_Evaluation__A.21.aspx
To evaluate if a family presence educational intervention during brain death evaluation improves understanding of brain death without affecting psychological distress.
Psychological wellbeing, health related quality of life and memories of intensive care
Psychological wellbeing, health related quality of life and memories of intensive care and a specialised weaning centre reported by survivors of prolonged mechanical ventilation. Intensive and Critical Care Nursing, June 2014, Vol. 30(3), p.145-51.
Rose, L., et al.
http://www.intensivecriticalcarenursing.com/article/S0964-3397(13)00116-X/abstract?rss=yes
To compare memories and recall of intensive care unit and specialised weaning centre admission, characterise health-related quality of life and psychological morbidity, and examine the relationship between delusional memories and psychological outcomes.
Rose, L., et al.
http://www.intensivecriticalcarenursing.com/article/S0964-3397(13)00116-X/abstract?rss=yes
To compare memories and recall of intensive care unit and specialised weaning centre admission, characterise health-related quality of life and psychological morbidity, and examine the relationship between delusional memories and psychological outcomes.
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