Patient-important upper gastrointestinal bleeding in the ICU: A mixed-methods study of patient and family perspectives

OBJECTIVES:To perform a systematic review and meta-analysis to assess the efficacy and safety of corticosteroids in patients with sepsis.DATA SOURCES:We searched PubMed, Embase, and the Cochrane Library, up to January 10, 2023.STUDY SELECTION:We included randomized controlled trials (RCTs) comparing corticosteroids with placebo or standard care with sepsis.DATA EXTRACTION:The critical outcomes of interest included mortality, shock reversal, length of stay in the ICU, and adverse events.DATA ANALYSIS:We performed both a pairwise and dose-response meta-analysis to evaluate the effect of different corticosteroid doses on outcomes. We used Grading of Recommendations Assessment, Development and Evaluation to assess certainty in pooled estimates.DATA SYNTHESIS:We included 45 RCTs involving 9563 patients. Corticosteroids probably reduce short-term mortality (risk ratio [RR], 0 …

Objective:To provide procedure-specific estimates of symptomatic venous thromboembolism (VTE) and major bleeding after abdominal surgery.Background:The use of pharmacological thromboprophylaxis represents a trade-off that depends on VTE and bleeding risks that vary between procedures; their magnitude remains uncertain.Methods:We identified observational studies reporting procedure-specific risks of symptomatic VTE or major bleeding after abdominal surgery, adjusted the reported estimates for thromboprophylaxis and length of follow-up, and estimated cumulative incidence at 4 weeks postsurgery, stratified by VTE risk groups, and rated evidence certainty.Results:

We report the short-and long-term results of the SOLIDARITY Finland on mortality and other patient-important outcomes in patients hospitalised for COVID-19. Between 08/2021 and 03/2023, we randomised 156 patients in 15 hospitals. In the imatinib group, 7.2% of patients had died at 30 days and 13.3% at 1 year and in the standard of care group 4.1% and 8.3%(adjusted HR at 30 days 1.09, 95% CI 0.23-5.07). In a meta-analysis of randomised trials of imatinib versus standard of care (n= 732), allocation to imatinib was associated with a mortality risk ratio of 0.73 (95% CI 0.32-1.63). At 1-year, self-reported recovery occurred in 79.0% in imatinib and in 88.3% in standard of care (RR 0.91, 95% CI 0.78-1.06). Of the 21 potential long COVID symptoms, patients often reported moderate or major bother from fatigue (24%), sleeping problems (19%) and memory difficulties (17%). We found no convincing difference between imatinib and standard of care groups in quality of life or symptom outcomes. The evidence raises serious doubts regarding the benefit of imatinib in reducing mortality, improving recovery and preventing potential long COVID symptoms when given to patients hospitalised for COVID-19.

Annals of Allergy, Asthma & Immunology

BackgroundGuidance addressing atopic dermatitis (AD) management, last issued in 2012 by the American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force, requires updating as a result of new treatments and improved guideline and evidence synthesis methodology.ObjectiveTo produce evidence-based guidelines that support patients, clinicians, and other decision-makers in the optimal treatment of AD.MethodsA multidisciplinary guideline panel consisting of patients and caregivers, AD experts (dermatology and allergy/immunology), primary care practitioners (family medicine, pediatrics, internal medicine), and allied health professionals (psychology, pharmacy, nursing) convened, prioritized equity, diversity, and inclusiveness, and implemented management strategies to minimize influence of conflicts of interest. The Evidence in Allergy Group …

JAMA

To the Editor Although sometimes considered the pinnacle of scientific evidence, meta-analyses can be problematic. Combining outcomes from heterogeneous trials performed in different settings or populations may give results directly applicable to few. Conclusions are also beholden to methodological design, often discordant from those of subsequent randomized clinical trials. 1 Such may be the case with the recently published dose-response meta-analysis of studies examining efficacy and tolerability of gefapixant for refractory or unexplained chronic cough. 2 Because gefapixant is the first novel efficacious therapy for refractory and unexplained chronic cough, its development involved changes in study design and participant inclusion criteria as well as drug formulation. 3 Four drug formulations were ultimately tested, with maximum bioavailability achieved for the formulation used in the phase 3 trials, such that …

Il s'agit d'un projet commun entre l'unité MERIT (McMaster Education Research, Innovation, and Theory), le programme de développement du corps professoral de la faculté des sciences de la santé de l'Université McMaster et le programme de maîtrise en éducation des sciences de la santé de l'Université McMaster. Ce livre électronique a été publié par l'Université McMaster, Faculté des sciences de la santé, Bureau du développement professionnel continu. The Health Professions Education Research Primer est disponible sous la licence internationale Creative Commons Attribution-NonCommercial-ShareAlike 4.0 (CC BY-NC-SA 4.0). Ce projet est rendu possible grâce au financement du gouvernement de l'Ontario et au soutien de eCampusOntario à la Stratégie d'apprentissage virtuel. Pour en savoir plus sur la Stratégie d'apprentissage virtuel, consultez le site https://vls.ecampusontario.ca. Cette ressource est …

For critically ill patients who are recovering from critical illness requiring invasive ventilation, liberation from mechanical ventilation refers to the processes of weaning and a Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; b Department of Medicine and Division of Critical Care, Unity Health Toronto, St. Michaels Hospital, Toronto, Ontario, Canada; c Li Ka Shing Knowledge Institute, Unity Health Toronto, St. Michael’s Hospital, Toronto, Ontario, Canada; d Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; e Department of Medicine, Hamilton Health Sciences, Juravinski Hospital, Hamilton, Ontario, Canada; f Department of Critical Care, Hamilton Health Sciences, Juravinski Hospital, Hamilton, Ontario, Canada; g Department of Critical Care, Ottawa Hospital, Ottawa, Ontario, Canada; h Division of …

PurposeAssessing efficacy of electrical impedance tomography (EIT) in optimizing positive end-expiratory pressure (PEEP) for acute respiratory distress syndrome (ARDS) patients to enhance respiratory system mechanics and prevent ventilator-induced lung injury (VILI), compared to traditional methods.MethodsWe carried out a systematic review and meta-analysis, spanning literature from January 2012 to May 2023, sourced from Scopus, PubMed, MEDLINE (Ovid), Cochrane, and LILACS, evaluated EIT-guided PEEP strategies in ARDS versus conventional methods. Thirteen studies (3 randomized, 10 non-randomized) involving 623 ARDS patients were analyzed using random-effects models for primary outcomes (respiratory mechanics and mechanical power) and secondary outcomes (PaO 2/FiO 2 ratio, mortality, stays in intensive care unit (ICU), ventilator-free days).ResultsEIT-guided PEEP significantly …

Human Vaccines & Immunotherapeutics

We sought in-depth understanding on the evolution of factors influencing COVID-19 booster dose and bivalent vaccine hesitancy in a longitudinal semi-structured interview-based qualitative study. Serial interviews were conducted between July 25th and September 1st, 2022 (Phase I: univalent booster dose availability), and between November 21st, 2022 and January 11th, 2023 (Phase II: bivalent vaccine availability). Adults (≥18 years) in Canada who had received an initial primary series and had not received a COVID-19 booster dose were eligible for Phase I, and subsequently invited to participate in Phase II. Twenty-two of twenty-three (96%) participants completed interviews for both phases (45 interviews). Nearly half of participants identified as a woman (n = 11), the median age was 37 years (interquartile range: 32–48), and most participants were employed full-time (n = 12); no participant reported …

The Lancet

Their stated aim is to summarise the “benefits and harms of weight-lowering drugs”, but the main findings and discussion focus on weight loss, without due consideration to the scarcity of evidence for benefits to health and wellbeing. For instance, quality of life and depression data are reported as low quality or insufficient, and there is no mention of the absence of long-term cardiovascular outcomes. A review on long-term effects of weight-reducing pharmacotherapy included only one trial with cardiovascular outcomes; it found no benefit.

Critical care medicine

OBJECTIVES:To provide evidence-based recommendations for hospital clinicians and administrators to optimize recognition and response to clinical deterioration in non-ICU patients.

Sepsis is common, global, and deadly. Although most of its victims live in low-and middle-income countries (LMICs)(1), clinical trials of treatment approaches are disproportionately conducted in high-income countries (HICs)(2). This disparity in access to research is an important and modifiable contributor to the inequitable distribution of the global burden of sepsis.Multiple factors—host, pathogen, and healthcare system factors—can impact the effectiveness of specific sepsis treatments; these differ around the world and are only rarely incorporated into trial design (Figure 1). Malnutrition and the human immunodeficiency virus may be more prevalent in LMICs. In HICs, sepsis is primarily driven by bacterial infection, whereas in LMICs parasitic and mycobacterial infections are more common (3). Antimicrobial resistance causes excess mortality worldwide, but its impact is most notable in Sub-Saharan Africa (4 …

JMIR research protocols

Background The optimal educational approach for preparing health professionals with the knowledge and skills to effectively recognize and respond to family violence, including child maltreatment and intimate partner violence, remains unclear. The Violence, Evidence, Guidance, and Action (VEGA) Family Violence Education Resources is a novel intervention that can be completed via self-directed learning or in a workshop format; both approaches focus on improving health professional preparedness to address family violence. Objective Our studies aim to determine the acceptability and feasibility of conducting a randomized controlled trial to evaluate the effectiveness of the self-directed (experimental intervention) and workshop (active control) modalities of VEGA, as an adjunct to standard education, to improve learner (Researching the Impact of Service provider Education [RISE] with Residents) and independent practice (RISE with Veterans) health professional preparedness, knowledge, and skills related to recognizing family violence in their health care encounters. Methods The RISE with Residents and RISE with Veterans research studies use embedded experimental mixed methods research designs. The quantitative strand for each study follows the principles of a pilot randomized controlled trial. For RISE with Residents, we aimed to recruit 80 postgraduate medical trainees; for RISE with Veterans, we intended to recruit 80 health professionals who work or have worked with Veterans (or their family members) of the Canadian military or the Royal Canadian Mounted Police in a direct …

SSM-Qualitative Research in Health

Canadians' health outcomes are inextricably tied to social inequities. Family medicine is uniquely situated to provide care that addresses social factors through longitudinal knowledge of patients and the contexts of their lives. However, family physicians have come under increased practice demands shaped by neoliberal ideological structuring of health care, compounding difficulties in providing care for persons experiencing health needs related to social inequities. Nursing scholar Ruth Malone has argued that remaining proximal, or close to patients, is a form of resistance to these demands. Using a critical narrative methodology, this paper presents the stories of 20 family physicians working with persons experiencing health needs related to inequity in Ontario, Canada, that express and expand upon Malone's proximity. We highlight how participants invoke notions of proximity through their stories, describing the …

Chest

BackgroundAlbumin is used commonly across a wide range of clinical settings to improve hemodynamics, to facilitate fluid removal, and to manage complications of cirrhosis. The International Collaboration for Transfusion Medicine Guidelines developed guidelines for the use of albumin in patients requiring critical care, undergoing cardiovascular surgery, undergoing kidney replacement therapy, or experiencing complications of cirrhosis.MethodsCochairs oversaw the guideline development process and the panel included researchers, clinicians, methodologists, and a patient representative. The evidence informing this guideline arises from a systematic review of randomized clinical trials and systematic reviews, in which multiple databases were searched (inception through November 23, 2022). The panel reviewed the data and formulated the guideline recommendations using Grading of Recommendations …

OBJECTIVES:We postulate that corticosteroid-related side effects in critically ill patients are similar across sepsis, acute respiratory distress syndrome (ARDS), and community-acquired pneumonia (CAP). By pooling data across all trials that have examined corticosteroids in these three acute conditions, we aim to examine the side effects of corticosteroid use in critical illness.DATA SOURCES:We performed a comprehensive search of MEDLINE, Embase, Centers for Disease Control and Prevention library of COVID research, CINAHL, and Cochrane center for trials.STUDY SELECTION:We included randomized controlled trials (RCTs) that compared corticosteroids to no corticosteroids or placebo in patients with sepsis, ARDS, and CAP.DATA EXTRACTION:We summarized data addressing the most described side effects of corticosteroid use in critical care: gastrointestinal bleeding, hyperglycemia, hypernatremia …

Canadian Journal of Anesthesia/Journal canadien d'anesthésie

PurposeThe ordering of routine blood test panels in advance is common in intensive care units (ICUs), with limited consideration of the pretest probability of finding abnormalities. This practice contributes to anemia, false positive results, and health care costs. We sought to understand practices and attitudes of Canadian adult intensivists regarding ordering of blood tests in critically ill patients.MethodsWe conducted a nationwide Canadian cross-sectional survey consisting of 15 questions assessing three domains (global perceptions, test ordering, daily practice), plus 11 demographic questions. The target sample was one intensivist per adult ICU in Canada. We summarized responses using descriptive statistics and present data as mean with standard deviation (SD) or count with percentage as appropriate.ResultsOver seven months, 80/131 (61%) physicians responded from 77 ICUs, 50% of which were from …

Journal of Critical Care

Introduction and aimTo determine the association between whole blood thiamine pyrophosphate (TPP) concentrations in critically ill patients and plasma metabolites and linked metabolic pathways using high resolution metabolomics.Patients and methodsThis cross-sectional study was performed at Erciyes University Hospital, Medical Intensive Care Unit (ICU), Kayseri, Turkiye and Emory University Department of Medicine Clinical Biomarkers Laboratory, Atlanta, GA, USA. Participants were enrolled as follows;≥18 years of age, with an expected length of ICU stay longer than 48 h and receiving furosemide therapy for at least 6 months or longer before ICU admission.ResultsBlood for TPP and metabolomics was obtained on the first day of ICU admission. Whole blood TPP concentrations were measured using high-performance liquid chromatography (HPLC). Liquid chromatography/mass spectrometry for high …

Journal of critical care

Authors response: "Etomidate as an induction agent for endotracheal intubation in critically ill patients: A meta-analysis of randomized trials" Authors response: "Etomidate as an induction agent for endotracheal intubation in critically ill patients: A meta-analysis of randomized trials" J Crit Care. 2024 Feb:79:154411. doi: 10.1016/j.jcrc.2023.154411. Epub 2023 Sep 9. Authors Yuki Kotani 1 , Matthew W Semler 2 , Todd C Lee 3 , Giovanni Landoni 4 Affiliations 1 Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Japan. Electronic address: kotani.yuki@kameda.jp. 2 Department of Medicine, Division of Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, United States; Vanderbilt Institute for …

Journal of critical care

Authors' response: "Brain magnetic resonance imaging findings six months after critical COVID-19: A prospective cohort study" Authors' response: "Brain magnetic resonance imaging findings six months after critical COVID-19: A prospective cohort study" J Crit Care. 2024 Mar 30:154800. doi: 10.1016/j.jcrc.2024.154800. Online ahead of print. Authors Henriikka Ollila 1 , Janne Pihlajamaa 2 , Juha Martola 2 , Laura Hokkanen 3 , Marjaana Tiainen 4 , Johanna Hästbacka 5 Affiliations 1 Department of Perioperative, Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland. Electronic address: henriikka.ollila@helsinki.fi. 2 HUS Medical Imaging Centre, Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland. 3 Department of Psychology and Logopaedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland. 4 Department of Neurology, …

Journal of critical care

Authors response: "Etomidate as an induction agent for endotracheal intubation in critically ill patients: A meta-analysis of randomized trials" Authors response: "Etomidate as an induction agent for endotracheal intubation in critically ill patients: A meta-analysis of randomized trials" J Crit Care. 2024 Feb:79:154411. doi: 10.1016/j.jcrc.2023.154411. Epub 2023 Sep 9. Authors Yuki Kotani 1 , Matthew W Semler 2 , Todd C Lee 3 , Giovanni Landoni 4 Affiliations 1 Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Japan. Electronic address: kotani.yuki@kameda.jp. 2 Department of Medicine, Division of Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, United States; Vanderbilt Institute for …

Journal of Critical Care

PurposeReal-world comparison of RRT modality on RRT dependence at 90 days postdischarge among ICU patients discharged alive after RRT for acute kidney injury (AKI).MethodsUsing claims-linked to US hospital discharge data (Premier PINC AI Healthcare Database [PHD]), we compared continuous renal replacement therapy (CRRT) vs. intermittent hemodialysis (IHD) for AKI in adult ICU patients discharged alive from January 1, 2018 to June 30, 2021. RRT dependence at 90 days postdischarge was defined as ≥2 RRT treatments in the last 8 days. Between-group differences were balanced using inverse probability treatment weighting (IPTW).ResultsOf 34,804 patients, 3804 patients (from 382 hospitals) had claims coverage for days 83–90 postdischarge. Compared to IHD-treated patients (n = 2740), CRRT-treated patients (n = 1064) were younger; had more admission to large teaching hospitals, surgery …

Journal of critical care

Ventilatory strategies during venovenous ECMO in ARDS: PEEPing at the elephant in the room Ventilatory strategies during venovenous ECMO in ARDS: PEEPing at the elephant in the room J Crit Care. 2023 Sep 9;79:154407. doi: 10.1016/j.jcrc.2023.154407. Online ahead of print. Authors Ryan Ruiyang Ling 1 , Kollengode Ramanathan 2 , Kiran Shekar 3 Affiliations 1 Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore. 2 Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Health System, Singapore. 3 Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, QLD, Australia; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Institute of Health and Biomedical Innovation…

Journal of Critical Care

Introduction and aimCentral venous catheter thrombosis (CRT) is a common entity in critical care units with incidence between 1.9% and 44%. The incidence of venous thromboembolism reaches to 14–59% in high risk trauma patients without thromboprophylaxis and 3.6–33% for those receiving prophylaxis. The majority of thrombotic events are asymptomatic or obscured by other pathologies in trauma patients so screening bedside ultrasonography may play a significant role in detection of thrombosis and related complications. The aim of this study was to evaluate the prevalence of catheter related venous thrombosis with Doppler sonography in adult trauma patients admitted in ICUs.Patients and methodsWith the aid of duplex ultrasonography we prospectively evaluated 82 adult intensive care unit trauma patients for the incidence of central venous thrombosis in four time points. Demographic data, as well as the …

Journal of Critical Care

PurposeTo investigate the development in quality of ICU care over time using the Dutch National Intensive Care Evaluation (NICE) registry.Materials and methodsWe included data from all ICU admissions in the Netherlands from those ICUs that submitted complete data between 2009 and 2021 to the NICE registry.We determined median and interquartile range for eight quality indicators. To evaluate changes over time on the indicators, we performed multilevel regression analyses, once without and once with the COVID-19 years 2020 and 2021 included. Additionally we explored between-ICU heterogeneity by calculating intraclass correlation coefficients (ICC).Results705,822 ICU admissions from 55 (65%) ICUs were included in the analyses. ICU length of stay (LOS), duration of mechanical ventilation (MV), readmissions, in-hospital mortality, hypoglycemia, and pressure ulcers decreased significantly between …

Journal of Critical Care

BackgroundNoradrenaline and metaraminol are commonly used vasopressors in critically ill patients. However, little is known of their dose equivalence.MethodsWe conducted a single centre retrospective cohort study of all ICU patients who transitioned from metaraminol to noradrenaline infusions between August 26, 2016 and December 31, 2020. Patients receiving additional vasoactive drug infusion were excluded. Dose equivalence was calculated based on the last hour metaraminol dose (in μg/min) and the first hour noradrenaline dose (in μg/min) with the closest matched mean arterial pressure (MAP). Sensitivity analyses were performed on patients with acute kidney injury (AKI), sepsis and mechanical ventilation.ResultsWe studied 195 patients. The median conversion ratio of metaraminol to noradrenaline was 12.5:1 (IQR 7.5–20.0) for the overall cohort. However, the coefficient of variation was 77% and …

Journal of Critical Care

IntroductionThe objective of this study was to create a definition of patient-important upper gastrointestinal bleeding during critical illness as an outcome for a randomized trial.DesignThis was a sequential mixed-methods qualitative-dominant multi-center study with an instrument-building aim. In semi-structured individual interviews or focus groups we elicited views from survivors of critical illness and family members of patients in the intensive care unit (ICU) regarding which features indicate important gastrointestinal bleeding. Quantitative demographic characteristics were collected. We analyzed qualitative data using inductive content analysis to develop a definition for patient-important upper gastrointestinal bleeding.SettingCanada and the United States.Participants51 ICU survivors and family members of ICU patients.ResultsParticipants considered gastrointestinal bleeding to be important if it resulted in death …

Journal of Critical Care

PurposeThe Harlequin syndrome may occur in patients treated with venoarterial extracorporal membrane oxygenation (VA-ECMO), in whom blood from the left ventricle and the ECMO system supply different parts of the body with different paCO2-levels. The purpose of this study was to compare two variants of paCO2-analysis to account for the Harlequin syndrome during apnea testing (AT) in brain death (BD) determination.Materials and methodsTwenty-seven patients (median age 48 years, 26–76 years; male n = 19) with VA-ECMO treatment were included who underwent BD determination. In variant 1, simultaneous arterial blood gas (ABG) samples were drawn from the right and the left radial artery. In variant 2, simultaneous ABG samples were drawn from the right radial artery and the postoxygenator ECMO circuit. Differences in paCO2-levels were analysed for both variants.ResultsAt the start of AT, median pa …

Journal of Critical Care

Introduction and aimTwo consecutive earthquakes that razed the southeast part of Turkiye on February 06, 2023, were one of the strongest earthquakes ever recorded in the last century. Unfortunately, over 13 million people were affected in 11 provinces, and around 50,000 patients passed away, based on the official reports of the Turkish Government (1). Data from previous earthquakes demonstrated that 80% of patients who suffered from earthquakes stuck under the rubble suddenly died, and 10% survived with minor injuries. The remaining 10% of patients had severe injuries and needed hospitalization, including intensive care unit (ICU) admission (2). Presenting the issues encountered in earthquakes and sharing experiences and the results of the medical interventions can enable more accurate treatments to be applied after future earthquakes. Therefore, this study aims to provide information regarding the …

Journal of Critical Care

As early as 1979, authors evoked the promise of Artificial Intelligence (AI) to provide diagnostic and therapeutic recommendations for patients in the intensive care unit (ICU)[1]. In the past several years the potential applications of AI in the ICU have skyrocketed [2, 3]. Yet, there are few outcome studies of AI models implemented in routine clinical care [2]. This is a notable problem given that AI models are beginning to be integrated into clinical care. Sepsis predictive models for example are currently in use at 54% of large hospitals in the United States [4]. In the midst of this growing use of AI in critical care medicine, it is now more important than ever to ensure that we are addressing sources of bias to promote both fairness and health equity.AI in health care should support the goal of achieving health equity. The US Department of Health and Human Services, through Healthy People 2030, has defined health equity …

Journal of Critical Care

IntroductionThe objective of this study was to create a definition of patient-important upper gastrointestinal bleeding during critical illness as an outcome for a randomized trial.DesignThis was a sequential mixed-methods qualitative-dominant multi-center study with an instrument-building aim. In semi-structured individual interviews or focus groups we elicited views from survivors of critical illness and family members of patients in the intensive care unit (ICU) regarding which features indicate important gastrointestinal bleeding. Quantitative demographic characteristics were collected. We analyzed qualitative data using inductive content analysis to develop a definition for patient-important upper gastrointestinal bleeding.SettingCanada and the United States.Participants51 ICU survivors and family members of ICU patients.ResultsParticipants considered gastrointestinal bleeding to be important if it resulted in death …

Journal of Critical Care

PurposeWe aimed to study the prevalence of frailty, evaluate risk factors, and understand impact on outcomes in India.MethodsThis was a prospective registry-embedded cohort study across 7 intensive care units (ICUs) and included adult patients anticipated to stay for at least 48 h. Primary exposure was frailty, as defined by a score ≥ 5 on the Clinical Frailty Scale and primary outcome was ICU mortality. Secondary outcomes included in-hospital mortality and resource utilization. We used generalized linear models to evaluate risk factors and model association between frailty and outcomes.Results838 patients were included, with median (IQR) age 57 (42,68) yrs.; 64.8% were male. Prevalence of frailty was 19.8%. Charlson comorbidity index (OR:1.73 (95%CI:1.39,2.15)), Subjective Global Assessment categories mild/moderate malnourishment (OR:1.90 (95%CI:1.29, 2.80)) and severe malnourishment (OR:4.76 …

Journal of Critical Care

IntroductionThe objective of this study was to create a definition of patient-important upper gastrointestinal bleeding during critical illness as an outcome for a randomized trial.DesignThis was a sequential mixed-methods qualitative-dominant multi-center study with an instrument-building aim. In semi-structured individual interviews or focus groups we elicited views from survivors of critical illness and family members of patients in the intensive care unit (ICU) regarding which features indicate important gastrointestinal bleeding. Quantitative demographic characteristics were collected. We analyzed qualitative data using inductive content analysis to develop a definition for patient-important upper gastrointestinal bleeding.SettingCanada and the United States.Participants51 ICU survivors and family members of ICU patients.ResultsParticipants considered gastrointestinal bleeding to be important if it resulted in death …

Journal of Critical Care

Introduction and aimTo determine the association between whole blood thiamine pyrophosphate (TPP) concentrations in critically ill patients and plasma metabolites and linked metabolic pathways using high resolution metabolomics.Patients and methodsThis cross-sectional study was performed at Erciyes University Hospital, Medical Intensive Care Unit (ICU), Kayseri, Turkiye and Emory University Department of Medicine Clinical Biomarkers Laboratory, Atlanta, GA, USA. Participants were enrolled as follows;≥18 years of age, with an expected length of ICU stay longer than 48 h and receiving furosemide therapy for at least 6 months or longer before ICU admission.ResultsBlood for TPP and metabolomics was obtained on the first day of ICU admission. Whole blood TPP concentrations were measured using high-performance liquid chromatography (HPLC). Liquid chromatography/mass spectrometry for high …

Journal of Critical Care

PurposeIdentifying thresholds at which the ROX index would satisfactorily predict HFNC failure across heterogenous resourced contexts is necessary for clinical use.MethodsPatients ≥18 years admitted to 30 diverse ICUs across 10 states in India who required HFNC for respiratory support were retrospectively included in this study. Patient data and hourly ROX indices were then analyzed and contextualized to clinical outcomes as well as with ROX index thresholds in other regions of the world.Measurements and main resultsAmong the 614 patients included, 276 (44.9%) required respiratory escalation. Pneumonia was the most common diagnosis on admission. Receiver operating characteristic curve analysis revealed that a baseline ROX score of 7.86 was similar to 4.88 in other populations which was confirmed by Kaplan-Mier curves (hazard ratio,3.58 (2.72–4.69, p < 0.001)). ROX scores at 11.84 or 5.89 had …

Journal of Critical Care

Introduction and aimCoronavirus Disease-2019 (Covid-19) is a globally pandemic and causes severe acute respiratory syndrome. It is commonly associated with gastrointestinal manifestations. Intestinal fatty acid binding protein (IFABp) and citrulline are thought to be potential biomarkers of intestinal function and injury. This study aimed to determine relationship between serum IFABp and citrulline concentrations and mortality in COVID-19 patients.Patients and methodsThis observational study was performed in medical intensive care unit (ICU) and included patients diagnosed by PCR-confirmed COVID-19 infection. Serum citrulline and IFABp concentrations were measured using ELISA method within first 24 h after ICU admission. The reference range of serum IFABp and serum citrulline concentrations were 19.89–23.30 ng/mL and 15.03–17.41 nmol/mL, respectively.ResultsA total of 85 critically ill patients …

Journal of Critical Care

Introduction and aimRight ventricular(RV)-pulmonary arterial(PA) coupling shows ventricular contractility to afterload and quantifies the response of the right ventricle to an increased pulmonary pressure. In a compensated state, RV contractile function is coupled with pulmonary pressure and increases with an increase in pulmonary afterload. Uncoupling of RV function and PA systolic pressure (PASP) has consistently been associated with adverse clinical outcomes in various conditions, including heart failure, PH, and valvular heart disease. As a noninvasive echocardiographic equivalant of RV-PA coupling TAPSE/PASP ratio was found to be more useful than TAPSE in predicting the prognosis of pulmonary hypertension, it was recommended instead of TAPSE in the 2022 pulmonary hypertension guideline. A ratio below 0.55 is considered low, while a ratio below 0.35 is considered a poor prognostic factor. The …