251
|
Li L, Cao J, Qin J, Chen X, Yuan F, Deng P, Xie H. Risk Factors for 30-Day Mortality of Community-Acquired Bloodstream Infection Patients in Changsha City, Hunan Province, China. Infect Drug Resist 2024; 17:3209-3218. [PMID: 39070716 PMCID: PMC11283804 DOI: 10.2147/idr.s471350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 07/19/2024] [Indexed: 07/30/2024] Open
Abstract
Purpose To analyze the factors affecting patients' prognoses based on the community acquired-bloodstream infection patient data from 2017 to 2021. Patients and Methods The data of 940 patients were retrieved, having at least one positive bilateral blood culture within 48 hours of hospitalization, and grouped into survivor and non-survivor groups. The clinical characteristics, laboratory results, causative pathogen and other indicators were collected and compared, and risk factors were identified by applying Cox proportional hazard regression model to the data. Results Community acquired-bloodstream infection is most commonly caused by Escherichia coli, Klebsiella species and Staphylococcus hominis. Among the total of 940 selected patients, 52 (5.5%) died during hospitalization. The demographic parameters like age and gender, clinical protocols like maintenance hemodialysis, glucocorticoid use during hospitalization, catheter placement, procaicitonin, total protein, albumin, creatinine, uric acid contents and Sequential Organ Failure Assessment scores were significantly different between the survivor and non-survivor groups. The survival analysis results revealed that age (HR=1.02, 95% CI: 1.00-1.05, P=0.002), glucocorticoid use during hospitalization (HR=3.69, 95% CI: 1.62-8.37, P=0.021) and Sequential Organ Failure Assessment score (HR=1.10, 95% CI: 1.03-1.18, P=0.004) might be the risk factors affecting 30-day mortality in patients with community acquired-bloodstream infection. Conclusion The identified risk factors may help guide clinical treatment protocol for patients with community acquired-bloodstream infection, providing more effective treatment strategy selection with improved clinical outcomes.
Collapse
Affiliation(s)
- Linqi Li
- School of Public Health, University of South China, Heng Yang, Hunan, People’s Republic of China
| | - Jing Cao
- The Affiliated Changsha Central Hospital, University of South China, Changsha, Hunan, People’s Republic of China
| | - Jiao Qin
- The Affiliated Changsha Central Hospital, University of South China, Changsha, Hunan, People’s Republic of China
| | - Xiangxiang Chen
- The Affiliated Changsha Central Hospital, University of South China, Changsha, Hunan, People’s Republic of China
| | - Feng Yuan
- The Affiliated Changsha Central Hospital, University of South China, Changsha, Hunan, People’s Republic of China
| | - Ping Deng
- The Affiliated Changsha Central Hospital, University of South China, Changsha, Hunan, People’s Republic of China
| | - Hebin Xie
- School of Public Health, University of South China, Heng Yang, Hunan, People’s Republic of China
- The Affiliated Changsha Central Hospital, University of South China, Changsha, Hunan, People’s Republic of China
| |
Collapse
|
252
|
Goodfellow LT, Miller AG, Varekojis SM, LaVita CJ, Glogowski JT, Hess DR. AARC Clinical Practice Guideline: Patient-Ventilator Assessment. Respir Care 2024; 69:1042-1054. [PMID: 39048148 PMCID: PMC11298231 DOI: 10.4187/respcare.12007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Given the important role of patient-ventilator assessments in ensuring the safety and efficacy of mechanical ventilation, a team of respiratory therapists and a librarian used Grading of Recommendations, Assessment, Development, and Evaluation methodology to make the following recommendations: (1) We recommend assessment of plateau pressure to ensure lung-protective ventilator settings (strong recommendation, high certainty); (2) We recommend an assessment of tidal volume (VT) to ensure lung-protective ventilation (4-8 mL/kg/predicted body weight) (strong recommendation, high certainty); (3) We recommend documenting VT as mL/kg predicted body weight (strong recommendation, high certainty); (4) We recommend an assessment of PEEP and auto-PEEP (strong recommendation, high certainty); (5) We suggest assessing driving pressure to prevent ventilator-induced injury (conditional recommendation, low certainty); (6) We suggest assessing FIO2 to ensure normoxemia (conditional recommendation, very low certainty); (7) We suggest telemonitoring to supplement direct bedside assessment in settings with limited resources (conditional recommendation, low certainty); (8) We suggest direct bedside assessment rather than telemonitoring when resources are adequate (conditional recommendation, low certainty); (9) We suggest assessing adequate humidification for patients receiving noninvasive ventilation (NIV) and invasive mechanical ventilation (conditional recommendation, very low certainty); (10) We suggest assessing the appropriateness of the humidification device during NIV and invasive mechanical ventilation (conditional recommendation, low certainty); (11) We recommend that the skin surrounding artificial airways and NIV interfaces be assessed (strong recommendation, high certainty); (12) We suggest assessing the dressing used for tracheostomy tubes and NIV interfaces (conditional recommendation, low certainty); (13) We recommend assessing the pressure inside the cuff of artificial airways using a manometer (strong recommendation, high certainty); (14) We recommend that continuous cuff pressure assessment should not be implemented to decrease the risk of ventilator-associated pneumonia (strong recommendation, high certainty); and (15) We suggest assessing the proper placement and securement of artificial airways (conditional recommendation, very low certainty).
Collapse
Affiliation(s)
- Lynda T Goodfellow
- Director of AARC Clinical Practice Guideline Development and is affiliated with American Association for Respiratory Care/Daedalus Enterprises, Irving, Texas, and Georgia State University, Atlanta, Georgia
| | | | | | | | | | - Dean R Hess
- Massachusetts General Hospital, Boston, Massachusetts; and Daedalus Enterprises, Irving, Texas
| |
Collapse
|
253
|
Yumoto T, Hongo T, Obara T, Ageta K, Aokage T, Tsukahara K, Nakao A, Naito H. Evolution and Effects of Ad Hoc Multidisciplinary Team Meetings in the Emergency Intensive Care Unit: A Five-Year Analysis. J Clin Med 2024; 13:4324. [PMID: 39124591 PMCID: PMC11312900 DOI: 10.3390/jcm13154324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 07/18/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024] Open
Abstract
Background: Multidisciplinary team meetings (MDTMs) are crucial in the ICU. However, daily rounds may not address all sensitive issues due to time constraints and the complexity of cases. This study aimed to describe detailed information and characteristics of ad hoc MDTMs in the ICU. Methods: This single-center, retrospective study analyzed adult emergency ICU admissions at Okayama University Hospital from 1 January 2019 to 31 December 2023. During this period, weekly regular multidisciplinary team ICU rounds were introduced in June 2020, and regular weekday morning MDTMs began in April 2022. A multiple logistic regression analysis was applied to determine the impact of these changes on the frequency of ad hoc MDTMs, adjusting for variables including annual changes. Results: The study analyzed 2487 adult EICU patients, with a median age of 66, and 63.3% of them male. MDTMs were held for 168 patients (6.8%), typically those with severe conditions, including higher COVID-19 prevalence and APACHE II scores, and longer ICU stays. Despite a constant total number of MDTMs, the likelihood of conducting ad hoc MDTMs increased annually (adjusted OR 1.19; 95% CI, 1.04-1.35). Of the 329 MDTMs conducted for these patients, 59.0% addressed end-of-life care, involving an average of 11 participants, mainly nurses and emergency and critical-care physicians. Conclusions: Changes in ICU round and meeting structures might be associated with a higher frequency of conducting ad hoc MDTMs, highlighting their evolving role and importance in patient care management.
Collapse
Affiliation(s)
- Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan; (T.H.); (T.O.); (K.A.); (T.A.); (K.T.); (A.N.); (H.N.)
| | | | | | | | | | | | | | | |
Collapse
|
254
|
Tworek KB, Ma CH, Opgenorth D, Baig N, Zampieri FG, Basmaji J, Rochwerg B, Lewis K, Kilcommons S, Mehta S, Honarmand K, Stelfox HT, Wilcox ME, Kutsogiannis DJ, Fiest KM, Karvellas CJ, Sligl W, Rewa O, Senaratne J, Sharif S, Bagshaw SM, Lau VI. Nonsteroidal anti-inflammatory drugs for analgesia in intensive care units: a survey of Canadian critical care physicians. Can J Anaesth 2024:10.1007/s12630-024-02800-7. [PMID: 39042215 DOI: 10.1007/s12630-024-02800-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 03/21/2024] [Accepted: 04/03/2024] [Indexed: 07/24/2024] Open
Abstract
PURPOSE Opioids remain the mainstay of analgesia for critically ill patients, but its exposure is associated with negative effects including persistent use after discharge. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be an effective alternative to opioids with fewer adverse effects. We aimed to describe beliefs and attitudes towards the use of NSAIDs in adult intensive care units (ICUs). METHODS Our survey of Canadian ICU physicians was conducted using a web-based platform and distributed through the Canadian Critical Care Society (CCCS) email distribution list. We used previously described survey development methodology including question generation and reduction, pretesting, and clinical sensibility and pilot testing. RESULTS We received 115 completed surveys from 321 CCCS members (36%). Nonsteroidal anti-inflammatory drugs use was most described as "rarely" (59 respondents, 51%) with the primary concern being adverse events (acute kidney injury [108 respondents, 94%] and gastrointestinal bleeding [92 respondents, 80%]). The primary preferred analgesic was acetaminophen (75 respondents, 65%) followed by opioids (40 respondents, 35%). Most respondents (91 respondents, 80%) would be willing to participate in a randomized controlled trial examining NSAID use in critical care. CONCLUSIONS In our survey, Canadian critical care physicians did not mention commonly using NSAIDs primarily because of concerns about adverse events. Nevertheless, respondents were interested in further studying ketorolac, a commonly used NSAID outside of the ICU, in critically ill patients.
Collapse
Affiliation(s)
- Kimberly B Tworek
- Alberta Health Services, Edmonton, AB, Canada.
- Department of Medicine, University of Alberta, Edmonton, AB, Canada.
| | - Chen-Hsiang Ma
- Alberta Health Services, Edmonton, AB, Canada
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Dawn Opgenorth
- Alberta Health Services, Edmonton, AB, Canada
- Department of Critical Care Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- Critical Care Strategic Clinical Network™, Alberta Health Services, Edmonton, AB, Canada
| | - Nadia Baig
- Alberta Health Services, Edmonton, AB, Canada
- Department of Critical Care Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Fernando G Zampieri
- Alberta Health Services, Edmonton, AB, Canada
- Department of Critical Care Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - John Basmaji
- Division of Critical Care Medicine, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Bram Rochwerg
- Department of Health Research Methods, Evidence & Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Division of Critical Care, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Kimberley Lewis
- Department of Health Research Methods, Evidence & Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Division of Critical Care, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | | | - Sangeeta Mehta
- Sinai Health System, University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Kimia Honarmand
- Division of Critical Care, Department of Medicine, Mackenzie Health, Vaughan, ON, Canada
| | - H Tom Stelfox
- Sinai Health System, University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Interdepartmental Division of Critical Care Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - M Elizabeth Wilcox
- Interdepartmental Division of Critical Care Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Sinai Health System, University Health Network, Toronto, ON, Canada
| | - Demetrios J Kutsogiannis
- Alberta Health Services, Edmonton, AB, Canada
- Department of Critical Care Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Kirsten M Fiest
- Alberta Health Services, Edmonton, AB, Canada
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Constantine J Karvellas
- Alberta Health Services, Edmonton, AB, Canada
- Department of Critical Care Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Wendy Sligl
- Alberta Health Services, Edmonton, AB, Canada
- Department of Critical Care Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Oleksa Rewa
- Alberta Health Services, Edmonton, AB, Canada
- Department of Critical Care Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Janek Senaratne
- Alberta Health Services, Edmonton, AB, Canada
- Department of Critical Care Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Sameer Sharif
- Division of Critical Care Medicine, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Sean M Bagshaw
- Alberta Health Services, Edmonton, AB, Canada
- Department of Critical Care Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- Critical Care Strategic Clinical Network™, Alberta Health Services, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Vincent I Lau
- Alberta Health Services, Edmonton, AB, Canada
- Department of Critical Care Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
255
|
Fatima SS, Sheikh NA, Osama A. Authentic assessment in medical education: exploring AI integration and student-as-partners collaboration. Postgrad Med J 2024:qgae088. [PMID: 39041454 DOI: 10.1093/postmj/qgae088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/25/2024] [Accepted: 07/03/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Traditional assessments often lack flexibility, personalized feedback, real-world applicability, and the ability to measure skills beyond rote memorization. These may not adequately accommodate diverse learning styles and preferences, nor do they always foster critical thinking or creativity. The inclusion of Artificial Intelligence (AI), especially Generative Pre-trained Transformers, in medical education marks a significant shift, offering both exciting opportunities and notable challenges for authentic assessment practices. Various fields, including anatomy, physiology, pharmacy, dentistry, and pathology, are anticipated to employ the metaverse for authentic assessments increasingly. This innovative approach will likely enable students to engage in immersive, project-based learning experiences, facilitating interdisciplinary collaboration and providing a platform for real-world application of knowledge and skills. METHODS This commentary paper explores how AI, authentic assessment, and Student-as-Partners (SaP) methodologies can work together to reshape assessment practices in medical education. RESULTS The paper provides practical insights into effectively utilizing AI tools to create authentic assessments, offering educators actionable guidance to enhance their teaching practices. It also addresses the challenges and ethical considerations inherent in implementing AI-driven assessments, emphasizing the need for responsible and inclusive practices within medical education. Advocating for a collaborative approach between AI and SaP methodologies, the commentary proposes a robust plan to ensure ethical use while upholding academic integrity. CONCLUSION Through navigating emerging assessment paradigms and promoting genuine evaluation of medical knowledge and proficiency, this collaborative effort aims to elevate the quality of medical education and better prepare learners for the complexities of clinical practice.
Collapse
Affiliation(s)
- Syeda Sadia Fatima
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi 74800, Pakistan
| | - Nabeel Ashfaque Sheikh
- Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore 54000, Pakistan
| | - Athar Osama
- INNOVentures Global (Pvt) Ltd., Karachi, 75350, Pakistan
| |
Collapse
|
256
|
Arulkumaran N, Thomas M, Stubbs M, Prasanna N, Subhan M, Singh D, Ambler G, Waller A, Singer M, Brealey D, Scully M. A randomised controlled trial of plasma exchange compared to standard of care in the treatment of severe COVID-19 infection (COVIPLEX). Sci Rep 2024; 14:16876. [PMID: 39043682 PMCID: PMC11266620 DOI: 10.1038/s41598-024-67028-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 07/08/2024] [Indexed: 07/25/2024] Open
Abstract
COVID-19 disease is associated with a hyperinflammatory, pro-thrombotic state and a high mortality. Our primary objective was to assess the change in inflammatory and thrombotic markers associated with PEX, and secondary objectives were to assess the effects of PEX on progression of respiratory failure and incidence of acute thrombotic events. We conducted a prospective, phase II, non-blinded randomised control trial of plasma exchange compared to standard of care in critically ill adults with severe COVID-19 associated respiratory failure, requiring supplemental oxygen or ventilatory support and elevated thrombo-inflammatory markers (LDH, CRP, ferritin, and D-Dimer). Patients randomised to receive PEX were treated with a daily single volume plasma exchange for a minimum of five days. Twenty-two patients were randomised of who 11 received PEX. Demographic and clinical characteristics were similar between groups at presentation. PEX was associated with a significant reduction in pro-thrombotic markers FVIII, VWF and VWF Ag: ADAMTS 13 ratio (p < 0.001). There were no differences in the reduction of inflammatory markers, severity of respiratory failure (p = 0.7), thrombotic events (p = 0.67), or mortality (p > 0.99) at 28 days. PEX successfully reduced pro-thrombotic markers, although was not associated with reduction in inflammatory markers, respiratory failure, or thrombotic events.Trial registration: (NCT04623255); first posted on 10/11/2020.
Collapse
Affiliation(s)
- Nishkantha Arulkumaran
- Intensive Care Unit, University College London Hospitals NHS Foundation Trust, London, UK
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, UK
| | - Mari Thomas
- Department of Haematology, University College London Hospitals NHS Foundation Trust and Haematology Programme-NIHR UCLH/UC BRC London, 235 Euston Road, London, NW12PG, UK
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Matthew Stubbs
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Nithya Prasanna
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Maryam Subhan
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Alessia Waller
- Intensive Care Unit, University College London Hospitals NHS Foundation Trust, London, UK
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, UK
| | - Mervyn Singer
- Intensive Care Unit, University College London Hospitals NHS Foundation Trust, London, UK
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, UK
| | - David Brealey
- Intensive Care Unit, University College London Hospitals NHS Foundation Trust, London, UK
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, UK
| | - Marie Scully
- Department of Haematology, University College London Hospitals NHS Foundation Trust and Haematology Programme-NIHR UCLH/UC BRC London, 235 Euston Road, London, NW12PG, UK.
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK.
| |
Collapse
|
257
|
Plotnikow GA, Bianchini FJF, Moracci R, Santana Mackinlay JA, Melgarejo F, Loustau MP, Acevedo VS, Di Salvo E, Gutierrez FJ, Madorno M, Mariani J. Impact of high-flow oxygen therapy via high velocity nasal insufflation on diaphragmatic thickening fraction in healthy subjects. Med Intensiva 2024:S2173-5727(24)00198-X. [PMID: 39048473 DOI: 10.1016/j.medine.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/22/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE The primary objective of this study was to evaluate the impact of high-flow nasal cannula oxygen therapy [HFNC] on the diaphragm thickening fraction. DESIGN Prospective, descriptive, cohort study SETTING: The study was conducted in the Physiology and Respiratory Care Laboratory, Intensive Care Unit, Hospital Británico de Buenos Aires. PARTICIPANTS Thirteen healthy subjects >18 years old INTERVENTIONS: High-flow nasal cannula oxygen therapy MAIN VARIABLES OF INTEREST: Demographic data (age and gender), anthropometric data (weight, height, and body mass index), and clinical and respiratory variables (Diaphragm thickening fraction [DTf], esophageal pressure swing, respiratory rate [RR], esophageal pressure-time product per minute [PTPes/min]). RESULTS Median DTf decreased significantly as flow increased (p < 0.05). The baseline DTf measurement was 21.4 %, 18.3 % with 20 L/m, and 16.4 % with 40 L/m. We also observed a significant decrease in RR as flow increased in HFNC (p < 0.05). In the 8 subjects with recordings, the PTPes/min was 81.3 (±30.8) cmH2O/sec/min and 64.4 (±25.3) cmH2O/sec/min at baseline and 40 L/m respectively (p = 0.044). CONCLUSIONS The use of high-flow oxygen therapy through nasal cannula of HFNC in healthy subjects decreases the DTf and RR in association with increased flow. In addition, the use of 40 L/m flow may reduce the muscular work associated with respiration.
Collapse
Affiliation(s)
- Gustavo Adrián Plotnikow
- División de Fisioterapia y Cuidados Respiratorios, Servicio de Rehabilitación, Unidad de Cuidados Intensivos, Hospital Británico de Buenos Aires, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina; Universidad Abierta Interamericana, Facultad de Medicina y Ciencias de la Salud, Buenos Aires, Buenos Aires, Argentina.
| | - Facundo José Federico Bianchini
- División de Fisioterapia y Cuidados Respiratorios, Servicio de Rehabilitación, Unidad de Cuidados Intensivos, Hospital Británico de Buenos Aires, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Roque Moracci
- División de Fisioterapia y Cuidados Respiratorios, Servicio de Rehabilitación, Unidad de Cuidados Intensivos, Hospital Británico de Buenos Aires, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Jaime Andrés Santana Mackinlay
- División de Fisioterapia y Cuidados Respiratorios, Servicio de Rehabilitación, Unidad de Cuidados Intensivos, Hospital Británico de Buenos Aires, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Federico Melgarejo
- División de Fisioterapia y Cuidados Respiratorios, Servicio de Rehabilitación, Unidad de Cuidados Intensivos, Hospital Británico de Buenos Aires, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Malena Paula Loustau
- División de Fisioterapia y Cuidados Respiratorios, Servicio de Rehabilitación, Unidad de Cuidados Intensivos, Hospital Británico de Buenos Aires, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Valeria Silvina Acevedo
- División de Fisioterapia y Cuidados Respiratorios, Servicio de Rehabilitación, Unidad de Cuidados Intensivos, Hospital Británico de Buenos Aires, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Emanuel Di Salvo
- División de Fisioterapia y Cuidados Respiratorios, Servicio de Rehabilitación, Unidad de Cuidados Intensivos, Hospital Británico de Buenos Aires, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Facundo Javier Gutierrez
- Unidad de Cuidados Intensivos, Hospital Británico de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Matias Madorno
- Instituto Tecnológico de Buenos Aires, MBMEd, Buenos Aires, Argentina
| | - Javier Mariani
- Departamento de Investigación Clínica No Rentada, Hospital Británico de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| |
Collapse
|
258
|
Kwon SB, Weinerman B, Nametz D, Megjhani M, Lee I, Habib A, Barry O, Park S. Non-invasive pulse arrival time is associated with cardiac index in pediatric heart transplant patients with normal ejection fraction. Physiol Meas 2024; 45:07NT01. [PMID: 38986482 PMCID: PMC11262133 DOI: 10.1088/1361-6579/ad61b9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 06/05/2024] [Accepted: 07/10/2024] [Indexed: 07/12/2024]
Abstract
Objective.Cardiac Index (CI) is a key physiologic parameter to ensure end organ perfusion in the pediatric intensive care unit (PICU). Determination of CI requires invasive cardiac measurements and is not routinely done at the PICU bedside. To date, there is no gold standard non-invasive means to determine CI. This study aims to use a novel non-invasive methodology, based on routine continuous physiologic data, called Pulse Arrival Time (PAT) as a surrogate for CI in patients with normal Ejection Fraction (EF).Approach.Electrocardiogram (ECG) and photoplethysmogram (PPG) signals were collected from beside monitors at a sampling frequency of 250 samples per second. Continuous PAT, derived from the ECG and PPG waveforms was averaged per patient. Pearson's correlation coefficient was calculated between PAT and CI, PAT and heart rate (HR), and PAT and EF.Main Results.Twenty patients underwent right heart cardiac catheterization. The mean age of patients was 11.7 ± 5.4 years old, ranging from 11 months old to 19 years old, the median age was 13.4 years old. HR in this cohort was 93.8 ± 17.0 beats per minute. The average EF was 54.4 ± 9.6%. The average CI was 3.51 ± 0.72 l min-1m-2, with ranging from 2.6 to 4.77 l min-1m-2. The average PAT was 0.31 ± 0.12 s. Pearson correlation analysis showed a positive correlation between PAT and CI (0.57,p< 0.01). Pearson correlation between HR and CI, and correlation between EF and CI was 0.22 (p= 0.35) and 0.03 (p= 0.23) respectively. The correlation between PAT, when indexed by HR (i.e. PAT × HR), and CI minimally improved to 0.58 (p< 0.01).Significance.This pilot study demonstrates that PAT may serve as a valuable surrogate marker for CI at the bedside, as a non-invasive and continuous modality in the PICU. The use of PAT in clinical practice remains to be thoroughly investigated.
Collapse
Affiliation(s)
- Soon Bin Kwon
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
- Program in Hospital and Intensive Care Informatics, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
| | - Bennett Weinerman
- Program in Hospital and Intensive Care Informatics, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
- Columbia University College of Physicians and Surgeons, Division of Pediatric Critical Care and Hospital Medicine, New York, NY, United States of America
| | - Daniel Nametz
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
- Program in Hospital and Intensive Care Informatics, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
| | - Murad Megjhani
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
- Program in Hospital and Intensive Care Informatics, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
| | - Isaac Lee
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
- Program in Hospital and Intensive Care Informatics, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
| | - Anthony Habib
- Columbia University College of Physicians and Surgeons, Division of Pediatric Anesthesiology, New York, NY, United States of America
| | - Oliver Barry
- Columbia University College of Physicians and Surgeons, Division of Pediatric Cardiology, New York, NY, United States of America
| | - Soojin Park
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
- Program in Hospital and Intensive Care Informatics, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
- NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, United States of America
- Department of Biomedical Informatics, Columbia University, New York, NY, United States of America
| |
Collapse
|
259
|
Turzhitsky V, Bash LD, Urman RD, Kattan M, Hofer I. Factors Influencing Neuromuscular Blockade Reversal Choice in the United States Before and During the COVID-19 Pandemic: Retrospective Longitudinal Analysis. JMIR Perioper Med 2024; 7:e52278. [PMID: 39038283 DOI: 10.2196/52278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/21/2023] [Accepted: 04/09/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Neuromuscular blockade (NMB) agents are a critical component of balanced anesthesia. NMB reversal methods can include spontaneous reversal, sugammadex, or neostigmine and the choice of reversal strategy can depend on various factors. Unanticipated changes to clinical practice emerged due to the COVID-19 pandemic, and a better understanding of how NMB reversal trends were affected by the pandemic may help provide insight into how providers view the tradeoffs in the choice of NMB reversal agents. OBJECTIVE We aim to analyze NMB reversal agent use patterns for US adult inpatient surgeries before and after the COVID-19 outbreak to determine whether pandemic-related practice changes affected use trends. METHODS A retrospective longitudinal analysis of a large all-payer national electronic US health care database (PINC AI Healthcare Database) was conducted to identify the use patterns of NMB reversal during early, middle, and late COVID-19 (EC, MC, and LC, respectively) time periods. Factors associated with NMB reversal choices in inpatient surgeries were assessed before and after the COVID-19 pandemic reached the United States. Multivariate logistic regression assessed the impact of the pandemic on NMB reversal, accounting for patient, clinical, procedural, and site characteristics. A counterfactual framework was used to understand if patient characteristics affected how COVID-19-era patients would have been treated before the pandemic. RESULTS More than 3.2 million inpatients experiencing over 3.6 million surgical procedures across 931 sites that met all inclusion criteria were identified between March 1, 2017, and December 31, 2021. NMB reversal trends showed a steady increase in reversal with sugammadex over time, with the trend from January 2018 onwards being linear with time (R2>0.99). Multivariate analysis showed that the post-COVID-19 time periods had a small but statistically significant effect on the trend, as measured by the interaction terms of the COVID-19 time periods and the time trend in NMB reversal. A slight increase in the likelihood of sugammadex reversal was observed during EC relative to the pre-COVID-19 trend (odds ratio [OR] 1.008, 95% CI 1.003-1.014; P=.003), followed by negation of that increase during MC (OR 0.992, 95% CI 0.987-0.997; P<.001), and no significant interaction identified during LC (OR 1.001, 95% CI 0.996-1.005; P=.81). Conversely, active reversal (using either sugammadex or neostigmine) did not show a significant association relative to spontaneous reversal, or a change in trend, during EC or MC (P>.05), though a slight decrease in the active reversal trend was observed during LC (OR 0.987, 95% CI 0.983-0.992; P<.001). CONCLUSIONS We observed a steady increase in NMB active reversal overall, and specifically with sugammadex compared to neostigmine, during periods before and after the COVID-19 outbreak. Small, transitory alterations in the NMB reversal trends were observed during the height of the COVID-19 pandemic, though these alterations were independent of the underlying NMB reversal time trends.
Collapse
Affiliation(s)
| | | | - Richard D Urman
- College of Medicine, The Ohio State University, Columbus, OH, United States
| | | | - Ira Hofer
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| |
Collapse
|
260
|
Cheng W, Zhang J, Li D, Lei X, Wang H, Cui N. CTLA-4 expression on CD4 + lymphocytes in patients with sepsis-associated immunosuppression and its relationship to mTOR mediated autophagic-lysosomal disorder. Front Immunol 2024; 15:1396157. [PMID: 39104530 PMCID: PMC11298341 DOI: 10.3389/fimmu.2024.1396157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 07/08/2024] [Indexed: 08/07/2024] Open
Abstract
Background The aim of this study was to clarify the relationship between expression level of CTLA-4 on CD4+ T cells and sepsis-associated immunosuppression (SAI), and to elucidate the possible mechanism of mTOR pathway mediated autophagic-lysosomal disorder in regulating CTLA-4 expression. Methods We enrolled 63 sepsis patients admitted to our ICU between January 1 and June 30, 2023. Peripheral blood mononuclear cells were isolated from the patients within 24 hours of recruitment. Expression levels of mTOR, P62, LC3II, and CTLA-4 on circulating CD4+ T lymphocytes were quantitated using flow cytometry. The association of these markers and relationship between CTLA-4 expression and the incidence of SAI and 28-day mortality were comprehensively analyzed. Results Compared with non-immunosuppressed patients with sepsis, patients with SAI had a higher 28-day mortality rate (37.5% vs 13.0%, P=0.039) and higher CTLA-4 mean fluorescence intensity (MFI) on CD4+ T cells (328.7 versus 78.7, P<0.0001). CTLA-4 MFI on CD4+ cells was independently associated with the occurrence of SAI (95% confidence interval: 1.00-1.14, P=0.044). In patients with sepsis and SAI, non-survivors had higher CTLA-4 expression than survivors (sepsis: 427.5 versus 130.6, P=0.002; and SAI: 506.7 versus 225.2, P<0.0001). The sensitivity and specificity of CTLA-4 MFI at predicting 28-day mortality in patients with SAI was 100% and 80% respectively with the cutoff value of 328.7 and the area under the curve of 0.949. The MFI of mTOR, P62, and LC3II on CD4+ T cells were statistically higher in patients with SAI than in non-immunosuppressed patients (267.2 versus 115.9, P<0.0001; 314.8 versus 173.7, P<0.0001; and 184.7 versus 1123.5, P=0.012, respectively); P62 and LC3II were markedly higher in non-survivors than in survivors of sepsis (302.9 versus 208.9, P=0.039; and 244.3 versus 122.8, P<0.0001 respectively). The expression of CTLA-4 statistically correlated with that of LC3II in patients with sepsis, patients with SAI, and patients with SAI who did not survive (correlation coefficient: 0.69, 0.68, and 0.73, respectively, P<0.0001). Conclusions CTLA-4 overexpression on CD4+ T cells was markedly associated with the incidence of SAI and had great relevance to 28-day mortality. mTOR pathway mediated autophagic-lysosomal disorder showed significant association with CTLA-4 expression.
Collapse
Affiliation(s)
- Wei Cheng
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jiahui Zhang
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Dongkai Li
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xianli Lei
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Hao Wang
- Department of Critical Care Medicine, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Na Cui
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| |
Collapse
|
261
|
Ma YT, Xian-Yu CY, Yu YX, Zhang C. Perioperative fluid management for adult cardiac surgery: network meta-analysis pooling on twenty randomised controlled trials. Perioper Med (Lond) 2024; 13:76. [PMID: 39033296 PMCID: PMC11264963 DOI: 10.1186/s13741-024-00440-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 07/16/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND The aim of this study was to evaluate colloids and crystalloids used in perioperative fluid therapy for cardiac surgery patients to further investigate the optimal management strategies of different solutions. METHOD RCTs about adult surgical patients allocated to receive perioperative fluid therapy for electronic databases, including Ovid MEDLINE, EMBase, and Cochrane Central Register of Controlled Trials, were searched up to February 15, 2023. RESULTS None of the results based on network comparisons, including mortality, transfuse PLA, postoperative chest tube output over the first 24 h following surgery, and length of hospital stay, were statistically significant. Due to the small number of included studies, the results, including acute kidney injury, serum creatinine, serum microglobulin, and blood urea nitrogen, are from the direct comparison. For transfusion of RBCs, significant differences were observed in the comparisons of 3% gelatine vs. 6% HES 200/0.5, 4% albumin vs. 5% albumin, 4% gelatine vs. 5% albumin, 5% albumin vs. 6% HES 200/0.5, and 6% HES 130/0.4 vs. 6% HES 200/0.5. In transfusion of FFP, significant differences were observed in comparisons of 3% gelatine vs. 4% gelatine, 3% gelatine vs. 6% HES 200/0.5, 5% albumin vs. 6% HES 200/0.5, 4% gelatine vs. 5% albumin, 4% gelatine vs. 6% HES 200/0.4, and 6% HES 130/0.4 vs. 6% HES 200/0.5. For urinary output at 24 h after surgery, the results are deposited in the main text. CONCLUSION This study showed that 3% gelatin and 5% albumin can reduce the transfuse RBC and FFP. In addition, the use of hypertonic saline solution can increase urine output, and 5% albumin and 6% HES can shorten the length of ICU stay. However, none of the perioperative fluids showed an objective advantage in various outcomes, including mortality, transfuse PLA, postoperative chest tube output over the first 24 h following surgery, and length of hospital stay. The reliable and sufficient evidences on the injury of the kidney, including acute kidney injury, serum creatinine, serum microglobulin, and blood urea nitrogen, was still lacking. In general, perioperative fluids had advantages and disadvantages, and there were no evidences to support the recommendation of the optimal perioperative fluid for cardiac surgery.
Collapse
Affiliation(s)
- Yu-Tong Ma
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, No.32, Renmin South Road, Shiyan, 442000, Hubei, China
| | - Chen-Yang Xian-Yu
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, No.32, Renmin South Road, Shiyan, 442000, Hubei, China
| | - Yun-Xiang Yu
- Department of Surgery, Taihe Hospital, Hubei University of Medicine, No.32, South Renmin Road, Shiyan, 442000, Hubei, China.
| | - Chao Zhang
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, No.32, Renmin South Road, Shiyan, 442000, Hubei, China.
| |
Collapse
|
262
|
Ruan J, Fu Z, Ying L. Clinical differences between Mycoplasma pneumoniae pneumonia and Streptococcus pneumoniae pneumonia: a case control study. Front Pediatr 2024; 12:1409687. [PMID: 39100649 PMCID: PMC11294199 DOI: 10.3389/fped.2024.1409687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 07/08/2024] [Indexed: 08/06/2024] Open
Abstract
Introduction Mycoplasma pneumoniae pneumonia (MPP) and Streptococcus pneumoniae pneumonia (SPP) are frequent causes of respiratory tract infection, the aims of the study were to explore the differences in clinical features between children with MPP and those with SPP. Methods This retrospective study included admitted children who were diagnosed with MPP or SPP over 5 years from January 2015 to January 2020. Children with MPP were compared to children with SPP in terms of clinical features. Results 506 patients with MPP were compared to 311 patients with SPP in terms of clinical differences. The MPP group with a median age of 60 [29-89] months and the SPP group with a median age of 24 [10-40] months. Patients with MPP were older and had a higher occurrence of receiving antibiotics before admission, fever, dry cough, polypnea and diarrhea than patients with SPP (all p < 0.01). Patients with SPP were more likely to have wheezing, cyanosis and irritability (all p < 0.01). Laboratory findings in our study showed that there were significant differences between MPP and SPP patients in mean leucocyte count, neutrophil % (N%), lymphocyte % (L%), ALT levels, AST levels, LDH levels and incidence of accelerated procalcitonin (PCT) (all p < 0.01). Lower age, no dry cough, no polypnea, lower LDH levels, and higher PCT might lead to the diagnosis of SPP. Our study showed that age had a higher accuracy in predicting MPP than LDH levels, with an age >48.5 months shown to be an independent predictive factor for the early evaluation and identification of MPP. Discussion In conclusion, patients with MPP and SPP usually present with fever, cough and some nonspecific symptoms. Our study showed that age, dry cough, polypnea, LDH levels, and PCT levels were independent predictive factors associated with MPP and SPP.
Collapse
Affiliation(s)
- Jinping Ruan
- Department of Pediatrics, Chongqing Red Cross Hospital (People’s Hospital of Jiangbei District), Chongqing, China
- Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Zhou Fu
- Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Linyan Ying
- Department of Pediatrics, Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
- Department of Pediatrics, Chongqing Health Center for Women and Children, Chongqing, China
| |
Collapse
|
263
|
Coman O, Grigorescu BL, Huțanu A, Bacârea A, Văsieșiu AM, Fodor RȘ, Stoica F, Azamfirei L. The Role of Programmed Cell Death 1/Programmed Death Ligand 1 (PD-1/PD-L1) Axis in Sepsis-Induced Apoptosis. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1174. [PMID: 39064603 PMCID: PMC11278887 DOI: 10.3390/medicina60071174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/17/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: Sepsis involves a dysregulated host response, characterized by simultaneous immunosuppression and hyperinflammation. Initially, there is the release of pro-inflammatory factors and immune system dysfunction, followed by persistent immune paralysis leading to apoptosis. This study investigates sepsis-induced apoptosis and its pathways, by assessing changes in PD-1 and PD-L1 serum levels, CD4+ and CD8+ T cells, and Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE II) severity scores. Materials and Methods: This prospective, observational, single-centre study enrolled 87 sepsis patients admitted to the intensive care unit at the County Emergency Clinical Hospital in Târgu Mureș, Romania. We monitored the parameters on day 1 (the day sepsis or septic shock was diagnosed as per the Sepsis-3 Consensus) and day 5. Results: Our study found a statistically significant variation in the SOFA score for the entirety of the patients between the studied days (p = 0.001), as well as for the studied patient groups: sepsis, septic shock, survivors, and non-survivors (p = 0.001, p = 0.003, p = 0.01, p = 0.03). On day 1, we found statistically significant correlations between CD8+ cells and PD-1 (p = 0.02) and PD-L1 (p = 0.04), CD4+ and CD8+ cells (p < 0.0001), SOFA and APACHE II scores (p < 0.0001), and SOFA and APACHE II scores and PD-L1 (p = 0.001 and p = 0.01). On day 5, we found statistically significant correlations between CD4+ and CD8+ cells and PD-L1 (p = 0.03 and p = 0.0099), CD4+ and CD8+ cells (p < 0.0001), and SOFA and APACHE II scores (p < 0.0001). Conclusions: The reduction in Th CD4+ and Tc CD8+ lymphocyte subpopulations were evident from day 1, indicating that apoptosis is a crucial factor in the progression of sepsis and septic shock. The increased expression of the PD-1/PD-L1 axis impairs costimulatory signalling, leading to diminished T cell responses and lymphopenia, thereby increasing the susceptibility to nosocomial infections.
Collapse
Affiliation(s)
- Oana Coman
- Department of Simulation Applied in Medicine, University of Medicine, Pharmacy, Science and Technology “George Emil Palade”, 540142 Targu Mures, Romania;
| | - Bianca-Liana Grigorescu
- Department of Anaesthesiology and Intensive Therapy, University of Medicine, Pharmacy, Science and Technology “George Emil Palade”, 540142 Targu Mures, Romania; (R.Ș.F.); (L.A.)
| | - Adina Huțanu
- Department of Laboratory Medicine, University of Medicine, Pharmacy, Science and Technology “George Emil Palade”, 540142 Targu Mures, Romania;
- Center for Advanced Medical and Pharmaceutical Research, Immunology, University of Medicine, Pharmacy, Science and Technology “George Emil Palade”, 540142 Targu Mures, Romania
| | - Anca Bacârea
- Department of Pathophysiology, University of Medicine, Pharmacy, Science and Technology “George Emil Palade”, 540142 Targu Mures, Romania;
| | - Anca Meda Văsieșiu
- Department of Infectious Disease, University of Medicine, Pharmacy, Science and Technology “George Emil Palade”, 540142 Targu Mures, Romania;
| | - Raluca Ștefania Fodor
- Department of Anaesthesiology and Intensive Therapy, University of Medicine, Pharmacy, Science and Technology “George Emil Palade”, 540142 Targu Mures, Romania; (R.Ș.F.); (L.A.)
| | - Florin Stoica
- Clinic of Internal Medicine II, Emergency County Hospital, 540136 Targu Mures, Romania;
| | - Leonard Azamfirei
- Department of Anaesthesiology and Intensive Therapy, University of Medicine, Pharmacy, Science and Technology “George Emil Palade”, 540142 Targu Mures, Romania; (R.Ș.F.); (L.A.)
| |
Collapse
|
264
|
Chen S, Zhang Y, Xiao Y, Cheng X, Peng L, Tian Y, Li T, He J, Hao P, Chong W, Hai Y, You C, Fang F. Association of high fibrinogen to albumin ratio with long-term mortality in patients with spontaneous intracerebral hemorrhage. Front Neurol 2024; 15:1412804. [PMID: 39099785 PMCID: PMC11294216 DOI: 10.3389/fneur.2024.1412804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 07/09/2024] [Indexed: 08/06/2024] Open
Abstract
Background The association between fibrinogen-to-albumin ratio (FAR) and in-hospital mortality in patients with spontaneous intracerebral hemorrhage (ICH) has been established. However, the association with long-term mortality in spontaneous ICH remains unclear. This study aims to investigate the association between FAR and long-term mortality in these patients. Methods Our retrospective study involved 3,538 patients who were diagnosed with ICH at West China Hospital, Sichuan University. All serum fibrinogen and serum albumin samples were collected within 24 h of admission and participants were divided into two groups according to the FAR. We conducted a Cox proportional hazard analysis to evaluate the association between FAR and long-term mortality. Results Out of a total of 3,538 patients, 364 individuals (10.3%) experienced in-hospital mortality, and 750 patients (21.2%) succumbed within one year. The adjusted hazard ratios (HR) showed significant associations with in-hospital mortality (HR 1.61, 95% CI 1.31-1.99), 1-year mortality (HR 1.45, 95% CI 1.25-1.67), and long-term mortality (HR 1.45, 95% CI 1.28-1.64). Notably, the HR for long-term mortality remained statistically significant at 1.47 (95% CI, 1.15-1.88) even after excluding patients with 1-year mortality. Conclusion A high admission FAR was significantly correlated with an elevated HR for long-term mortality in patients with ICH. The combined assessment of the ICH score and FAR at admission showed higher predictive accuracy for long-term mortality than using the ICH score in isolation.
Collapse
Affiliation(s)
- Shiping Chen
- Department of Neurosurgery, Clinical Medical College and Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Yu Zhang
- Department of Neurosurgery, Clinical Medical College and Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Yangchun Xiao
- Department of Neurosurgery, Clinical Medical College and Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Xin Cheng
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Liyuan Peng
- Department of Neurosurgery, Clinical Medical College and Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Yixin Tian
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tiangui Li
- Department of Neurosurgery, The First People's Hospital of Longquanyi District Chengdu, Chengdu, Sichuan, China
| | - Jialing He
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Neurosurgery, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Pengfei Hao
- Department of Neurosurgery, Shanxi Provincial People’s Hospital, Taiyuan, Shanxi, China
| | - Weelic Chong
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Yang Hai
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Fang Fang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
265
|
Engoren M, Arslanian-Engoren C. Risk factors for readmission after sepsis and its association with mortality. Heart Lung 2024; 68:195-201. [PMID: 39032421 DOI: 10.1016/j.hrtlng.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 07/09/2024] [Accepted: 07/11/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Sepsis is associated with an approximately 20 % 30-day readmission rate and with subsequent mortality. OBJECTIVES To determine the demographics, comorbidities that had been documented prior to sepsis onset, processes of care, commonly administered laboratory tests measured near discharge, and post-sepsis infections that may be associated with readmission and, secondarily, whether readmission is an independent risk factor for 90-day mortality. METHODS Using a database of patients who met Sepsis-3 criteria divided into Construction and Validation groups, we used logistic regression to estimate the factors independently associated with readmission within 30 days after discharge and proportional hazard regression to estimate the factors independently associated with 90-day mortality. RESULTS Of the 30,798 patients ≥ 18 years at our combined referral and community hospital and were discharged alive who met Sepsis-3 criteria between July 10, 2009 and September 7, 2019, 5943 (19 %) were readmitted within 30 days. Thirteen thousand, four hundred forty-four (44 %) of the patients were female, 25,293 (82 %) White, 3523 (11 %) Black, and the mean age was 59 ± 17 years. Among the readmitted patients, 894 (15 %) died within 90 days from the original discharge compared to 11 % (p < 0.001) who had not been readmitted. Seven comorbidities, five processes of care (presepsis platelet transfusion, postsepsis platelet transfusion, operation, ICU length of stay, and hospital length of stay), five culture results, two discharge laboratory values, and discharge location were associated with readmission. The model had good discrimination, 0.770 ± 0.004 (Construction Group) and 0.748 ± 0.006 (Validation Group) and good relevancy (area under the precision recall curve), 0.390 ± 0.004 (Construction group) and 0.476 ± 0.005 (Validation group). Readmission within 30 days was independently associated with a 56 % higher risk of death (HR=1.562, 95 % CI=1.434, 1.703, p < 0.001) within 90 days from discharge. CONCLUSIONS Comorbidities, abnormal laboratory values, processes of care, and post-sepsis onset culture results, but not demographic characteristics, were associated with 30-day readmission. Readmission was associated with 90-day mortality.
Collapse
Affiliation(s)
- Milo Engoren
- Department of Anesthesiology, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109, United States.
| | | |
Collapse
|
266
|
Riccò M, Cascio A, Corrado S, Bottazzoli M, Marchesi F, Gili R, Giuri PG, Gori D, Manzoni P. Occurrence of Central Nervous System Complications of Respiratory Syncytial Virus Infections: A Systematic Review with Meta-Analysis. EPIDEMIOLOGIA 2024; 5:421-455. [PMID: 39051211 PMCID: PMC11270441 DOI: 10.3390/epidemiologia5030031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 07/16/2024] [Accepted: 07/16/2024] [Indexed: 07/27/2024] Open
Abstract
An increasing base of evidence suggests that respiratory syncytial virus (RSV) infections may be associated with neurological complications. In accord with the PRISMA statement, we performed a systematic review and meta-analysis on the occurrence of encephalitis and encephalopathy associated with documented RSV infections. PubMed, Embase, and Scopus databases were searched for eligible observational studies published up to 10 April 2024. Raw data included the occurrence of RSV infections among cases of encephalitis and/or encephalopathy and cases of encephalitis and/or encephalopathy among series of RSV infections. Data were pooled in a random effects model. Case reports were also collected, and their data pooled as a cumulative series. Heterogeneity was assessed using the I2 measure, while reporting bias was assessed by means of funnel plots and regression analysis. A total of 15 studies for a total of 7719 RSV infections and 1631 cases of encephalitis were analyzed. Moreover, 27 case reports and case series were retrieved, for a total of 84 individual cases of encephalitis/encephalopathy occurring during a documented RSV infection. A pooled prevalence of 2.20 cases of encephalitis/encephalopathy per 100 RSV cases (I2 = 99%) was calculated, while a prevalence of RSV infections among cases of encephalitis/encephalopathy was estimated to 3.53 per 100 cases for studies on respiratory specimens (I2 = 48%) and 0.37 per cases on central nervous system (CNS) specimens (I2 = 0%). Detection of RSV within the CNS was relatively rare (17.86% of pooled case reports), being associated with male gender (adjusted odds ratio [aOR] 5.021, 95% confidence interval [95%CI] 1.104 to 22.831) and recovery with long-term sequelae (aOR 5.699, 95%CI 1.152; 28.183). Case fatality ratio was estimated to be 0.43 per 100 cases on observational studies and 10.71% in case reports, a difference likely due to publication bias. In summary, RSV represented a not frequent but notable cause of encephalitis/encephalopathy in adults and children. The paucity of available studies not only recommends a cautious appraisal of our results but stresses the clinical significance of future studies on incident cases of encephalitis and/or encephalopathy.
Collapse
Affiliation(s)
- Matteo Riccò
- AUSL–IRCCS di Reggio Emilia, Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), Local Health Unit of Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Antonio Cascio
- Infectious and Tropical Diseases Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, “G D’Alessandro”, University of Palermo, AOUP P. Giaccone, 90127 Palermo, Italy;
| | - Silvia Corrado
- ASST Rhodense, Dipartimento della donna e Area Materno-Infantile, UOC Pediatria, 20024 Milan, Italy
| | - Marco Bottazzoli
- Department of Otorhinolaryngology, APSS Trento, 38122 Trento, Italy
| | - Federico Marchesi
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Renata Gili
- Department of Prevention, Turin Local Health Authority, 10125 Torino, Italy
| | | | - Davide Gori
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy
| | - Paolo Manzoni
- Department of Public Health and Pediatric Sciences, University of Torino School of Medicine, 10125 Turin, Italy
| |
Collapse
|
267
|
Tan D, Wang B, Cao P, Wang Y, Sun J, Geng P, Walline JH, Wang Y, Wang C. High flow nasal cannula oxygen therapy versus non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease with acute-moderate hypercapnic respiratory failure: a randomized controlled non-inferiority trial. Crit Care 2024; 28:250. [PMID: 39026242 PMCID: PMC11264824 DOI: 10.1186/s13054-024-05040-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 07/16/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Although cumulative studies have demonstrated a beneficial effect of high-flow nasal cannula oxygen (HFNC) in acute hypercapnic respiratory failure, randomized trials to compare HFNC with non-invasive ventilation (NIV) as initial treatment in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) patients with acute-moderate hypercapnic respiratory failure are limited. The aim of this randomized, open label, non-inferiority trial was to compare treatment failure rates between HFNC and NIV in such patients. METHODS Patients diagnosed with AECOPD with a baseline arterial blood gas pH between 7.25 and 7.35 and PaCO2 ≥ 50 mmHg admitted to two intensive care units (ICUs) at a large tertiary academic teaching hospital between March 2018 and December 2022 were randomly assigned to HFNC or NIV. The primary endpoint was the rate of treatment failure, defined as endotracheal intubation or a switch to the other study treatment modality. Secondary endpoints were rates of intubation or treatment change, blood gas values, vital signs at one, 12, and 48 h, 28-day mortality, as well as ICU and hospital lengths of stay. RESULTS 225 total patients (113 in the HFNC group and 112 in the NIV group) were included in the intention-to-treat analysis. The failure rate of the HFNC group was 25.7%, while the NIV group was 14.3%. The failure rate risk difference between the two groups was 11.38% (95% CI 0.25-21.20, P = 0.033), which was higher than the non-inferiority cut-off of 9%. In the per-protocol analysis, treatment failure occurred in 28 of 110 patients (25.5%) in the HFNC group and 15 of 109 patients (13.8%) in the NIV group (risk difference, 11.69%; 95% CI 0.48-22.60). The intubation rate in the HFNC group was higher than in the NIV group (14.2% vs 5.4%, P = 0.026). The treatment switch rate, ICU and hospital length of stay or 28-day mortality in the HFNC group were not statistically different from the NIV group (all P > 0.05). CONCLUSION HFNC was not shown to be non-inferior to NIV and resulted in a higher incidence of treatment failure than NIV when used as the initial respiratory support for AECOPD patients with acute-moderate hypercapnic respiratory failure. TRIAL REGISTRATION chictr.org (ChiCTR1800014553). Registered 21 January 2018, http://www.chictr.org.cn.
Collapse
Affiliation(s)
- Dingyu Tan
- Department of Emergency, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China
| | - Bingxia Wang
- Department of Emergency, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China
| | - Peng Cao
- Department of Emergency, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China
| | - Yunyun Wang
- Department of Emergency, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China.
| | - Jiayan Sun
- Pharmacy Department, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China.
| | - Ping Geng
- Department of Emergency, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China
| | - Joseph Harold Walline
- Department of Emergency Medicine, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA
| | - Yachao Wang
- Department of Emergency, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China
| | - Chenlong Wang
- Department of Emergency, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China
| |
Collapse
|
268
|
Pettersson C, Forsén J, Joelsson-Alm E, Fridh I, Björling G, Mattsson J. Piloting and watch over in the end-of-life care of intensive care unit patients with COVID-19-A qualitative study. Nurs Crit Care 2024. [PMID: 39021308 DOI: 10.1111/nicc.13126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 06/20/2024] [Accepted: 07/01/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND During the COVID-19 pandemic, intensive care units (ICUs) were under heavy pressure, with a significantly increased number of severely ill patients. Hospitals introduced restrictions, and families could not visit their ill and dying family members. Patients were cared for without privacy, and several died in shared patient rooms, leaving the intensive care nurse to protect the patient's need for loving care in a vulnerable situation at the end of life. AIMS This study aimed to investigate how piloting and watch over were revealed in end-of-life care for patients with COVID-19 in intensive care COVID-19. STUDY DESIGN A qualitative study was conducted with an abductive approach was conducted. Data were collected via semi-structured interviews to cover the research area while allowing the informant to talk freely about the topic; 11 informants were interviewed. RESULTS The findings are presented based on four categories: The road to the decision, End-of-life care, Farewell of close family members and Closure. Each category and subcategory reveal how piloting and watch over were addressed in the end-of-life care of patients with COVID-19 in the ICU during the pandemic. Overall findings indicated that workload and organization of care directly affect the quality of care given, the acceptance of privacy and the possibility of dignified end-of-life care. CONCLUSIONS Workload directly affects the quality of care, risking dehumanization of the patient. Visiting restrictions hindered supporting family members through the various piloting phases. Visiting restrictions also forced the ICU nurses to take on the role of the relative in watching over the patient. RELEVANCE TO CLINICAL PRACTICE Collaboration with family members is essential for the intensive care nurse to be able to provide a person-centred and dignified end-of-life care.
Collapse
Affiliation(s)
- Charlotte Pettersson
- Department of Anaesthesiology and Intensive Care, Stockholm South General Hospital, Stockholm, Sweden
| | - Johanna Forsén
- Department of Anaesthesiology and Intensive Care, Stockholm South General Hospital, Stockholm, Sweden
| | - Eva Joelsson-Alm
- Department of Anaesthesiology and Intensive Care, Stockholm South General Hospital, Stockholm, Sweden
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Isabell Fridh
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Gunilla Björling
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
- Faculty of Nursing, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Janet Mattsson
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
- Faculty of Nursing and Health Sciences, University of South-Eastern Norway, Notodden, Norway
- Department of Health Science, Kristianstad University, Kristianstad, Sweden
| |
Collapse
|
269
|
Gerhart J, Bruins G, Hoerger M, Boehm LM, White K, Brugh C, Greenberg JA. Understanding Intensive Care Unit Family Caregivers' Vulnerability to Post-Traumatic Stress Disorder: The Impact of Neurotic Personality Traits, Emotional Suppression, and Perceptions of Unexpected Death. J Palliat Med 2024. [PMID: 39023049 DOI: 10.1089/jpm.2023.0689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024] Open
Abstract
Rationale: Family members of patients who die in an intensive care unit (ICU) are at heightened risk of post-traumatic stress disorder (PTSD) symptoms. Not all surrogates develop these symptoms and heterogeneity exists in PTSD symptom clusters. Objectives: The study tested a personality model of PTSD symptoms in bereaved family caregivers of ICU patients. It was hypothesized that family members endorsing higher levels of neurotic personality traits would report higher levels of PTSD symptom clusters and that these associations would be explained by tendencies to view the patient's death as unexpected and to cope by suppressing their emotions. Methods: Participants were family members of ICU patients at an urban, academic medical center who either died or were discharged to an inpatient hospice unit. Participants were contacted for participation at least six months after the patient's death. Participants completed measures of personality, emotion regulation, and PTSD symptoms. Data were analyzed using path analysis. Results: Approximately one-third (35%) of the sample of 162 caregivers endorsed at-risk levels of PTSD. Individuals reporting higher levels of neurotic personality traits reported more PTSD symptoms (r = 0.53, p < 0.001). Perceptions that the patient death was unexpected partially explained the association of neuroticism with the intrusive re-experiencing PTSD symptoms (B = 0.45, p = 0.031). In contrast, emotional suppression partially explained the association of neuroticism with avoidance (B = 0.70, p = 0.010) and hyperarousal symptom clusters (B = 0.37, p = 0.041). Conclusions: Family vulnerability to PTSD after an ICU death can be conceptualized based on neurotic personality traits. Tendencies to view the patient's death as unexpected may contribute to intrusive thoughts and memories of the ICU experience. Individuals may avoid reminders and remain at heightened levels of arousal when they suppress their emotional experiences. Key Message: Family members who experience the death of a loved one following ICU treatment are vulnerable to PTSD symptoms. These reactions to ICU-related losses may be shaped by family members' personalities, expectations, and emotion regulation styles. Understanding these characteristics could inform family screening and intervention efforts in the ICU.
Collapse
Affiliation(s)
- James Gerhart
- Department of Psychology, Central Michigan University, Mt. Pleasant, Michigan, USA
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Grace Bruins
- Department of Psychology, Central Michigan University, Mt. Pleasant, Michigan, USA
| | - Michael Hoerger
- Departments of Psychology and Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Leanne M Boehm
- School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
| | - Katherine White
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Casey Brugh
- Department of Psychology, Central Michigan University, Mt. Pleasant, Michigan, USA
| | - Jared A Greenberg
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
270
|
Rajsic S, Treml B, Rugg C, Innerhofer N, Eckhardt C, Breitkopf R. Organ Utilization From Donors Following Extracorporeal Cardiopulmonary Resuscitation: A Systematic Review of Graft and Recipient Outcome. Transplantation 2024:00007890-990000000-00816. [PMID: 39020459 DOI: 10.1097/tp.0000000000005133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Abstract
BACKGROUND The global shortage of solid organs for transplantation is exacerbated by high demand, resulting in organ deficits and steadily growing waiting lists. Diverse strategies have been established to address this issue and enhance organ availability, including the use of organs from individuals who have undergone extracorporeal cardiopulmonary resuscitation (eCPR). The main aim of this work was to examine the outcomes for both graft and recipients of solid organ transplantations sourced from donors who underwent eCPR. METHODS We performed a systematic literature review using a combination of the terms related to extracorporeal life support and organ donation. Using Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, PubMed and Scopus databases were searched up to February 2024. RESULTS From 1764 considered publications, 13 studies comprising 130 donors and 322 organ donations were finally analyzed. On average, included patients were 36 y old, and the extracorporeal life support was used for 4 d. Kidneys were the most often transplanted organs (68%; 220/322), followed by liver (22%; 72/322) and heart (5%; 15/322); with a very good short-term graft survival rate (95% for kidneys, 92% for lungs, 88% for liver, and 73% for heart). Four studies with 230 grafts reported functional outcomes at the 1-y follow-up, with graft losses reported for 4 hearts (36%), 8 livers (17%), and 7 kidneys (4%). CONCLUSIONS Following eCPR, organs can be successfully used with very high graft and recipient survival. In terms of meeting demand, the use of organs from patients after eCPR might be a suitable method for expanding the organ donation pool.
Collapse
Affiliation(s)
- Sasa Rajsic
- Department of Anesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | | | | | | | | | | |
Collapse
|
271
|
Parr NJ, Beech EH, Young S, Valley TS. Racial and Ethnic Disparities in Occult Hypoxemia Prevalence and Clinical Outcomes Among Hospitalized Patients: A Systematic Review and Meta-analysis. J Gen Intern Med 2024:10.1007/s11606-024-08852-1. [PMID: 39020232 DOI: 10.1007/s11606-024-08852-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 05/31/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND There is growing concern that pulse oximeters are routinely less accurate in hospitalized patients with darker skin pigmentation, in turn increasing risk of undetected (occult) hypoxemia and adverse clinical outcomes. The aim of this systematic review and meta-analysis was to synthesize evidence on racial and ethnic disparities in occult hypoxemia prevalence and clinical impacts of undetected hypoxemia. METHODS Ovid MEDLINE, Embase, and CINAHL databases were searched for relevant articles published through January 2024. Eligible studies must have been conducted among adults in inpatient or outpatient settings and report occult hypoxemia prevalence stratified by patient race or ethnicity, or clinical outcomes stratified by patient race or ethnicity and occult hypoxemia status. Screening for inclusion was conducted independently by two investigators. Data extraction and risk of bias assessment were conducted by one investigator then checked by a second. Outcome data were synthesized using random-effects meta-analyses. RESULTS Fifteen primary studies met eligibility criteria and reported occult hypoxemia prevalence in 732,505 paired oximetry measurements from 207,464 hospitalized patients. Compared with White patients, occult hypoxemia is likely more common among Black patients (pooled prevalence ratio = 1.67, 95% CI 1.47 to 1.90) and among patients identifying as Asian, Latinx, Indigenous, multiracial, or other race or ethnicity (pooled prevalence ratio = 1.39, 95% CI 1.19 to 1.64). Findings from studies reporting clinical outcomes suggest that Black patients with undetected hypoxemia may experience poorer treatment delivery outcomes than White patients with undetected hypoxemia. No evidence was found from outpatient settings. DISCUSSION This review and included primary studies rely on self-identified race or ethnicity, which may obscure variability in occult hypoxemia risk. Findings underscore that clinicians should be aware of the risk of occult hypoxemia in hospitalized patients with darker skin pigmentation. Moreover, oximetry data from included studies suggests that the accuracy of pulse oximeters could vary substantially from patient to patient and even within individual patients. TRIAL REGISTRATION PROSPERO ( CRD42023402152 ).
Collapse
Affiliation(s)
- Nicholas J Parr
- VA Evidence Synthesis Program Coordinating Center, VA Portland Health Care System, 3710 SW US Veterans Hospital Road R&D 71, Portland, OR, 97239, USA.
| | - Erin H Beech
- VA Evidence Synthesis Program Coordinating Center, VA Portland Health Care System, 3710 SW US Veterans Hospital Road R&D 71, Portland, OR, 97239, USA
| | - Sarah Young
- VA Evidence Synthesis Program Coordinating Center, VA Portland Health Care System, 3710 SW US Veterans Hospital Road R&D 71, Portland, OR, 97239, USA
| | - Thomas S Valley
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
272
|
Mester P, Amend P, Schmid S, Wenzel JJ, Höring M, Liebisch G, Krautbauer S, Müller M, Buechler C, Pavel V. Proprotein Convertase Subtilisin/Kexin Type 9 Induction in COVID-19 Is Poorly Associated with Disease Severity and Cholesterol Levels. Infect Dis Rep 2024; 16:593-607. [PMID: 39051245 PMCID: PMC11270413 DOI: 10.3390/idr16040045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 07/10/2024] [Accepted: 07/15/2024] [Indexed: 07/27/2024] Open
Abstract
SARS-CoV-2 infection was shown to induce proprotein convertase subtilisin/kexin type 9 (PCSK9) plasma levels in sepsis. Here, we investigate the association between serum PCSK9 levels and disease severity. PCSK9 was measured in serum of 55 controls, 40 patients with moderate and 60 patients with severe COVID-19 disease. Serum PCSK9 was elevated in moderate COVID-19 compared to controls and further increased in severe cases. PCSK9 levels were not associated with C-reactive protein, bacterial superinfections, interventions, or survival in patients with severe COVID-19. PCSK9 regulates circulating cholesterol levels, and 15 cholesteryl ester (CE) species and free cholesterol (FC) were quantified by direct flow injection analysis using a high-resolution hybrid quadrupole-Orbitrap mass spectrometer. Most CE species with shorter fatty acid chains were decreased in severe compared to moderate COVID-19, and none of the CE species were correlated with PCSK9 in patients with severe COVID-19. Levels of all CE species negatively correlated with C-reactive protein in severe COVID-19 patients. Notably, FC was induced in severe compared to moderate COVID-19. The FC/CE ratio correlated positively with inflammatory markers and was associated with non-survival. The current study suggests that the imbalance between CE and FC levels is associated with disease severity and mortality in patients with COVID-19.
Collapse
Affiliation(s)
- Patricia Mester
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, 93053 Regensburg, Germany; (P.M.); (P.A.); (S.S.); (M.M.); (V.P.)
| | - Pablo Amend
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, 93053 Regensburg, Germany; (P.M.); (P.A.); (S.S.); (M.M.); (V.P.)
| | - Stephan Schmid
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, 93053 Regensburg, Germany; (P.M.); (P.A.); (S.S.); (M.M.); (V.P.)
| | - Jürgen J. Wenzel
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, 93053 Regensburg, Germany;
| | - Marcus Höring
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, 93053 Regensburg, Germany; (M.H.); (G.L.); (S.K.)
| | - Gerhard Liebisch
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, 93053 Regensburg, Germany; (M.H.); (G.L.); (S.K.)
| | - Sabrina Krautbauer
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, 93053 Regensburg, Germany; (M.H.); (G.L.); (S.K.)
| | - Martina Müller
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, 93053 Regensburg, Germany; (P.M.); (P.A.); (S.S.); (M.M.); (V.P.)
| | - Christa Buechler
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, 93053 Regensburg, Germany; (P.M.); (P.A.); (S.S.); (M.M.); (V.P.)
| | - Vlad Pavel
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, 93053 Regensburg, Germany; (P.M.); (P.A.); (S.S.); (M.M.); (V.P.)
| |
Collapse
|
273
|
Romero-Garcia N, Robba C, Monleon B, Ruiz-Zarco A, Ruiz-Pacheco A, Pascual-Gonzalez M, Perdomo F, Garcia-Perez ML, Taccone FS, Badenes R. Neurological outcomes and mortality of hyperoxaemia in patients with acute brain injury: protocol for a systematic review and meta-analysis. BMJ Open 2024; 14:e084849. [PMID: 39019641 PMCID: PMC11256059 DOI: 10.1136/bmjopen-2024-084849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 06/17/2024] [Indexed: 07/19/2024] Open
Abstract
INTRODUCTION Oxygen is frequently prescribed in neurocritical care units. Avoiding hypoxaemia is a key objective in patients with acute brain injury (ABI). However, several studies suggest that hyperoxaemia may also be related to higher mortality and poor neurological outcomes in these patients. The evidence in this direction is still controversial due to the limited number of prospective studies, the lack of a common definition for hyperoxaemia, the heterogeneity in experimental designs and the different causes of ABI. To explore the correlation between hyperoxaemia and poor neurological outcomes and mortality in hospitalised adult patients with ABI, we will conduct a systematic review and meta-analysis of observational studies and RCTs. METHODS AND ANALYSIS The systematic review methods have been defined according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and follow the PRISMA-Protocols structure. Studies published until June 2024 will be identified in the electronic databases MEDLINE, Embase, Scopus, Web of Science, The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature and ClinicalTrials.gov. Retrieved records will be independently screened by four authors working in pairs, and the selected variables will be extracted from studies reporting data on the effect of 'hyperoxaemia' versus 'no hyperoxaemia on neurological outcomes and mortality in hospitalised patients with ABI. We will use covariate-adjusted ORs as outcome measures when reported since they account for potential cofounders and provide a more accurate estimate of the association between hyperoxaemia and outcomes; when not available, we will use univariate ORs. If the study presents the results as relative risks, it will be considered equivalent to the OR as long as the prevalence of the condition is close to 10%. Pooled estimates of both outcomes will be calculated applying random-effects meta-analysis. Interstudy heterogeneity will be assessed using the I2 statistic; risk of bias will be assessed through Risk Of Bias In Non-Randomised Studies of Interventions, Newcastle-Ottawa or RoB2 tools. Depending on data availability, we plan to conduct subgroup analyses by ABI type (traumatic brain injury, postcardiac arrest, subarachnoid haemorrhage, intracerebral haemorrhage and ischaemic stroke), arterial partial pressure of oxygen values, study quality, study time, neurological scores and other selected clinical variables of interest. ETHICS AND DISSEMINATION Specific ethics approval consent is not required as this is a review of previously published anonymised data. Results of the study will be shared with the scientific community via publication in a peer-reviewed journal and presentation at relevant conferences and workshops. It will also be shared key stakeholders, such as national or international health authorities, healthcare professionals and the general population, via scientific outreach journals and research institutes' newsletters.
Collapse
Affiliation(s)
- Nekane Romero-Garcia
- Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clinic Universitari de València, Valencia, Spain
- Department of Surgery. School of Medicine, University of Valencia, Valencia, Spain
| | - Chiara Robba
- IRCCS Policlinico San Martino, Policlinico San Martino, Genova, Genova, Italy
- Dipartimento di Scienze Chirurgiche diagnostiche e integrate, University of Genoa, Genoa, Italy
| | - Berta Monleon
- Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clinic Universitari de València, Valencia, Spain
- Department of Surgery. School of Medicine, University of Valencia, Valencia, Spain
| | - Ana Ruiz-Zarco
- Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clinic Universitari de València, Valencia, Spain
| | - Alberto Ruiz-Pacheco
- Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clinic Universitari de València, Valencia, Spain
| | - Maria Pascual-Gonzalez
- Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clinic Universitari de València, Valencia, Spain
| | - Felipe Perdomo
- Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clinic Universitari de València, Valencia, Spain
| | - Maria Luisa Garcia-Perez
- Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clinic Universitari de València, Valencia, Spain
- Department of Surgery. School of Medicine, University of Valencia, Valencia, Spain
| | - Fabio Silvio Taccone
- Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Rafael Badenes
- Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clinic Universitari de València, Valencia, Spain
- Department of Surgery. School of Medicine, University of Valencia, Valencia, Spain
| |
Collapse
|
274
|
Elbus LMS, Mostafa MG, Mahmoud FZ, Shaban M, Mahmoud SA. Nurse managers' managerial innovation and it's relation to proactivity behavior and locus of control among intensive care nurses. BMC Nurs 2024; 23:485. [PMID: 39014395 PMCID: PMC11251221 DOI: 10.1186/s12912-024-02084-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/10/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND The nursing profession is undergoing rapid transformation, requiring innovation in management approaches and proactive behaviors among staff. Nurse Managers play a vital role through managerial innovation, but its impacts on intensive care nurses' proactivity and locus of control remain underexplored. OBJECTIVES This study aimed to assess the levels of Nurse Managers' managerial innovation and relate it to proactivity behaviors and locus of control orientations among intensive care nurses. METHODS A cross-sectional correlational design was adopted, recruiting 242 intensive care nurses from Tanta University Hospital, Egypt. Participants completed standardized questionnaires measuring perceived managerial innovation, proactivity behavior, and locus of control. RESULTS Nurse Managers demonstrated moderately high innovation across all dimensions, especially in continuous learning and development (mean = 4.65) and advanced technology use (mean = 4.56). Nurses exhibited sound proactivity levels, particularly in adaptability (mean = 4.40) and planning (mean = 4.35). The majority of nurses showed an internal locus of control (64.5%). Managerial innovation had significant positive correlations with nurses' proactivity (r = 0.45, p < 0.001) and internal locus of control (r = 0.42, p < 0.001). Regression analysis revealed age, gender, experience, education, and ICU type as significant predictors of proactivity and locus of control. CONCLUSION Innovative nursing leadership positively influences staff's proactivity levels and perceived control over their practice. This underscores the vital role of nurse managers in creating empowering environments in intensive care.
Collapse
Affiliation(s)
| | | | | | - Mostafa Shaban
- Community Health Nursing Department, College of Nursing, Jouf University, Sakak, Saudi Arabia
| | | |
Collapse
|
275
|
Băetu AE, Mirea LE, Cobilinschi C, Grințescu IC, Grințescu IM. Platelet Contribution and Endothelial Activation and Stress Index-Potential Mortality Predictors in Traumatic Brain Injury. Int J Mol Sci 2024; 25:7763. [PMID: 39063005 PMCID: PMC11276696 DOI: 10.3390/ijms25147763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 07/09/2024] [Accepted: 07/14/2024] [Indexed: 07/28/2024] Open
Abstract
Coagulopathy and traumatic brain injury (TBI) are complexly intertwined. In isolated TBI, coagulopathy may contribute to hemorrhagic lesion development, progression, or recurrence, as it may lead to a particular pattern of coagulopathy called TBI-induced coagulopathy (TBI-IC). We performed a retrospective and descriptive evaluation of 63 patients admitted to the Emergency Clinical Hospital Bucharest with the diagnosis of moderate/severe brain injury. In addition to demographic data, all included patients had a complete paraclinical evaluation that included rotational thromboelastometric (ROTEM) blood-clot analysis. The platelet component (PLTEM) and the endotheliopathy activation and stress index score (EASIX) were calculated. These parameters were presented comparatively according to survival at 30 days and helped define the two study groups: survivors and non-survivors at 30 days. The contribution of platelets to clot strength is derived from maximum clot elasticity (MCE) and maximum clot firmness (MCF). MCE is defined as (MCF × 100)/(100 - MCF), and PLTEM is defined as EXTEM MCE-FIBTEM MCE. EASIX is a novel biomarker recently studied in TBI patients, calculated according to the following formula: lactate dehydrogenase (U/L) × creatinine (mg/dL)/platelets (109 cells/L). Regarding the demographic data, there were no significant differences between the survivors and non-survivors. All ROTEM parameters related to clot amplitude (A5, A10, A20, MCF in EXTEM and FIBTEM channels) were higher in the group of patients who survived. Also, PLTEM was decreased in the group of deceased patients (89.71 ± 22.86 vs. 132.3 ± 16.56 p < 0.0001). The cut-off point determined with the ROC curve is 114.10, with a sensitivity of 94.74% and a specificity of 93.18%, for the detection of the negative prognosis (death at 30 days). The EASIX score was significantly higher in the patients who survived the traumatic event, with a median difference value of 1.15 (p < 0.0001). The ROC analysis of this biomarker highlights a cut-off point of 2.12, with a sensitivity of 88.64% and a specificity of 94.74% (AUC = 0.95, p < 0.0001), for the prediction of mortality. The comparative analysis of the two studied markers was performed using the Cox proportional hazard ratio and highlighted the greater influence that PLTEM has on survival time (b value = -0.05, p < 0.0001) compared to EASIX (b value = 0.49, p = 0.0026). The present retrospective study indicates the potential of the TBI-IC reflecting parameters PLTEM and EASIX as markers of mortality prognosis. Larger prospective studies are needed to confirm their combined prognostic value and use in decision-making and reduction in the burden of disease by adequate allocation of resources in a personalized and timely manner.
Collapse
Affiliation(s)
- Alexandru Emil Băetu
- Department of Anesthesiology and Intensive Care II, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.E.B.); (I.M.G.)
- Department of Anesthesiology and Intensive Care, Grigore Alexandrescu Clinical Emergency Hospital for Children, 011743 Bucharest, Romania
| | - Liliana Elena Mirea
- Department of Anesthesiology and Intensive Care II, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.E.B.); (I.M.G.)
- Department of Anesthesiology and Intensive Care, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania
| | - Cristian Cobilinschi
- Department of Anesthesiology and Intensive Care II, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.E.B.); (I.M.G.)
- Department of Anesthesiology and Intensive Care, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania
| | | | - Ioana Marina Grințescu
- Department of Anesthesiology and Intensive Care II, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.E.B.); (I.M.G.)
- Department of Anesthesiology and Intensive Care, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania
| |
Collapse
|
276
|
Hughes AD, Teachey DT, Diorio C. Riding the storm: managing cytokine-related toxicities in CAR-T cell therapy. Semin Immunopathol 2024; 46:5. [PMID: 39012374 PMCID: PMC11252192 DOI: 10.1007/s00281-024-01013-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/18/2024] [Indexed: 07/17/2024]
Abstract
The advent of chimeric antigen receptor T cells (CAR-T) has been a paradigm shift in cancer immunotherapeutics, with remarkable outcomes reported for a growing catalog of malignancies. While CAR-T are highly effective in multiple diseases, salvaging patients who were considered incurable, they have unique toxicities which can be life-threatening. Understanding the biology and risk factors for these toxicities has led to targeted treatment approaches which can mitigate them successfully. The three toxicities of particular interest are cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), and immune effector cell-associated hemophagocytic lymphohistiocytosis (HLH)-like syndrome (IEC-HS). Each of these is characterized by cytokine storm and hyperinflammation; however, they differ mechanistically with regard to the cytokines and immune cells that drive the pathophysiology. We summarize the current state of the field of CAR-T-associated toxicities, focusing on underlying biology and how this informs toxicity management and prevention. We also highlight several emerging agents showing promise in preclinical models and the clinic. Many of these established and emerging agents do not appear to impact the anti-tumor function of CAR-T, opening the door to additional and wider CAR-T applications.
Collapse
Affiliation(s)
- Andrew D Hughes
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - David T Teachey
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Immune Dysregulation Frontier Program, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Caroline Diorio
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
- Immune Dysregulation Frontier Program, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| |
Collapse
|
277
|
Khalfoun J, Zouhal H, Triki R, Jribi W, Saeidi A, Almaqhawi A, Clark CCT, Laher I, Ben Abderrahman A. Ramadan Intermittent Fasting and Plasma Volume Variations in Individuals with Different Body Weights. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1143. [PMID: 39064573 PMCID: PMC11278820 DOI: 10.3390/medicina60071143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 06/30/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024]
Abstract
Background: There is increasing awareness of the physiological effects of Ramadan intermittent fasting (RIF) in obese subjects. However, there are no data on the effects of RIF on plasma volume changes (ΔPV) in individuals with different body weights. Background and Objectives: This study investigated the effects of RIF on ΔPV in normal-weight (NW) and overweight (OW) adult men, and adult men with obesity (OB) and severe obesity (SO). Materials and Methods: Thirty-two male subjects (32) were divided into four groups (n = 8 per group) according to their body mass index (BMI): normal weight (NW) (BMI < 25 kg/m2; age = 27.4 ± 3.8), overweight (OW) (BMI between 25 and 29.9 kg/m2; age = 26.8 ± 3.7), obese subjects (OB) (BMI between 30 and 34.9 kg/m2; age = 25.6 ± 2.9), and severely obesity (SO) (BMI between 35 and 40 kg/m2; age = 24.0 ± 4.1). Blood samples were collected for 24 h on 4 different occasions, at T0 before the start of the Ramadan month, at T1 15 days after the start of Ramadan, at T2 one day after the end of Ramadan, and at T3 on the 21st day after the end of Ramadan to determine ΔPV. All groups completed their fasting rituals for the 30 days of Ramadan. Results: A significant group × time effect occurred for body mass (p = 0.001; ES = 0.53), BMI (p = 0.001; ES = 0.53), and body fat percentage (p = 0.001; ES = 0.52). Post hoc tests indicated reductions in body mass in OB and SO at T1 (p = 0.03; ES = 0.21 and p = 0.002; ES = 0.12) and T2 (p = 0.03; ES = 0.31 and p = 0.02; ES = 0.23), reductions in BMI in OB and SO at T1 (p = 0.04; ES = 0.35 and p = 0.03; ES = 0.42) and T2 (p = 0.03; ES = 0.52 and p = 0.005; ES = 0.48), and reductions in body fat percentage only in OB AT T1 (p = 0.002; ES = 0.31) and T2 (p = 0.001; ES = 0.17). A significant group × time effect occurred for hematocrit (p = 0.02; ES = 0.34), hemoglobin (p = 0.01; ES = 0.35), and ΔPV (p = 0.02; ES = 0.18). Post hoc tests indicated increases in hematocrit in OB at T2 (p = 0.03; ES = 0.36) and hemoglobin in OB and SO at T1 (p = 0.03; ES = 0.35 and p = 0.002; ES = 0.32) and T2 (p = 0.003; ES = 0.21 and p = 0.002; ES = 0.33). There were also increases in ΔPV in OB at T1 and T2 (p = 0.002; ES = 0.25 and p = 0.003; ES = 0.22) and in SO only at T2 (p = 0.02; ES = 0.37). Contrast analysis indicated that NW was significantly lower than the grand mean of OW, Ob, and SO for all anthropometric and PVV variables (all p < 0.05). Conclusions: The effects of RIF on ΔPV and anthropometric characters was greater in obese individuals compared to normal-weight and overweight participants, suggesting that the improvements in body composition and ΔPV produced by RIF could positively influence obesity.
Collapse
Affiliation(s)
- Jihen Khalfoun
- Higher Institute of Sport and Physical Education of Ksar-Said, University of Manouba, Cité Nasr 2010, Tunisia; (J.K.); (R.T.); (A.B.A.)
| | - Hassane Zouhal
- M2S (Laboratoire Mouvement, Sport, Santé)—EA 1274, University of Rennes, 35000 Rennes, France
- Institut International des Sciences du Sport (2I2S), 35850 Irodouer, France
| | - Raoua Triki
- Higher Institute of Sport and Physical Education of Ksar-Said, University of Manouba, Cité Nasr 2010, Tunisia; (J.K.); (R.T.); (A.B.A.)
- Tunisian Research Laboratory “Sports Performance Optimization”, National Center of Medicine and Science in Sports (CNMSS) LR09SEP01, Tunis 1002, Tunisia
| | - Wafa Jribi
- High Institute of Sport and Physical Education Sfax, Sfax University, Sfax 3029, Tunisia;
| | - Ayoub Saeidi
- Department of Physical Education and Sport Sciences, Faculty of Humanities and Social Sciences, University of Kurdistan, Sanandaj 6617715175, Iran
| | - Abdullah Almaqhawi
- Department of Family and Community Medicine, College of Medicine, King Faisal University, Al Hofuf P.O. Box 400, Saudi Arabia;
| | - Cain C. T. Clark
- College of Life Sciences, Birmingham City University, Birmingham B15 3TN, UK;
| | - Ismail Laher
- Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, BC V6T1Z4, Canada;
| | - Abderraouf Ben Abderrahman
- Higher Institute of Sport and Physical Education of Ksar-Said, University of Manouba, Cité Nasr 2010, Tunisia; (J.K.); (R.T.); (A.B.A.)
- Tunisian Research Laboratory “Sports Performance Optimization”, National Center of Medicine and Science in Sports (CNMSS) LR09SEP01, Tunis 1002, Tunisia
| |
Collapse
|
278
|
Goury A, Houlla Z, Jozwiak M, Urbina T, Turpin M, Lavalard A, Laghlam D, Voicu S, Rosman J, Coutureau C, Mourvillier B. Effect of noninvasive ventilation on mortality and clinical outcomes among patients with severe hypoxemic COVID-19 pneumonia after high-flow nasal oxygen failure: a multicenter retrospective French cohort with propensity score analysis. Respir Res 2024; 25:279. [PMID: 39010097 PMCID: PMC11251296 DOI: 10.1186/s12931-024-02873-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 06/08/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND We assessed the effect of noninvasive ventilation (NIV) on mortality and length of stay after high flow nasal oxygenation (HFNO) failure among patients with severe hypoxemic COVID-19 pneumonia. METHODS In this multicenter, retrospective study, we enrolled COVID-19 patients admitted in intensive care unit (ICU) for severe COVID-19 pneumonia with a HFNO failure from December 2020 to January 2022. The primary outcome was to compare the 90-day mortality between patients who required a straight intubation after HFNO failure and patients who received NIV after HFNO failure. Secondary outcomes included ICU and hospital length of stay. A propensity score analysis was performed to control for confounding factors between groups. Exploratory outcomes included a subgroup analysis for 90-day mortality. RESULTS We included 461 patients with HFNO failure in the analysis, 233 patients in the straight intubation group and 228 in the NIV group. The 90-day mortality did not significantly differ between groups, 58/228 (25.4%) int the NIV group compared with 59/233 (25.3%) in the straight intubation group, with an adjusted hazard ratio (HR) after propensity score weighting of 0.82 [95%CI, 0.50-1.35] (p = 0.434). ICU length of stay was significantly shorter in the NIV group compared to the straight intubation group, 10.0 days [IQR, 7.0-19.8] versus 18.0 days [IQR,11.0-31.0] with a propensity score weighted HR of 1.77 [95%CI, 1.29-2.43] (p < 0.001). A subgroup analysis showed a significant increase in mortality rate for intubated patients in the NIV group with 56/122 (45.9%), compared to 59/233 (25.3%) for patients in the straight intubation group (p < 0.001). CONCLUSIONS In severely hypoxemic COVID-19 patients, no significant differences were observed on 90-day mortality between patients receiving straight intubation and those receiving NIV after HFNO failure. NIV strategy was associated with a significant reduction in ICU length of stay, despite an increase in mortality in the subgroup of patients finally intubated.
Collapse
Affiliation(s)
- Antoine Goury
- Unité de Médecine Intensive et Réanimation Polyvalente, CHU Reims, Reims, F-51100, France.
| | - Zeyneb Houlla
- Unité de Médecine Intensive et Réanimation Polyvalente, CHU Reims, Reims, F-51100, France
| | - Mathieu Jozwiak
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, Hôpital l'Archet 1, Nice, France
- UR2CA - Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France
| | - Tomas Urbina
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Matthieu Turpin
- Service de Médecine Intensive Réanimation, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Alexandra Lavalard
- Unité de Réanimation Polyvalente, Centre Hospitalier de Troyes, Troyes, France
| | - Driss Laghlam
- Service de Médecine Intensive et Réanimation, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Sebastian Voicu
- Réanimation Médicale et Toxicologique, Hôpital Lariboisière, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Jeremy Rosman
- Unité de Soins Intensifs et Réanimation, Groupe Hospitalier de Territoire Nord-Ardennes, Charleville-Mézières, France
| | - Claire Coutureau
- Université de Reims Champagne-Ardenne, VieFra, Reims, F-51100, France
- Unité d'Aide Méthodologique, CHU Reims, Reims, F-51100, France
| | - Bruno Mourvillier
- Unité de Médecine Intensive et Réanimation Polyvalente, CHU Reims, Reims, F-51100, France
- Université de Reims Champagne-Ardenne, EA-4684 CardioVir, Reims, F-51100, France
| |
Collapse
|
279
|
Feys S, Carvalho A, Clancy CJ, Gangneux JP, Hoenigl M, Lagrou K, Rijnders BJA, Seldeslachts L, Vanderbeke L, van de Veerdonk FL, Verweij PE, Wauters J. Influenza-associated and COVID-19-associated pulmonary aspergillosis in critically ill patients. THE LANCET. RESPIRATORY MEDICINE 2024:S2213-2600(24)00151-6. [PMID: 39025089 DOI: 10.1016/s2213-2600(24)00151-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 05/06/2024] [Accepted: 05/07/2024] [Indexed: 07/20/2024]
Abstract
Influenza-associated pulmonary aspergillosis (IAPA) and COVID-19-associated pulmonary aspergillosis (CAPA) are increasingly recognised as important complications in patients requiring intensive care for severe viral pneumonia. The diagnosis can typically be made in 10-20% of patients with severe influenza or COVID-19, but only when appropriate diagnostic tools are used. Bronchoalveolar lavage sampling for culture, galactomannan testing, and PCR forms the cornerstone of diagnosis, whereas visual examination of the tracheobronchial tract during bronchoscopy is required to detect invasive Aspergillus tracheobronchitis. Azoles are the first-choice antifungal drugs, with liposomal amphotericin B as an alternative in settings where azole resistance is prevalent. Despite antifungal therapy, IAPA and CAPA are associated with poor outcomes, with fatality rates often exceeding 50%. In this Review, we discuss the mechanistic and clinical aspects of IAPA and CAPA. Moreover, we identify crucial knowledge gaps and formulate directions for future research.
Collapse
Affiliation(s)
- Simon Feys
- Medical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium; Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium.
| | - Agostinho Carvalho
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's Associate Laboratory, Braga/ Guimarães, Portugal
| | - Cornelius J Clancy
- Division of Infectious Diseases, University of Pittsburgh, PA, USA; VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Jean-Pierre Gangneux
- Université de Rennes, CHU Rennes, INSERM, EHESP, IRSET, UMR_S 1085, Rennes, France; Centre Hospitalier Universitaire de Rennes, Laboratoire de Parasitologie-Mycologie, ECMM Excellence Center in Medical Mycology, French National Reference Center on Mycoses and Antifungals (CNRMA-LA AspC), Rennes, France
| | - Martin Hoenigl
- Division of Infectious Diseases, ECMM Excellence Center in Medical Mycology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; Translational Medical Mycology Research Group, Medical University of Graz, Graz, Austria; Bio TechMed-Graz, Graz, Austria
| | - Katrien Lagrou
- Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium; Department of Laboratory Medicine and National Reference Center for Mycosis, University Hospitals Leuven, Leuven, Belgium
| | - Bart J A Rijnders
- Department of Internal Medicine, Section of Infectious Diseases and Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | | | - Lore Vanderbeke
- Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | | | - Paul E Verweij
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands; Center of Expertise for Mycology, Radboud University Medical Center/Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Joost Wauters
- Medical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium; Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
| |
Collapse
|
280
|
Tekin A, Devarajan A, Sakata KK, Qamar S, Sharma M, Valencia Morales DJ, Malinchoc M, Talaei F, Welle S, Taji J, Khosa S, Sharma N, Brown M, Lal A, Bansal V, Khan SA, La Nou AT, Sanghavi D, Cartin-Ceba R, Kashyap R, Gajic O, Domecq JP, Azadeh N. Pneumomediastinum and pneumothorax in coronavirus disease-2019: Description of a case series and a matched cohort study. Heliyon 2024; 10:e33679. [PMID: 39055836 PMCID: PMC11269848 DOI: 10.1016/j.heliyon.2024.e33679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 06/21/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024] Open
Abstract
Objective To describe the characteristics of COVID-19 patients with pneumothorax and pneumomediastinum (PTX/PM) and their association with patient outcomes. Patients and methods Adults admitted to five Mayo Clinic hospitals with COVID-19 between 03/2020-01/2022 were evaluated. PTX/PM was defined by imaging. Descriptive analyses and a matched (age, sex, admission month, COVID-19 severity) cohort comparison was performed. Hospital mortality, length of stay (LOS), and predisposing factors were assessed. Results Among 6663 patients, 197 had PTX/PM (3 %) (75 PM, 40 PTX, 82 both). The median age was 59, with 71 % males. Exposure to invasive and non-invasive mechanical ventilation and high-flow nasal cannula before PTX/PM were 42 %, 17 %, and 20 %, respectively. Among isolated PTX and PM/PTX patients 70 % and 53.7 % underwent an intervention, respectively, while 96 % of the PM-only group was followed conservatively.A total of 171 patients with PTX/PM were compared to 171 matched controls. PTX/PM patients had more underlying lung disease (40.9 vs. 23.4 %, p < 0.001) and lower median body mass index (BMI) (29.5 vs. 31.3 kg/m2, p = .007) than controls. Among patients with available data, PTX/PM patients had higher median positive end-expiratory and plateau pressures than controls; however, differences were not significant (10 vs. 8 cmH2O; p = 0.38 and 28 vs. 22 cmH2O; p = 0.11, respectively). PTX/PM patients had a higher odds of mortality (adjusted odds ratio [95%CI]: 3.37 [1.61-7.07]) and longer mean LOS (percent change [95%CI]: 39 [9-77]) than controls. Conclusion In COVID-19 patients with similar severity, PTX/PM patients had more underlying lung disease and lower BMI. They had significantly increased mortality and LOS.
Collapse
Affiliation(s)
- Aysun Tekin
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Anusha Devarajan
- Division of Pulmonary, Department of Medicine and Department of Critical Care Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Kenneth K. Sakata
- Division of Pulmonary, Department of Medicine and Department of Critical Care Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Shahraz Qamar
- Post-Baccalaureate Research Education Program, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Mayank Sharma
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | - Fahimeh Talaei
- Division of Pulmonary, Department of Medicine and Department of Critical Care Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Stephanie Welle
- Division of Critical Care Medicine, Mayo Clinic Health System, Mankato, MN, USA
| | - Jamil Taji
- Division of Pulmonary Medicine, Division of Critical Care Medicine, Mayo Clinic Health Systems, Mankato, MN, USA
| | - Sandeep Khosa
- Division of Pulmonary Medicine, Division of Critical Care Medicine, Mayo Clinic Health Systems, Mankato, MN, USA
| | - Nikhil Sharma
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Meghan Brown
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amos Lal
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Vikas Bansal
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Syed Anjum Khan
- Division of Critical Care Medicine, Mayo Clinic Health System, Mankato, MN, USA
| | - Abigail T. La Nou
- Division of Critical Care Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Devang Sanghavi
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Rodrigo Cartin-Ceba
- Division of Pulmonary, Department of Medicine and Department of Critical Care Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Rahul Kashyap
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Research, WellSpan Health, York, PA, USA
| | - Ognjen Gajic
- Division of Critical Care Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Juan P. Domecq
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Natalya Azadeh
- Division of Pulmonary, Department of Medicine and Department of Critical Care Medicine, Mayo Clinic, Scottsdale, AZ, USA
| |
Collapse
|
281
|
Jeong YH, Lim SK, Cho Y, Kim YJ, Jang HJ, Cho YH, Shin Y, Jung JS, Kang JK, Cho SM, Lee JH. Neuron-Specific Enolase as a Predictor of Neurologic Outcomes in Extracorporeal Cardiopulmonary Resuscitation Patients. J Clin Med 2024; 13:4135. [PMID: 39064175 PMCID: PMC11277770 DOI: 10.3390/jcm13144135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 07/12/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Neuron-specific enolase (NSE) has traditionally been used as a biomarker to predict neurologic outcomes after cardiac arrest. This study aimed to evaluate the utility of NSE in predicting neurologic outcomes in patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR). Methods: This observational cohort study included 47 consecutive adult ECPR patients (median age, 59.0 years; 74.5% males) treated between January 2018 and December 2021 at a tertiary extracorporeal life support center. The primary outcome was a poor neurologic outcome, defined as a Cerebral Performance Category score of 3-5 at hospital discharge. Results: Twelve (25.5%) patients had abnormal findings on computed tomography of the brain. A poor neurologic outcome was demonstrated in 22 (46.8%) patients. The NSE level at 72 h after ECPR showed the best prediction power for a poor neurologic outcome compared with NSE at 24 and 48 h. A cutoff value exceeding 61.9 μg/L for NSE at 72 h yielded an area under the curve (AUC) of 0.791 for predicting poor neurologic outcomes and exceeding 62.1 μg/L with an AUC of 0.838 for 30-day mortality. Conclusions: NSE levels at 72 h after ECPR appear to be a reliable biomarker for predicting poor neurologic outcomes and 30-day mortality in ECPR patients.
Collapse
Affiliation(s)
- Yong Ho Jeong
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea;
| | - Suk Kyung Lim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul 06351, Republic of Korea; (S.K.L.); (Y.H.C.)
| | - Yongil Cho
- Department of Emergency Medicine, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul 04763, Republic of Korea;
| | - Yun Jin Kim
- Department of Medicine, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea;
- Biostatistics Lab, Medical Research Collaborating Center, Hanyang University, Seoul 04763, Republic of Korea
| | - Hyo Jun Jang
- Department of Thoracic and Cardiovascular Surgery, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul 04763, Republic of Korea;
| | - Yang Hyun Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul 06351, Republic of Korea; (S.K.L.); (Y.H.C.)
| | - Yonghoon Shin
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea; (Y.S.); (J.S.J.)
| | - Jae Seung Jung
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea; (Y.S.); (J.S.J.)
| | - Jin Kook Kang
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA;
| | - Sung-Min Cho
- Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Jun Ho Lee
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea; (Y.S.); (J.S.J.)
| |
Collapse
|
282
|
Li C, Zhang J, Yang P, Wang R, Chen T, Li L. The role of polymyxin B-immobilized hemoperfusion in reducing mortality and enhancing hemodynamics in patients with sepsis and septic shock: A systematic review and meta-analysis. Heliyon 2024; 10:e33735. [PMID: 39040355 PMCID: PMC11261863 DOI: 10.1016/j.heliyon.2024.e33735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 05/17/2024] [Accepted: 06/26/2024] [Indexed: 07/24/2024] Open
Abstract
Purpose Polymyxin B-immobilized hemoperfusion (PMX-HP) is a therapeutic strategy for removing circulating endotoxins from patients with sepsis or septic shock. However, the survival advantage of PMX-HP treatment remains controversial for patients with sepsis/septic shock. Therefore, this study collected all the clinical trials to assess the effect and the safety of PMX-HP treatment. Methods PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for eligible trials fromtheir inception through June 30, 2023. All clinical trials that investigated the effect of polymyxin B hemoperfusion in patients who died with sepsis or septic shock within 28-day mortality were eligible. The Cochrane Risk of Bias Assessment instrument and the ROBINS-I tool were used to assess the risk of bias. Results A total of 30 trials, including 25680 adult patients, were included. PMX-HP decreased 28-day mortality (OR 0.75, 95 % CI 0.65-0.88; p<0.00001). Subgroup analysis revealed that 28-day mortality was significantly reduced after PMX-HP treatment in the mixed infection site group and in the age under 70 years old group. PMX-HP might also lower endotoxin levels (MD -1.22, 95 % CI -1.62 - 0.81, p < 0.00001) and improve SOFA scores (MD -2.11, 95 % CI -3.80- 0.43, p = 0.01). PMX-HP was not linked to the development of significant adverse events (p = 0. 05). Conclusion Our findings suggest that PMX-HP therapy can reduce 28-day mortality in individuals with sepsis or septic shock. The therapeutic effect may be due to the ability of PMX-HP to lower endotoxin levels and enhance hemodynamics. However, further assessment of the clinical effects of PMX-HP on sepsis or septic shock is required.
Collapse
Affiliation(s)
- Chao Li
- Department of Clinical Pharmacy, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinlian Zhang
- Department of Clinical Pharmacy, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ping Yang
- Department of Clinical Pharmacy, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ranran Wang
- Department of Clinical Pharmacy, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ting Chen
- Department of Clinical Pharmacy, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lixia Li
- Department of Clinical Pharmacy, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
283
|
Capoccia M, Brewer JM, Rackauskas M, Becker TK, Maybauer DM, Stukov Y, Lorusso R, Maybauer MO. Outcome of Veno-Pulmonary Extracorporeal Life Support in Lung Transplantation Using ProtekDuo Cannula: A Systematic Review and Description of Configurations. J Clin Med 2024; 13:4111. [PMID: 39064150 PMCID: PMC11277848 DOI: 10.3390/jcm13144111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 06/29/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Refractory end-stage pulmonary failure may benefit from extracorporeal life support (ECLS) as a bridge to lung transplantation. Veno-venous (VV) extracorporeal membrane oxygenation (ECMO) has been recommended for patients who have failed conventional medical therapy and mechanical ventilation. Veno-arterial (VA) ECMO may be used in patients with acute right ventricular (RV) failure, haemodynamic instability, or refractory respiratory failure. Peripheral percutaneous approaches, either dual-site single-lumen cannulation for veno-pulmonary (VP) ECMO or single-site dual-lumen (dl)VP ECMO, using the ProtekDuo right ventricular assist device (RVAD) cannula, has made this configuration a desirable option as a bridge to transplantation. These configurations support the right ventricle, prevent recirculation by placing the tricuspid and pulmonary valve between the drainage and return cannulas, provide the direct introduction of oxygenated blood into the pulmonary artery, and have been shown to decrease the incidence of acute kidney injury (AKI), requiring continuous renal replacement therapy (CRRT) in certain disease states. This promotes haemodynamic stability, potential sedation-weaning trials, extubation, mobilisation, and pre-transplant rehabilitation. Methods: A web-based literature search in PubMed and EMBASE was undertaken based on a combination of keywords. The PICOS and PRISMA approaches were used. Results: Four case series were identified out of 323 articles, with a total of 34 patients placed on VP ECMO as a bridge to lung transplantation. All relevant data are reviewed and integrated into the Discussion. Conclusions: Despite the limited available evidence, the use of ProtekDuo has become very promising for the management of end-stage lung disease as a bridge to lung transplantation.
Collapse
Affiliation(s)
- Massimo Capoccia
- South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU, UK
| | - Joseph M. Brewer
- Nazih Zuhdi Transplant Institute, Specialty Critical Care and Acute Circulatory Support Service, INTEGRIS Baptist Medical Center, Oklahoma City, OK 73112, USA;
- Queen’s University Health Quality Programs, Kingston, ON K7L 3N6, Canada
| | - Mindaugas Rackauskas
- Department of Surgery, Division of Thoracic Surgery, University of Florida College of Medicine, Gainesville, FL 32610, USA; (M.R.); (Y.S.)
| | - Torben K. Becker
- Department of Emergency Medicine, Division of Critical Care Medicine, University of Florida College of Medicine, Gainesville, FL 32610, USA;
| | - Dirk M. Maybauer
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University, 35032 Marburg, Germany;
| | - Yuriy Stukov
- Department of Surgery, Division of Thoracic Surgery, University of Florida College of Medicine, Gainesville, FL 32610, USA; (M.R.); (Y.S.)
| | - Roberto Lorusso
- Extracorporeal Life Support (ECLS) Centrum, Cardio-Thoracic Surgery and Cardiology Department, Heart & Vascular Center, Maastricht University Medical Center (MUMC), 6229 ER Maastricht, The Netherlands;
- Cardiovascular Research Institute (CARIM), 6229 ER Maastricht, The Netherlands
| | - Marc O. Maybauer
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University, 35032 Marburg, Germany;
- Department of Anesthesiology, Division of Critical Care Medicine, University of Florida College of Medicine, Gainesville, FL 32610, USA
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Brisbane 4032, Australia
| |
Collapse
|
284
|
Vlachakis PK, Theofilis P, Leontsinis I, Drakopoulou M, Karakasis P, Oikonomou E, Chrysohoou C, Tsioufis K, Tousoulis D. Bridge to Life: Current Landscape of Temporary Mechanical Circulatory Support in Heart-Failure-Related Cardiogenic Shock. J Clin Med 2024; 13:4120. [PMID: 39064160 PMCID: PMC11277937 DOI: 10.3390/jcm13144120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 07/02/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
Acute heart failure (HF) presents a significant mortality burden, necessitating continuous therapeutic advancements. Temporary mechanical circulatory support (MCS) is crucial in managing cardiogenic shock (CS) secondary to acute HF, serving as a bridge to recovery or durable support. Currently, MCS options include the Intra-Aortic Balloon Pump (IABP), TandemHeart (TH), Impella, and Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO), each offering unique benefits and risks tailored to patient-specific factors and clinical scenarios. This review examines the clinical implications of recent advancements in temporary MCS, identifies knowledge gaps, and explores promising avenues for future research and clinical application. Understanding each device's unique attributes is crucial for their efficient implementation in various clinical scenarios, ultimately advancing towards intelligent, personalized support strategies.
Collapse
Affiliation(s)
- Panayotis K. Vlachakis
- 1st Department of Cardiology, “Hippokration” General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.K.V.); (I.L.); (M.D.); (C.C.); (K.T.); (D.T.)
| | - Panagiotis Theofilis
- 1st Department of Cardiology, “Hippokration” General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.K.V.); (I.L.); (M.D.); (C.C.); (K.T.); (D.T.)
| | - Ioannis Leontsinis
- 1st Department of Cardiology, “Hippokration” General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.K.V.); (I.L.); (M.D.); (C.C.); (K.T.); (D.T.)
| | - Maria Drakopoulou
- 1st Department of Cardiology, “Hippokration” General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.K.V.); (I.L.); (M.D.); (C.C.); (K.T.); (D.T.)
| | - Paschalis Karakasis
- 2nd Department of Cardiology, “Hippokration” General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece;
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, Thoracic Diseases General Hospital “Sotiria”, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Christina Chrysohoou
- 1st Department of Cardiology, “Hippokration” General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.K.V.); (I.L.); (M.D.); (C.C.); (K.T.); (D.T.)
| | - Konstantinos Tsioufis
- 1st Department of Cardiology, “Hippokration” General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.K.V.); (I.L.); (M.D.); (C.C.); (K.T.); (D.T.)
| | - Dimitris Tousoulis
- 1st Department of Cardiology, “Hippokration” General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.K.V.); (I.L.); (M.D.); (C.C.); (K.T.); (D.T.)
| |
Collapse
|
285
|
White AJ, Kelly-Hedrick M, Miranda SP, Abdelbarr MM, Lázaro-Muñoz G, Pouratian N, Shen F, Nahed BV, Williamson T. Bioethics and Neurosurgery: An Overview of Existing and Emerging Topics for the Practicing Neurosurgeon. World Neurosurg 2024; 190:181-186. [PMID: 39004179 DOI: 10.1016/j.wneu.2024.07.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 07/05/2024] [Indexed: 07/16/2024]
Abstract
Neurosurgery is a field with complex ethical issues. In this article, we aim to provide an overview of key and emerging ethical issues in neurosurgery with a focus on issues relevant to practicing neurosurgeons. These issues include those of informed consent, capacity, clinical trials, emerging neurotechnology, innovation, equity and justice, and emerging bioethics areas including community engagement and organizational ethics. We argue that bioethics can help neurosurgeons think about and address these issues, and, in turn, the field of bioethics can benefit from engagement by neurosurgeons. Several ideas for increasing engagement in bioethics are proposed.
Collapse
Affiliation(s)
- Alexandra J White
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Margot Kelly-Hedrick
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
| | - Stephen P Miranda
- Department of Neurosurgery, University of Pennsylvania, Pennsylvania, Pennsylvania, USA
| | | | | | - Nader Pouratian
- Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas, USA
| | - Francis Shen
- Center for Bioethics, Harvard Medical School, Boston, Massachusetts, USA; Harvard Law School, Cambridge, Massachusetts, USA
| | - Brian V Nahed
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Theresa Williamson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
286
|
Cui Z, Liu X, Qu H, Wang H. Technical Principles and Clinical Applications of Electrical Impedance Tomography in Pulmonary Monitoring. SENSORS (BASEL, SWITZERLAND) 2024; 24:4539. [PMID: 39065936 PMCID: PMC11281055 DOI: 10.3390/s24144539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 06/11/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024]
Abstract
Pulmonary monitoring is crucial for the diagnosis and management of respiratory conditions, especially after the epidemic of coronavirus disease. Electrical impedance tomography (EIT) is an alternative non-radioactive tomographic imaging tool for monitoring pulmonary conditions. This review proffers the current EIT technical principles and applications on pulmonary monitoring, which gives a comprehensive summary of EIT applied on the chest and encourages its extensive usage to clinical physicians. The technical principles involving EIT instrumentations and image reconstruction algorithms are explained in detail, and the conditional selection is recommended based on clinical application scenarios. For applications, specifically, the monitoring of ventilation/perfusion (V/Q) is one of the most developed EIT applications. The matching correlation of V/Q could indicate many pulmonary diseases, e.g., the acute respiratory distress syndrome, pneumothorax, pulmonary embolism, and pulmonary edema. Several recently emerging applications like lung transplantation are also briefly introduced as supplementary applications that have potential and are about to be developed in the future. In addition, the limitations, disadvantages, and developing trends of EIT are discussed, indicating that EIT will still be in a long-term development stage before large-scale clinical applications.
Collapse
Affiliation(s)
- Ziqiang Cui
- School of Electrical and Information Engineering, Tianjin University, Tianjin 300072, China; (X.L.); (H.Q.); (H.W.)
| | | | | | | |
Collapse
|
287
|
Shandera WX. COVID-19 ethics: unique aspects and a review as of early 2024. Monash Bioeth Rev 2024:10.1007/s40592-024-00199-x. [PMID: 39003388 DOI: 10.1007/s40592-024-00199-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 07/15/2024]
Abstract
COVID-19 presents a variety of ethical challenges in a set of arenas, arenas not always considered in past pandemics. These challenges include issues related to autonomy, distributive ethics, and the establishment of policies of equity and justice. Methods are a literature review based on regular editing of an online textbook during the COVID-19 outbreak and a literature review using key ethical terms. Patients are confronted with new issues related to autonomy. Providers need to expand their concepts of ethical issues to include decisions based on proportionality and public health ethics. The public health sector needs to assess the beneficence of alternative modes of disease control. The research community needs to redefine the concept of informed consent in emergent conditions. All elements of the medical spectrum-physicians, scientists, and the community-at-large including the pharmaceutical industry-need to consider the multifaceted methods for preventing future pandemics. This will require giving particular emphasis to public health funding and ending the documented discrimination that exists in the provision of proven therapies. The developing world is especially at risk for most of the ethical issues, especially those related to equity and justice. The ethical issues associated with the COVID-19 outbreak are not unique but provide a diverse set of issues that apply to patients, providers, social groups, and investigators. The further study of such issues can help with preventing future outbreaks.
Collapse
|
288
|
Isha S, Balasubramanian P, Raavi L, Hanson AJ, Jenkins A, Satashia P, Balavenkataraman A, Huespe IA, Tekin A, Bansal V, Caples SM, Khan SA, Jain NK, LaNou AT, Kashyap R, Cartin-Ceba R, Patel BM, Farres H, Helgeson SA, Milian RD, Venegas CP, Waldron N, Shapiro AB, Bhattacharyya A, Chaudhary S, Kiley SP, Erben YM, Quinones QJ, Patel NM, Guru PK, Franco PM, Sanghavi DK. Association Of Estimated Plasma Volume with New Onset Acute Kidney Injury in Hospitalized COVID-19 Patients. Am J Med Sci 2024:S0002-9629(24)01353-3. [PMID: 39004280 DOI: 10.1016/j.amjms.2024.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 07/08/2024] [Accepted: 07/09/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE To explore the association of estimated plasma volume (ePV) and plasma volume status (PVS) as surrogates of volume status with new-onset AKI and in-hospital mortality among hospitalized COVID-19 patients. MATERIALS AND METHODS We performed a retrospective multi-center study on COVID-19-related ARDS patients who were admitted to the Mayo Clinic Enterprise health system. Plasma volume was calculated using the formulae for ePV and PVS, and longitudinal analysis was performed to find the association of ePV and PVS with new-onset AKI during hospitalization as the primary outcome and in-hospital mortality as a secondary outcome. RESULTS Our analysis included 7616 COVID-19 patients with new-onset AKI occurring in 1365 (17.9%) and a mortality rate of 25.96% among them. A longitudinal multilevel multivariate analysis showed both ePV (OR 1.162; 95% CI 1.048-1.288, p=0.004) and PVS (OR 1.032; 95% CI 1.012-1.050, p=0.001) were independent predictors of new onset AKI. Higher PVS was independently associated with increased in-hospital mortality (OR 1.038, 95% CI 1.007-1.070, p=0.017), but not ePV (OR 0.868, 95% CI 0.740-1.018, p=0.082). CONCLUSION A higher PVS correlated with a higher incidence of new-onset AKI and worse outcomes in our cohort of hospitalized COVID-19 patients. Further large-scale and prospective studies are needed to understand its utility.
Collapse
Affiliation(s)
- Shahin Isha
- Department of Critical Care Medicine, Mayo Clinic in Florida, 4500 San Pablo Rd S, Jacksonville, FL32224.
| | - Prasanth Balasubramanian
- Department of Critical Care Medicine, Department of Pulmonary and Critical Care, Mayo Clinic in Florida, 4500 San Pablo Rd S, Jacksonville, FL32224.
| | - Lekhya Raavi
- Department of Critical Care Medicine, Mayo Clinic in Florida, 4500 San Pablo Rd S, Jacksonville, FL32224.
| | - Abby J Hanson
- Department of Critical Care Medicine, Mayo Clinic in Florida, 4500 San Pablo Rd S, Jacksonville, FL32224.
| | - Anna Jenkins
- Department of Critical Care Medicine, Mayo Clinic in Florida, 4500 San Pablo Rd S, Jacksonville, FL32224.
| | - Parthkumar Satashia
- Department of Critical Care Medicine, Mayo Clinic in Florida, 4500 San Pablo Rd S, Jacksonville, FL32224.
| | - Arvind Balavenkataraman
- Department of Critical Care Medicine, Department of Pulmonary and Critical Care, Mayo Clinic in Florida, 4500 San Pablo Rd S, Jacksonville, FL32224.
| | - Iván A Huespe
- Department of Critical Care Medicine, Hospital Italiano de Buenos Aires, Argentina, Gascon 450 1181.
| | - Aysun Tekin
- Department of Critical Care Medicine, Mayo Clinic in Rochester, Minnesota, MN 55905.
| | - Vikas Bansal
- Department of Critical Care Medicine, Mayo Clinic in Rochester, Minnesota, MN 55905.
| | - Sean M Caples
- Department of Critical Care Medicine, Department of Pulmonary and Critical Care, Mayo Clinic in Rochester, Minnesota, MN 55905.
| | - Syed Anjum Khan
- Department of Critical Care Medicine, Mayo Clinic Health System in Mankato, Minnesota, MN 56003.
| | - Nitesh K Jain
- Department of Critical Care Medicine, Mayo Clinic Health System in Mankato, Minnesota, MN 56003.
| | - Abigail T LaNou
- Department of Emergency Medicine and Critical Care, Mayo Clinic Health System, Eau Claire, Wisconsin, WI 54703.
| | - Rahul Kashyap
- Department of Anesthesia and Critical Care Medicine, Mayo Clinic in Rochester, Minnesota, MN 55905.
| | - Rodrigo Cartin-Ceba
- Department of Critical Care Medicine, Mayo Clinic in Arizona, Phoenix, AZ 85054.
| | - Bhavesh M Patel
- Department of Critical Care Medicine, Mayo Clinic in Arizona, Phoenix, AZ 85054.
| | - Houssam Farres
- Department of Surgery, Division of Vascular Surgery, Mayo Clinic in Florida, 4500 San Pablo Rd S, Jacksonville, FL32224.
| | - Scott A Helgeson
- Department of Critical Care Medicine, Department of Pulmonary and Critical Care, Mayo Clinic in Florida, 4500 San Pablo Rd S, Jacksonville, FL32224.
| | - Ricardo Diaz Milian
- Department of Critical Care Medicine, Mayo Clinic in Florida, 4500 San Pablo Rd S, Jacksonville, FL32224.
| | - Carla P Venegas
- Department of Critical Care Medicine, Mayo Clinic in Florida, 4500 San Pablo Rd S, Jacksonville, FL32224.
| | - Nathan Waldron
- Department of Critical Care Medicine, Mayo Clinic in Florida, 4500 San Pablo Rd S, Jacksonville, FL32224.
| | - Anna B Shapiro
- Department of Critical Care Medicine, Mayo Clinic in Florida, 4500 San Pablo Rd S, Jacksonville, FL32224.
| | - Anirban Bhattacharyya
- Department of Critical Care Medicine, Mayo Clinic in Florida, 4500 San Pablo Rd S, Jacksonville, FL32224.
| | - Sanjay Chaudhary
- Department of Critical Care Medicine, Mayo Clinic in Florida, 4500 San Pablo Rd S, Jacksonville, FL32224.
| | - Sean P Kiley
- Department of Critical Care Medicine, Mayo Clinic in Florida, 4500 San Pablo Rd S, Jacksonville, FL32224.
| | - Young M Erben
- Division of Vascular and Endovascular Surgery, Mayo Clinic in Florida, 4500 San Pablo Rd S, Jacksonville, FL32224.
| | - Quintin J Quinones
- Department of Critical Care Medicine, Mayo Clinic in Florida, 4500 San Pablo Rd S, Jacksonville, FL32224.
| | - Neal M Patel
- Department of Critical Care Medicine, Mayo Clinic in Florida, 4500 San Pablo Rd S, Jacksonville, FL32224.
| | - Pramod K Guru
- Department of Critical Care Medicine, Mayo Clinic in Florida, 4500 San Pablo Rd S, Jacksonville, FL32224.
| | - Pablo Moreno Franco
- Department of Critical Care Medicine, Mayo Clinic in Florida, 4500 San Pablo Rd S, Jacksonville, FL32224.
| | - Devang K Sanghavi
- Department of Critical Care Medicine, Mayo Clinic in Florida, 4500 San Pablo Rd S, Jacksonville, FL32224.
| |
Collapse
|
289
|
Moll V, Khanna AK, Kurz A, Huang J, Smit M, Swaminathan M, Minear S, Parr KG, Prabhakar A, Zhao M, Malbrain MLNG. Optimization of kidney function in cardiac surgery patients with intra-abdominal hypertension: expert opinion. Perioper Med (Lond) 2024; 13:72. [PMID: 38997752 PMCID: PMC11245849 DOI: 10.1186/s13741-024-00416-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 06/09/2024] [Indexed: 07/14/2024] Open
Abstract
Cardiac surgery-associated acute kidney injury (CSA-AKI) affects up to 42% of cardiac surgery patients. CSA-AKI is multifactorial, with low abdominal perfusion pressure often overlooked. Abdominal perfusion pressure is calculated as mean arterial pressure minus intra-abdominal pressure (IAP). IAH decreases cardiac output and compresses the renal vasculature and renal parenchyma. Recent studies have highlighted the frequent occurrence of IAH in cardiac surgery patients and have linked the role of low perfusion pressure to the occurrence of AKI. This review and expert opinion illustrate current evidence on the pathophysiology, diagnosis, and therapy of IAH and ACS in the context of AKI.
Collapse
Affiliation(s)
- Vanessa Moll
- Department of Anesthesiology, Division of Critical Care Medicine, University of Minnesota, Minneapolis, MN, USA
- Department of Anesthesiology, Division of Critical Care Medicine, Emory School of Medicine, Atlanta, GA, USA
| | - Ashish K Khanna
- Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
- Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA
- Outcomes Research Consortium, Cleveland, OH, USA
| | - Andrea Kurz
- Departments of General Anesthesiology and Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Anesthesiology, Emergency Medicine and Intensive Care Medicine, Medical University Graz, Graz, Austria
| | - Jiapeng Huang
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USA
| | - Marije Smit
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Madhav Swaminathan
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Steven Minear
- Department of Anesthesiology, Cleveland Clinic Florida, Weston Hospital, Weston, FL, USA
| | - K Gage Parr
- Department of Anesthesiology and Critical Care Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Amit Prabhakar
- Department of Anesthesiology, Division of Critical Care Medicine, Emory School of Medicine, Atlanta, GA, USA
| | - Manxu Zhao
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Manu L N G Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University Lublin, Lublin, Poland.
- Medical Data Management, Medaman, Geel, Belgium.
- International Fluid Academy, Lovenjoel, Belgium.
| |
Collapse
|
290
|
Chen J, Liang S, Wei M, Ma Y, Bi T, Liu Z, Song Y, Chen H, Wang Y. Trace of delirium after robotic lower abdominal tumor resection at different end-tidal carbon dioxide: a RCT trial. BMC Anesthesiol 2024; 24:234. [PMID: 38997624 PMCID: PMC11241950 DOI: 10.1186/s12871-024-02617-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 07/01/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Postoperative delirium (POD) often occurs in oncology patients, further increasing the medical and financial burden. Robotic technology in lower abdominal tumors resection reduces surgical trauma but increases risks such as carbon dioxide (CO2) absorption. This study aimed to investigate the differences in their occurrence of POD at different end-tidal CO2 levels. METHOD This study was approved by the Ethics Committee of Affiliated Hospital of He Bei University (HDFY-LL-2022-169). The study was registered with the Chinese Clinical Trials Registry on URL: http://www.chictr.org.cn , Registry Number: ChiCTR2200056019 (Registry Date: 27/08/2022). In patients scheduled robotic lower abdominal tumor resection from September 1, 2022 to December 31, 2022, a comprehensive delirium assessment was performed three days postoperatively using the CAM scale with clinical review records. Intraoperative administration of different etCO2 was performed depending on the randomized grouping after intubation. Group L received lower level etCO2 management (31-40mmHg), and Group H maintained the higher level(41-50mmHg) during pneumoperitoneum. Data were analyzed using Pearson Chi-Square or Wilcoxon Rank Sum tests and multiple logistic regression. Preoperative mental status score, alcohol impairment score, nicotine dependence score, history of hypertension and diabetes, duration of surgery and worst pain score were included in the regression model along with basic patient information for covariate correction analysis. RESULTS Among the 103 enrolled patients, 19 (18.4%) developed postoperative delirium. The incidence of delirium in different etCO2 groups was 21.6% in Group L and 15.4% in Group H, respectively, with no statistical differences. In adjusted multivariate analysis, age and during of surgery were statistically significant predictors of postoperative delirium. The breath-hold test was significantly lower postoperatively, but no statistical differences were found between two groups. CONCLUSION With robotic assistant, the incidence of postoperative delirium in patients undergoing lower abdominal tumor resection was not modified by different end-tidal carbon dioxide management, however, age and duration of surgery were positively associated risk factors.
Collapse
Affiliation(s)
- Jingwen Chen
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Si Liang
- Department of Anesthesiology, Affiliated Hospital of He Bei University, Baoding, 071000, China
- Clinical Medical College, Hebei University, Baoding, 071000, China
| | - Ming Wei
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Yue Ma
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Tianpeng Bi
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Zheng Liu
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Yang Song
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Hong Chen
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China.
| | - Yu Wang
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China.
| |
Collapse
|
291
|
Samuelsen A, Lehman E, Burrows P, Bonavia AS. Time-Dependent Variation in Immunoparalysis Biomarkers Among Patients with Sepsis and Critical Illness. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.07.11.24310285. [PMID: 39040186 PMCID: PMC11261946 DOI: 10.1101/2024.07.11.24310285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
Immunoparalysis is a significant concern in patients with sepsis and critical illness, potentially leading to increased risk of secondary infections. This study aimed to perform a longitudinal assessment of immune function over the initial two weeks following the onset of sepsis and critical illness. We compared ex vivo stimulated cytokine release to traditional markers of immunoparalysis, including monocyte Human Leukocyte Antigen (mHLA)-DR expression and absolute lymphocyte count (ALC). A total of 64 critically ill patients were recruited in a tertiary care academic medical setting, including 31 septic and 33 non-septic patients. Results showed that while mHLA-DR expression significantly increased over time, this was primarily driven by the non-septic subset of critically ill patients. ALC recovery was more prominent in septic patients. Ex vivo stimulation revealed significant increases in TNF and IL-6 production over time in septic patients. However, IFNγ production varied with the stimulant used and did not show significant recovery when normalized to cell count. No significant correlation was found between mHLA-DR expression and other immunoparalysis biomarkers. These findings suggest the need for more nuanced immune monitoring approaches beyond the traditional 'sepsis' versus 'non-sepsis' classifications in critically ill patients. It also provided further evidence of a potential window for targeted immunotherapeutic interventions in the first week of critical illness.
Collapse
Affiliation(s)
- Abigail Samuelsen
- Department of Anesthesiology and Perioperative Medicine, Penn State Hershey Medical Center, Hershey, PA 17033
| | - Erik Lehman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA 17033
| | - Parker Burrows
- Department of Anesthesiology and Perioperative Medicine, Penn State Hershey Medical Center, Hershey, PA 17033
| | - Anthony S Bonavia
- Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Medicine, Penn State Hershey Medical Center, Hershey, PA 17033
| |
Collapse
|
292
|
Mazraeh A, Azaran A, Shalilahmadi D, Jalilian S, Hesam S. Prevalence of COVID-19 neurological manifestations in patients referred to the Golestan Hospital in Ahvaz between March 2020 to the March 2023. Front Neurol 2024; 15:1413628. [PMID: 39055314 PMCID: PMC11269145 DOI: 10.3389/fneur.2024.1413628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 07/01/2024] [Indexed: 07/27/2024] Open
Abstract
Due to the abundance of ACE2 receptors in nervous system cells, the SARS-CoV-2 virus can cause damage to this system. This study aims to examine the prevalence of neurological symptoms in COVID-19 patients. In this cross-sectional observational study, 75 COVID-19 positive patients admitted to Golestan Hospital's neurology department in Ahvaz, Iran, from March 2020 to March 2023, were investigated. Neurological clinical symptoms were categorized into three groups: central nervous system, peripheral, and muscular symptoms. The relevant information was collected from patient files, including medical history, imaging data, and laboratory test results. Statistical analysis was performed using SPSS software, employing the rank-biserial correlation coefficient (r), Mann-Whitney U tests, Phi correlation, Cramer's V, and Kendall's Tau to evaluate the prevalence and significance of neurological symptoms. The most common clinical symptoms observed were hemiparesis, dysarthria, Central Facial Palsy (CFP), ataxia, and nausea, respectively. Among these symptoms, headaches (p = 0.001), seizures (p = 0.024), and nausea (p = 0.046) were found to be more prevalent in younger patients. Additionally, a significant relationship was identified between the level of serum Creatine phosphokinase (CPK) and seizures (p = 0.024), with lower levels observed in individuals with vomiting (p = 0.024), and higher levels observed in individuals with CFP (p = 0.040). This study highlights that patients with COVID-19 may experience serious neurological symptoms. The clinical spectrum and range of neurological symptoms associated with COVID-19 were found to be diverse and extensive, emphasizing the importance of considering this infection as a potential cause of neurological disorders.
Collapse
Affiliation(s)
- Alireza Mazraeh
- Department of Medical Virology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Azarakhsh Azaran
- Department of Medical Virology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Davood Shalilahmadi
- Department of Neurology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Shahram Jalilian
- Department of Medical Virology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saeed Hesam
- Department of Biostatistics and Epidemiology, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| |
Collapse
|
293
|
Gambadoro G, Kopp BJ, Erstad BL. Implications of opioid-sparing medications in critically ill patients: A scoping review. Med Intensiva 2024:S2173-5727(24)00174-7. [PMID: 38997907 DOI: 10.1016/j.medine.2024.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 06/10/2024] [Indexed: 07/14/2024]
Abstract
OBJECTIVE The purpose of this scoping review was to evaluate literature involving opioid-sparing medications in critically ill patients with a focus on clinically meaningful outcomes. DESIGN Scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. SETTING Intensive care unit. PATIENTS OR PARTICIPANTS Adult patients in an intensive care unit setting. INTERVENTIONS None. MAIN VARIABLES OF INTEREST PubMed and Cochrane Library were searched from October 1, 2019 to June 1, 2023. Inclusion criteria consisted of randomized controlled trials evaluating adjunctive analgesic use in adult patients in an intensive care unit setting. RESULTS There were 343 citations and titles identified in the initial search, with 328 remaining after removal of duplicates, 294 excluded at title and abstract screening, 34 available for full text review, and six included in the scoping review. Most studies reported modest reductions in opioid use as a secondary endpoint. Improvement in clinical outcomes such as reduction in duration of mechanical ventilation or delirium were reported in two trials with dexmedetomidine. CONCLUSIONS In recently published trials of adjunctive agents in critically ill patients, opioid-sparing effects were small. Data to support improvements in clinical outcomes remains limited.
Collapse
Affiliation(s)
- Gabriella Gambadoro
- Critical Care Pharmacist, Banner - University Medical Center, 1625 N. Campbell Avenue, Tucson, AZ, 85719, USA
| | - Brian J Kopp
- Clinical Pharmacy Specialist, Surgical-Trauma ICU, Banner - University Medical Center, 1625 N. Campbell Avenue, Tucson, AZ, 85719, USA
| | - Brian L Erstad
- Department of Pharmacy Practice & Science, University of Arizona R. Ken Coit College of Pharmacy, Tucson, AZ, 85721, USA.
| |
Collapse
|
294
|
Min DD, Min JH. Pregnancy-related and Neonatal Outcomes during Omicron Variant-Dominant COVID-19 Pandemic among the Black-Dominant Population. Am J Perinatol 2024. [PMID: 38889887 DOI: 10.1055/a-2347-3608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
OBJECTIVE This study aimed to determine the effect of the Omicron variant on pregnancy-related and neonatal outcomes among the Black-dominant population. STUDY DESIGN We performed a single-center, retrospective cohort study during the prepandemic period from December 1, 2019, to February 29, 2020, and the Omicron surging period from December 1, 2021, to February 28, 2022. A total of 518 pregnant women were admitted for delivery during the study period. Multiple gestations (n = 21) and deliveries at less than 20 weeks of gestation (n = 5) were excluded. We analyzed and compared the sociodemographic and clinical data from mothers and their neonates between the two cohorts as well as between severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) positive and negative mothers during the Omicron surge. Subgroup analyses were also conducted specifically among the Black-only population. RESULTS The cohorts were predominantly Black (88.6%), with smaller proportions of Hispanic (8.9%), Asian (0.8%), White (0.8%), and other ethnicities (0.8%). Of 492 singleton deliveries, 275 live births, 8 (2.8%) stillbirths, and 31 (11.3%) preterm births (PTBs) occurred during the prepandemic period, and 207 live births, 2 (1%) stillbirths, and 33 (15.9%) PTBs occurred during the Omicron wave. There was no statistically significant difference in the rates of PTBs, stillbirths, medically indicated PTBs, and cesarean delivery between the two cohorts. SARS-CoV-2-positive mothers were not at an increased risk of adverse outcomes. However, neonatal intensive care unit (NICU) admission rate significantly increased among neonates born to SARS-CoV-2 positive mothers compared with negative mothers (32.3 vs. 16.5%, p = 0.038). In subgroup analyses among Black individuals, this difference was not observed. CONCLUSION There was no significant difference in pregnancy-related or neonatal outcomes in the Black-dominant population between the two cohorts. SARS-CoV-2 infection did not alter these findings except for an increased NICU admission rate among neonates born to SARS-CoV-2-positive mothers. KEY POINTS · Most pregnant women infected with SARS-CoV-2 during the Omicron wave were asymptomatic.. · The Omicron wave did not increase the risk of pregnancy-related or neonatal adverse outcomes when compared with the prepandemic period.. · Maternal SARS-CoV-2 infection increased NICU admission rate.. · Among Black individuals, no significant increase in adverse outcomes was observed during the Omicron pandemic..
Collapse
Affiliation(s)
- Daniel D Min
- Department of Pediatrics, State University of New York Downstate Health Sciences University, Brooklyn, New York
| | - Jae H Min
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, State University of New York Downstate Health Sciences University, Brooklyn, New York
| |
Collapse
|
295
|
Hasegawa D, Sato R, Lee YI, Wang HY, Nishida K, Steiger D. The prevalence, risk factors, and outcomes of acute pulmonary embolism complicating sepsis and septic shock: a national inpatient sample analysis. Sci Rep 2024; 14:16049. [PMID: 38992133 PMCID: PMC11239923 DOI: 10.1038/s41598-024-67105-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 07/08/2024] [Indexed: 07/13/2024] Open
Abstract
The study aimed to evaluate the prevalence, risk factors, and clinical outcomes of pulmonary embolism in patients diagnosed with sepsis with and without shock. The National Inpatient Sample was used to identify adults with sepsis with and without shock between 2017 and 2019. The prevalence of acute pulmonary embolism and the association of acute pulmonary embolism with in-hospital mortality, hospital length of stay for survivors, and overall costs of hospitalization were evaluated. Multivariable logistic and linear regression analyses, adjusted for various parameters, were used to explore these associations. Of the estimated 5,019,369 sepsis hospitalizations, 1.2% of patients with sepsis without shock and 2.3% of patients with septic shock developed pulmonary embolism. The odds ratio for in-hospital mortality was 1.94 (95% confidence interval (CI) 1.85-2.03, p < 0.001). The coefficient for hospital length of stay was 3.24 (95% CI 3.03-3.45, p < 0.001). The coefficient for total costs was 46,513 (95% CI 43,079-49,947, p < 0.001). The prevalence of pulmonary embolism in patients diagnosed with sepsis with and without shock was 1.2 and 2.3%, respectively. Acute pulmonary embolism was associated with higher in-hospital mortality, longer hospital length of stay for survivors, and higher overall costs of hospitalization.
Collapse
Affiliation(s)
- Daisuke Hasegawa
- Department of Medicine, Mount Sinai Beth Israel, 281 1st Ave, New York, NY, 10003, USA.
| | - Ryota Sato
- Division of Critical Care Medicine, Department of Medicine, The Queen's Medical Center, Honolulu, HI, USA
| | - Young Im Lee
- Division of Pulmonary and Critical Care Medicine, Mount Sinai Beth Israel, Mount Sinai West, New York, NY, USA
| | - Hong Yu Wang
- Department of Medicine, Mount Sinai Beth Israel, 281 1st Ave, New York, NY, 10003, USA
| | - Kazuki Nishida
- Department of Biostatistics, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan
| | - David Steiger
- Division of Pulmonary and Critical Care Medicine, Mount Sinai Beth Israel, Mount Sinai West, New York, NY, USA
| |
Collapse
|
296
|
Hackl G, Schreiber N. [Extracorporeal treatment in poisoning]. Med Klin Intensivmed Notfmed 2024:10.1007/s00063-024-01156-6. [PMID: 38985349 DOI: 10.1007/s00063-024-01156-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 07/11/2024]
Abstract
In rare cases, intoxicated patients may require an extracorporeal procedure for enhanced toxin elimination. The Extracorporeal Treatments in Poisoning (EXTRIP) workgroup provides consensus- and evidence-based recommendations regarding the use of extracorporeal procedures in the management of critically ill, poisoned patients, with ongoing updates. Extracorporeal clearance is highest for low molecular weight substances with low volume of distribution, low plasma protein binding, and high water-solubility. To maximize the effect of extracorporeal clearance, blood and dialysate flow rates should be as high as possible, and the membrane with the largest surface area should be utilized. Intermittent hemodialysis is the most commonly employed extracorporeal procedure due to its highest effectiveness, while hemodynamically compromised patients can benefit from a continuous procedure.
Collapse
Affiliation(s)
- Gerald Hackl
- Allgemeine Intensivstation, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Auenbruggerplatz 15, 8036, Graz, Österreich.
| | - Nikolaus Schreiber
- Klinische Abteilung für Nephrologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Auenbruggerplatz 27, 8036, Graz, Österreich.
| |
Collapse
|
297
|
Seffer MT, Kielstein JT. [Extracorporeal removal of pathogens using a biomimetic adsorber-A new treatment strategy for the intensive care unit : Seraph® 100 Microbind® Affinity Blood Filter and its fields of application]. Med Klin Intensivmed Notfmed 2024:10.1007/s00063-024-01153-9. [PMID: 38981926 DOI: 10.1007/s00063-024-01153-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 03/31/2024] [Accepted: 05/15/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND In 2019 the World Health Organization (WHO) listed antimicrobial resistance among the top 10 threats to global health. The Seraph® 100 Microbind® Affinity blood filter (Seraph® 100) has been in use since 2019 to eliminate pathogens from the bloodstream in addition to anti-infective pharmacotherapy. It is the first device used to rapidly and efficiently reduce the number of circulating bacteria and viruses. OBJECTIVE After a background on the concept of extracorporeal pathogen removal in general, this review summarizes the preclinical and clinical data on the Seraph® 100 Affinity Blood Filter. The clinical effect of this treatment and potential therapeutic options are described. METHODS Structured PubMed review including references published up to February 2024. RESULTS Case reports, uncontrolled observational studies and data from registries show widespread clinical use of the Seraph® 100 ranging from difficult to treat bacterial (super) infections to viral infections. The treatment can be done as stand-alone hemoperfusion or in combination with all forms of kidney replacement therapy as well as in extracorporeal membrane oxygenation. CONCLUSION The use of the Seraph® 100 varies in terms of duration, concomitant therapy and clinical settings. Due to the absence of prospective controlled trials the clinical effect cannot be properly evaluated.
Collapse
Affiliation(s)
- Malin-Theres Seffer
- Helmholtz Centre for Infection Research, Microbial Proteomics, Braunschweig, Deutschland
- Medizinische Klinik V Nephrologie | Rheumatologie | Blutreinigungsverfahren, Städtisches Klinikum Braunschweig, Salzdahlumer Str. 90, 38126, Braunschweig, Deutschland
| | - Jan T Kielstein
- Medizinische Klinik V Nephrologie | Rheumatologie | Blutreinigungsverfahren, Städtisches Klinikum Braunschweig, Salzdahlumer Str. 90, 38126, Braunschweig, Deutschland.
| |
Collapse
|
298
|
Koyama H, Sakai K, Fukaguchi K, Hadano H, Aida Y, Kamio T, Abe T, Nishii M, Takeuchi I. A comparison study of temporal trends of SARS-CoV2 RNAemia and biomarkers to predict success and failure of high flow oxygen therapy among patients with moderate to severe COVID-19. PLoS One 2024; 19:e0305077. [PMID: 38985808 PMCID: PMC11236165 DOI: 10.1371/journal.pone.0305077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 05/22/2024] [Indexed: 07/12/2024] Open
Abstract
Optimal timing for intubating patients with coronavirus disease 2019 (COVID-19) has been debated throughout the pandemic. Early use of high-flow nasal cannula (HFNC) can help reduce the need for intubation, but delay can result in poorer outcomes. This study examines trends in laboratory parameters and serum severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA levels of patients with COVID-19 in relation to HFNC failure. Patients requiring HFNC within three days of hospitalization between July 1 and September 30, 2021 were enrolled. The primary outcome was HFNC failure (early failure ≤Day 3; late failure ≥Day 4), defined as transfer to intensive care just before/after intubation or in-hospital death. We examined changes in laboratory markers and SARS-CoV2-RNAemia on Days 1, 4, and 7, together with demographic data, oxygenation status, and therapeutic agents. We conducted a univariate logistic regression with the explanatory variables defined as 10% change rate in each laboratory marker from Day 1 to 4. We utilized the log-rank test to assess the differences in HFNC failure rates, stratified based on the presence of SARS-CoV2 RNAemia. Among 122 patients, 17 (13.9%) experienced HFNC failure (early: n = 6, late: n = 11). Seventy-five patients (61.5%) showed an initial SpO2/FiO2 ratio ≤243, equivalent to PaO2/FiO2 ratio ≤200, and the initial SpO2/FiO2 ratio was significantly lower in the failure group (184 vs. 218, p = 0.018). Among the laboratory markers, a 10% increase from Day 1 to 4 of lactate dehydrogenase (LDH) and interleukin (IL)-6 was associated with late failure (Odds ratio [OR]: 1.42, 95% confidence interval [CI]: 1.09-1.89 and OR: 1.04, 95%CI: 1.00-1.19, respectively). Furthermore, in patients with persistent RNAemia on Day 4 or 7, the risk of late HFNC failure was significantly higher (Log-rank test, p<0.01). In conclusion, upward trends in LDH and IL-6 levels and the persistent RNAemia even after treatment were associated with HFNC failure.
Collapse
Affiliation(s)
- Hiroshi Koyama
- Department of Critical Care Medicine, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Kazuya Sakai
- Department of Emergency Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| | - Kiyomitsu Fukaguchi
- Department of Critical Care Medicine, Shonan Kamakura General Hospital, Kamakura, Japan
- Center for Acute and General Medicine, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Hiroki Hadano
- Department of Critical Care Medicine, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Yoshihisa Aida
- Center for Acute and General Medicine, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Tadashi Kamio
- Department of Critical Care Medicine, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Takeru Abe
- Department of Emergency Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| | - Mototsugu Nishii
- Department of Emergency Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| | - Ichiro Takeuchi
- Department of Emergency Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| |
Collapse
|
299
|
Diaz-Martinez J, Kotzker W, Mendoza-Hernandez MA, Gadh RS, Hernandez-Fuentes GA, Bañuelos A, Guzmán-Esquivel J, Hong A, Delgado-Enciso OG, Geyer-Roberts E, Martinez-Fierro ML, Rodriguez-Sanchez IP, Garza-Veloz I, Canseco-Ávila LM, Delgado-Enciso I. Analysis of Survival Modification by Furosemide Use in a Cohort of Hospitalized COVID-19 Patients with Severe or Critical Disease in Mexico: Due to Its Chemical Structure, Furosemide Is More than Just a Diuretic. Pharmaceutics 2024; 16:920. [PMID: 39065617 PMCID: PMC11280466 DOI: 10.3390/pharmaceutics16070920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 07/04/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
In the ongoing fight against Coronavirus Disease 2019 (COVID-19), researchers are exploring potential treatments to improve outcomes, especially in severe cases. This includes investigating the repurposing of existing medications, such as furosemide, which is widely available. This study aimed to evaluate the impact of furosemide on mortality rates among COVID-19 patients with severe or critical illness. We assessed a cohort of 515 hospitalized adults who experienced a high mortality rate of 43.9%. Using a multivariate analysis with adjusted risk ratios (AdRRs), factors like smoking (AdRR 2.48, 95% CI 1.53-4.01, p < 0.001), a high Pneumonia Severity Index (PSI) score (AdRR 7.89, 95% CI 5.82-10.70, p < 0.001), mechanical ventilation (AdRR 23.12, 95% CI 17.28-30.92, p < 0.001), neutrophilia (AdRR 2.12, 95% CI 1.52-2.95, p < 0.001), and an elevated neutrophil-to-lymphocyte ratio (NLR) (AdRR 2.39, 95% CI 1.72-3.32, p < 0.001) were found to increase mortality risk. In contrast, vaccination and furosemide use were associated with reduced mortality risk (AdRR 0.58, p = 0.001 and 0.60, p = 0.008; respectively). Furosemide showed a pronounced survival benefit in patients with less severe disease (PSI < 120) and those not on hemodialysis, with mortality rates significantly lower in furosemide users (3.7% vs. 25.7%). A Kaplan-Meier analysis confirmed longer survival and better oxygenation levels in patients treated with furosemide. Furthermore, a Structure-Activity Relationship analysis revealed that furosemide's sulfonamide groups may interact with cytokine sites such as tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6), potentially explaining its beneficial effects in COVID-19 management. These findings suggest that furosemide could be a beneficial treatment option in certain COVID-19 patient groups, enhancing survival and improving oxygenation.
Collapse
Affiliation(s)
- Janet Diaz-Martinez
- Research Center in Minority Institutions, Robert Stempel College of Public Health, Florida International University, Miami, FL 33199, USA;
| | - Wayne Kotzker
- Florida Kidney Physicians, Panoramic Health Practice, Boca Raton, FL 33431, USA;
| | - Martha A. Mendoza-Hernandez
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico; (M.A.M.-H.); (G.A.H.-F.); (O.G.D.-E.)
- COVID Unit, General Hospital Number 1, Mexican Institute of Social Security, Villa de Alvarez, Colima 29883, Mexico
| | - Rajdeep S. Gadh
- Florida Kidney Physicians, Panoramic Health Practice, Coral Springs, FL 33071, USA;
| | - Gustavo A. Hernandez-Fuentes
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico; (M.A.M.-H.); (G.A.H.-F.); (O.G.D.-E.)
| | - Andrew Bañuelos
- Department GME (General Medicine Education), Hospital Corporation of America Westside, Westside, FL 33324, USA; (A.B.); (A.H.)
| | - José Guzmán-Esquivel
- Clinical Epidemiology Research Unit, Mexican Institute of Social Security, Villa de Alvarez, Colima 29883, Mexico;
| | - Angelina Hong
- Department GME (General Medicine Education), Hospital Corporation of America Westside, Westside, FL 33324, USA; (A.B.); (A.H.)
| | - Osiris G. Delgado-Enciso
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico; (M.A.M.-H.); (G.A.H.-F.); (O.G.D.-E.)
| | - Elizabeth Geyer-Roberts
- Department of Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova University, Fort Lauderdale, FL 33328, USA;
| | - Margarita L. Martinez-Fierro
- Molecular Medicine Laboratory, Academic Unit of Human Medicine and Health Sciences, Autonomous University of Zacatecas, Zacatecas 98160, Mexico; (M.L.M.-F.); (I.G.-V.)
| | - Iram P. Rodriguez-Sanchez
- Molecular and Structural Physiology Laboratory, School of Biological Sciences, Autonomous University of Nuevo Leon, San Nicolas de los Garza 66455, Mexico;
| | - Idalia Garza-Veloz
- Molecular Medicine Laboratory, Academic Unit of Human Medicine and Health Sciences, Autonomous University of Zacatecas, Zacatecas 98160, Mexico; (M.L.M.-F.); (I.G.-V.)
| | - Luis M. Canseco-Ávila
- Diagnostic and Molecular Biomedicine Laboratory, Faculty of Chemistry Sciences, Campus IV, Autonomous University of Chiapas, Tapachula 30700, Mexico;
| | - Ivan Delgado-Enciso
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico; (M.A.M.-H.); (G.A.H.-F.); (O.G.D.-E.)
- Department of Research, Colima Cancerology State Institute, Mexican Institute of Social Security (IMSS-Bienestar) Colima, Colima 28085, Mexico
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199, USA
| |
Collapse
|
300
|
van Eerten FJC, de Fraiture EJ, Duebel LV, Vrisekoop N, van Wessem KJP, Koenderman L, Hietbrink F. Limited impact of traumatic brain injury on the post-traumatic inflammatory cellular response. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02574-z. [PMID: 38980396 DOI: 10.1007/s00068-024-02574-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 06/10/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE Trauma triggers a systemic inflammatory cellular response due to tissue damage, potentially leading to a secondary immune deficiency. Trauma severity is quantified by the Injury Severity Score (ISS). Severe Traumatic Brain Injury (TBI) is associated with high ISSs due to high lethality, despite limited tissue damage. Therefore, ISS might overestimate the post-traumatic inflammatory cellular response. This study investigated the effect of TBI on the occurrence of different systemic neutrophil phenotypes as alternative read-out for systemic inflammation. METHODS A single-center retrospective cohort study was conducted at a level-1 trauma center. Patients aged ≥ 18 years, admitted between 01-03-2021-01-11-2022 and providing a diagnostic blood sample were included. Four groups were created: isolated TBI, isolated non-TBI, multitrauma TBI and multitrauma non-TBI. Primary outcome was occurrence of different neutrophil phenotypes determined by automated flow cytometry. Secondary outcome was infectious complications. RESULTS In total, 404 patients were included. TBI and non-TBI patients demonstrated similar occurrences of different neutrophil phenotypes. However, isolated TBI patients had higher ISSs than their isolated non-TBI controls who suffered similar post-traumatic inflammatory cellular responses. Regardless of the type of injury, patients exhibiting higher systemic inflammation had a high infection risk. CONCLUSION When TBI is involved, ISS tends to be higher compared to similar patients in the absence of TBI. However, TBI patients did not demonstrate an increased inflammatory cellular response compared to non-TBI patients. Therefore, TBI does not add much to the inflammatory cellular response in trauma patients. The degree of the inflammatory response was related to the incidence of infectious complications.
Collapse
Affiliation(s)
- F J C van Eerten
- Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, Netherlands.
| | - E J de Fraiture
- Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - L V Duebel
- Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, Netherlands
- CTI Center Translational Immunology, University Medical Center Utrecht, Utrecht, Netherlands
| | - N Vrisekoop
- Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, Netherlands
- CTI Center Translational Immunology, University Medical Center Utrecht, Utrecht, Netherlands
| | - K J P van Wessem
- Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - L Koenderman
- Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, Netherlands
- CTI Center Translational Immunology, University Medical Center Utrecht, Utrecht, Netherlands
| | - F Hietbrink
- Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| |
Collapse
|