2015 Dec - Predictive value of EEG-awakening for behavioral awakening from coma

Kang X, Yang F, Li W, Ma C, Li L and Jiang W Annals of Intensive Care 2015, 5:52 (21 December 2015)

Background: A reliable predictor for early recovery of consciousness in comatose patients is of great clinical significance. Here we aimed to investigate the potentially prognostic value of electroencephalogram-reactivity (EEG-R) in combination with sleep spindles, termed EEG-awakening, for behavioral awakening in etiologically diverse comatose patients.

Read more ...

2015 Dec - Evaluation of a systematic approach to weaning of tracheotomized neurological patients: an early interrupted randomized controlled trial

Vaschetto R, Frigerio P, Sommariva M, Boggero A, Rondi V, Grossi F, Cavuto S, Nava S et al. Annals of Intensive Care 2015, 5:54 (23 December 2015)

Background: While a systematic approach to weaning reduces the rate of extubation failure in intubated brain-injured patients, no data are available on the weaning outcome of these patients after tracheotomy. We aimed to assess whether a systematic approach to disconnect tracheotomized neurological and neurosurgical patients off the ventilator (intervention) is superior to the sole physician’s judgment (control). Based on previous work in intubated patients, we hypothesized a reduction of the rate of failure within 48 h from 15 to 5 %. Secondary endpoints were duration of mechanical ventilation, ICU length of stay and mortality.

Read more ...

2015 Dec - Fenoldopam to prevent acute kidney injury after major surgery—a systematic review and meta-analysis

Michael Gillies, Vivek Kakar, Robert Parker, Patrick Honoré, Marlies Ostermann Critical Care 2015, 19:449 (25 December 2015)

Background: Acute kidney injury (AKI) after surgery is associated with increased mortality and healthcare costs. Fenoldopam is a selective dopamine-1 receptor agonist with renoprotective properties. We conducted a systematic review and meta-analysis of randomised controlled trials comparing fenoldopam with placebo to prevent AKI after major surgery.

Read more ...

2015 Dec - Long-term remote organ consequences following acute kidney injury

Chih-Chung Shiao, Pei-Chen Wu, Tao-Min Huang, Tai-Shuan Lai, Wei-Shun Yang, Che-Hsiung Wu, Chun-Fu Lai, Vin-Cent Wu, Tzong-Shinn Chu, Kwan-Dun Wu, on behalf of the National Taiwan University Hospital Study Group on Acute Renal Failure (NSARF) and the Taiwan Consortium for Acute Kidney Injury and Renal Diseases (CAKs) Critical Care 2015, 19:438 (28 December 2015)

Acute kidney injury (AKI) has been a global health epidemic problem with soaring incidence, increased long-term risks for multiple comorbidities and mortality, as well as elevated medical costs. Despite the improvement of patient outcomes following the advancements in preventive and therapeutic strategies, the mortality rates among critically ill patients with AKI remain as high as 40–60 %.

Read more ...

2015 Dec - Prevention and treatment of sepsis-induced acute kidney injury: an update

Honore PM, Jacobs R, Hendrickx I, Bagshaw SM, Joannes-Boyau O, Boer W, De Waele E, Van Gorp V et al. Annals of Intensive Care 2015, 5:51 (21 December 2015)

Sepsis-induced acute kidney injury (SAKI) remains an important challenge in critical care medicine. We reviewed current available evidence on prevention and treatment of SAKI with focus on some recent advances and developments. Prevention of SAKI starts with early and ample fluid resuscitation preferentially with crystalloid solutions. Balanced crystalloids have no proven superior benefit...

Read more ...

2016 Jan - Maternal Sepsis and Septic Shock

Chebbo A, Tan S, Kassis C, Tamura L, Carlson RW.; Crit Care Clin. 2016 Jan;32(1):119-35. Epub 2015 Oct 19. Review.

The year 2015 marked the 200th anniversary of the birth of Ignaz Semmelweis, the Hungarian physician who identified unhygienic practices of physicians as a major cause of childbed fever or puerperal sepsis. Although such practices have largely disappeared as a factor in the development of chorioamnionitis and postpartum or puerperal endometritis, it is appropriate that this article on sepsis in pregnancy acknowledges his contributions to maternal health. This review describes the incidence and mortality of sepsis in pregnancy, methods to identify and define sepsis in this population, including scoring systems, causes, and sites of infection during pregnancy and parturition and management guidelines.

Read more ...

2015 Dec - Extracorporeal membrane oxygenation (ECMO) for critically ill adults in the emergency department: history, current applications, and future directions

Jarrod Mosier, Melissa Kelsey, Yuval Raz, Kyle Gunnerson, Robyn Meyer, Cameron Hypes, Josh Malo, Sage Whitmore, Daniel Spaite Critical Care 2015, 19:431 (17 December 2015)

Extracorporeal membrane oxygenation (ECMO) is a mode of extracorporeal life support that augments oxygenation, ventilation and/or cardiac output via cannulae connected to a circuit that pumps blood through an oxygenator and back into the patient. ECMO has been used for decades to support cardiopulmonary disease refractory to conventional therapy. While not robust, there are promising data for the use of ECMO in acute hypoxemic respiratory failure, cardiac arrest, and cardiogenic shock and the potential indications for ECMO continue to increase. This review discusses the existing literature on the potential use of ECMO in critically ill patients within the emergency department.

Read more ...

2015 Dec - Accuracy of intracranial pressure monitoring: systematic review and meta-analysis

Lucia Zacchetti, Sandra Magnoni, Federica Di Corte, Elisa Zanier, Nino Stocchetti Critical Care 2015, 19:420 (2 December 2015)

Introduction: Intracranial pressure (ICP) measurement is used to tailor interventions and to assist in formulating the prognosis for traumatic brain injury patients. Accurate data are therefore essential. The aim of this study was to verify the accuracy of ICP monitoring systems on the basis of a literature review.

Read more ...

2015 Dec - Timing of tracheotomy in ICU patients: a systematic review of randomized controlled trials

Koji Hosokawa, Masaji Nishimura, Moritoki Egi, Jean-Louis Vincent Critical Care 2015, 19:424 (4 December 2015)

Introduction: The optimal timing of tracheotomy in critically ill patients remains a topic of debate. We performed a systematic review to clarify the potential benefits of early versus late tracheotomy.

Read more ...

2015 Nov - Pain-related Somato Sensory Evoked Potentials: a potential new tool to improve the prognostic prediction of coma after cardiac arrest

Paolo Zanatta, Federico Linassi, Anna Mazzarolo, Maria Aricò, Enrico Bosco, Matteo Bendini, Carlo Sorbara, Carlo Ori, Michele Carron, Bruno Scarpa Critical Care 2015, 19:403 (17 November 2015)

Introduction: Early prediction of a good outcome in comatose patients after cardiac arrest still remains an unsolved problem. The main aim of the present study was to examine the accuracy of middle-latency SSEP triggered by a painful electrical stimulation on median nerves to predict a favorable outcome.

Read more ...

2015 Nov - Argatroban in the management of heparin-induced thrombocytopenia: a multicenter clinical trial

Brigitte Tardy-Poncet, Philippe Nguyen, Jean-Claude Thiranos, Pierre-Emmanuel Morange, Christine Biron-Andréani, Yves Gruel, Jérome Morel, Alain Wynckel, Lelia Grunebaum, Judith Villacorta-Torres, Sandrine Grosjean, Emmanuel de Maistre Critical Care 2015, 19:396 (11 November 2015)

Introduction: The aim of this study was to collect data in France in patients with heparin-induced thrombocytopenia who required parenteral anticoagulation and for whom other non-heparin anticoagulant therapies were contraindicated including patients with renal failure, cross-reactivity to danaparoid or at high hemorrhagic risk.

Read more ...

2015 Nov - Considerations for initial therapy in the treatment of acute heart failure

William Peacock, Chad Cannon, Adam Singer, Brian Hiestand Critical Care 2015, 19:399 (10 November 2015)

The diagnosis of patients presenting to the emergency department with acute heart failure (AHF) is challenging due to the similarity of AHF symptoms to other conditions such as chronic obstructive pulmonary disease and pneumonia. Additionally, because AHF is most common in an older population, the presentation of coexistent pathologies further increases the challenge of making an accurate diagnosis and selecting the most appropriate treatment.

Read more ...

2015 Oct - The efficacy of recombinant human soluble thrombomodulin for obstetric disseminated intravascular coagulation: a retrospective study

Masato Yoshihara, Kaname Uno, Sho Tano, Michinori Mayama, Mayu Ukai, Shinya Kondo, Tetsuya Kokabu, Yasuyuki Kishigami, Hidenori Oguchi Critical Care 2015, 19:369 (20 October 2015)

Introduction: Recombinant human soluble thrombomodulin (rhTM) is a novel anti-coagulant agent that regulates the imbalanced coagulation system by reducing the excessive activation of thrombin. rhTM potentially reduces the morbidity and mortality in patients with sepsis-induced disseminated intravascular coagulation (DIC). However, the efficacy of rhTM in obstetric DIC has not yet been established. We performed this study to examine whether the administration of rhTM was a potentially effective treatment for DIC induced by one or more underlying obstetric disorders.

Read more ...

2015 Oct - Aspirin as a potential treatment in sepsis or acute respiratory distress syndrome

Philip Toner, Danny McAuley, Murali Shyamsundar Critical Care 2015, 19:374 (23 October 2015)

Sepsis is a common condition that is associated with significant morbidity, mortality and health-care cost. Pulmonary and non-pulmonary sepsis are common causes of the acute respiratory distress syndrome (ARDS). The mortality from ARDS remains high despite protective lung ventilation, and currently there are no specific pharmacotherapies to treat sepsis or ARDS.

Read more ...

2015 Oct - The effect of parenteral selenium on outcomes of mechanically ventilated patients following sepsis: a prospective randomized clinical trial

Chelkeba L, Ahmadi A, Abdollahi M, Najafi A, Ghadimi MH, Mosaed R and Mojtahedzadeh M Annals of Intensive Care 2015, 5:29 (1 October 2015)

Background: Sepsis and septic shock is characterized by oxidative stress that mainly promotes systemic inflammation and organ failure due to excessive free radical production and depletion of antioxidant defenses. Therefore, we investigated the effect of selenium administration on antioxidant status, levels of cytokines and clinical outcomes.

Read more ...

2015 Oct - Efficacy of chlorhexidine bathing for reducing healthcare associated bloodstream infections: a meta-analysis

Choi EY, Park DA, Kim HJ and Park J Annals of Intensive Care 2015, 5:31 (7 October 2015)

Background: We performed a meta-analysis of randomized controlled trials (RCTs) to determine if daily bathing with chlorhexidine decreased hospital-acquired BSIs in critically ill patients.

Read more ...

2015 Oct - Management and outcome of patients supported with Impella 5.0 for refractory cardiogenic shock

Philippe Gaudard, Marc Mourad, Jacob Eliet, Norddine Zeroual, Geraldine Culas, Philippe Rouvière, Bernard Albat, Pascal Colson Critical Care 2015, 19:363 (9 October 2015)

Introduction: Cardiogenic shock refractory to standard therapy with inotropes and/or intra-aortic balloon pump is accompanied with an unacceptable high mortality. Percutaneous left ventricular assist devices may provide a survival benefit for these very sick patients. In this study, we describe our experience with the Impella 5.0 device used in the setting of refractory cardiogenic shock.

Read more ...

2015 Sep - Risk factors for delirium after on-pump cardiac surgery: a systematic review

Gosselt AN, Slooter AJ, Boere PR, Zaal IJ.; Crit Care. 2015 Sep 23;19(1):346.

INTRODUCTION: As evidence-based effective treatment protocols for delirium after cardiac surgery are lacking, efforts should be made to identify risk factors for preventive interventions. Moreover, knowledge of these risk factors could increase validity of etiological studies in which adjustments need to be made for confounding variables. This review aims to systematically identify risk factors for delirium after cardiac surgery and to grade the evidence supporting these associations.

Read more ...

2015 Sep - Non-invasive monitoring of oxygen delivery in acutely ill patients: new frontiers

Perel A Annals of Intensive Care 2015, 5:24 (17 September 2015)

Hypovolemia, anemia and hypoxemia may cause critical deterioration in the oxygen delivery (DO 2 ). Their early detection followed by a prompt and appropriate intervention is a cornerstone in the care of critically ill patients. And yet, the remedies for these life-threatening conditions, namely fluids, blood and oxygen, have to be carefully titrated as they are all associated with severe side-effects when administered in excess.

Read more ...

2015 Sep - Breakthrough in cardiac arrest: reports from the 4th Paris International Conference

Kudenchuk PJ, Sandroni C, Drinhaus HR, Böttiger BW, Cariou A, Sunde K, Dworschak M, Taccone FS et al. Annals of Intensive Care 2015, 5:22 (17 September 2015)

The French Intensive Care Society organized on 5th and 6th June 2014 its 4th “Paris International Conference in Intensive Care”, whose principle is to bring together the best international experts on a hot topic in critical care medicine. The 2014 theme was “Breakthrough in cardiac arrest”, with many high-quality updates on epidemiology, public health data, pre-hospital and in-ICU cares. The present review includes short summaries of the major presentations, classified into six main chapters..

Read more ...