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Grim CCA, van der Wal LI, Helmerhorst HJF, van Westerloo DJ, Pelosi P, Schultz MJ, de Jonge E, del Prado MR, Wigbers J, Sigtermans MJ, Dawson L, van der Heijden PLJ, den Berg EYSV, Loef BG, Reidinga AC, de Vreede E, Qualm J, Boerma EC, Rijnhart-de Jong H, Koopmans M, Cornet AD, Krol T, Rinket M, Vermeijden JW, Beishuizen A, Schoonderbeek FJ, van Holten J, Tsonas AM, Botta M, Winters T, Horn J, Paulus F, Loconte M, Battaglini D, Ball L, Brunetti I. ICONIC study—conservative versus conventional oxygenation targets in intensive care patients: study protocol for a randomized clinical trial. Trials 2022; 23:136. [PMID: 35152909 PMCID: PMC8842972 DOI: 10.1186/s13063-022-06065-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 01/29/2022] [Indexed: 12/02/2022] Open
Abstract
Background Oxygen therapy is a widely used intervention in acutely ill patients in the intensive care unit (ICU). It is established that not only hypoxia, but also prolonged hyperoxia is associated with poor patient-centered outcomes. Nevertheless, a fundamental knowledge gap remains regarding optimal oxygenation for critically ill patients. In this randomized clinical trial, we aim to compare ventilation that uses conservative oxygenation targets with ventilation that uses conventional oxygen targets with respect to mortality in ICU patients. Methods The “ConservatIve versus CONventional oxygenation targets in Intensive Care patients” trial (ICONIC) is an investigator-initiated, international, multicenter, randomized clinical two-arm trial in ventilated adult ICU patients. The ICONIC trial will run in multiple ICUs in The Netherlands and Italy to enroll 1512 ventilated patients. ICU patients with an expected mechanical ventilation time of more than 24 h are randomized to a ventilation strategy that uses conservative (PaO2 55–80 mmHg (7.3–10.7 kPa)) or conventional (PaO2 110–150 mmHg (14.7–20 kPa)) oxygenation targets. The primary endpoint is 28-day mortality. Secondary endpoints are ventilator-free days at day 28, ICU mortality, in-hospital mortality, 90-day mortality, ICU- and hospital length of stay, ischemic events, quality of life, and patient opinion of research and consent in the emergency setting. Discussion The ICONIC trial is expected to provide evidence on the effects of conservative versus conventional oxygenation targets in the ICU population. This study may guide targeted oxygen therapy in the future. Trial registration Trialregister.nl NTR7376. Registered on 20 July, 2018.
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Schluep M, Endeman H, Gravesteijn BY, Kuijs C, Blans MJ, van den Bogaard B, Van Gemert AWMMK, Hukshorn CJ, van der Meer BJM, Knook AHM, van Melsen T, Peters R, Simons KS, Spijkers G, Vermeijden JW, Wils EJ, Stolker RJ, Hoeks SE. In-depth assessment of health-related quality of life after in-hospital cardiac arrest. J Crit Care 2021; 68:22-30. [PMID: 34856490 DOI: 10.1016/j.jcrc.2021.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/11/2021] [Accepted: 11/13/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Evidence on physical and psychological well-being of in-hospital cardiac arrest (IHCA) survivors is scarce. The aim of this study is to describe long-term health-related quality of life (HRQoL), functional independence and psychological distress 3 and 12 months post-IHCA. METHODS A multicenter prospective cohort study in 25 hospitals between January 2017 - May 2018. Adult IHCA survivors were included. HRQoL (EQ-5D-5L, SF-12), psychological distress (HADS, CSI) and functional independence (mRS) were assessed at 3 and 12 months post-IHCA. RESULTS At 3-month follow-up 136 of 212 survivors responded to the questionnaire and at 12 months 110 of 198 responded. The median (IQR) EQ-utility Index score was 0.77 (0.65-0.87) at 3 months and 0.81 (0.70-0.91) at 12 months. At 3 months, patients reported a median SF-12 (IQR) physical component scale (PCS) of 38.9 (32.8-46.5) and mental component scale (MCS) of 43.5 (34.0-39.7) and at 12 months a PCS of 43.1 (34.6-52.3) and MCS 46.9 (38.5-54.5). DISCUSSION Using various tools most IHCA survivors report an acceptable HRQoL and a substantial part experiences lower HRQoL compared to population norms. Our data suggest that younger (male) patients and those with poor functional status prior to admission are at highest risk of impaired HRQoL.
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Affiliation(s)
- M Schluep
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - H Endeman
- Department of Intensive Care Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - B Y Gravesteijn
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - C Kuijs
- Department of Intensive Care Medicine, Maasstad Hospital, Rotterdam, the Netherlands; Resuscitation Committee, Maasstad Hospital, Rotterdam, the Netherlands
| | - M J Blans
- Department of Intensive Care Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - B van den Bogaard
- Department of Intensive Care Medicine, OLVG, Amsterdam, the Netherlands
| | | | - C J Hukshorn
- Department of Intensive Care Medicine, Isala Hospital, Zwolle, the Netherlands
| | | | - A H M Knook
- Department of Intensive Care Medicine, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - T van Melsen
- Department of Intensive Care Medicine, Haaglanden Medisch Centrum, The Hague, the Netherlands
| | - R Peters
- Department of Cardiology, Tergooi Hospital, Hilversum, the Netherlands
| | - K S Simons
- Department of Intensive Care Medicine, Jeroen Bosch Hospital, 's Hertogenbosch, the Netherlands
| | - G Spijkers
- Department of Hospital Medicine, ZorgSaam Zeeuws-Vlaanderen, Terneuzen, the Netherlands
| | - J W Vermeijden
- Department of Intensive Care Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
| | - E-J Wils
- Department of Intensive Care Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - R J Stolker
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - S E Hoeks
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands
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Hooijman PE, Beishuizen A, de Waard MC, de Man FS, Vermeijden JW, Steenvoorde P, Bouwman RA, Lommen W, van Hees HWH, Heunks LMA, Dickhoff C, van der Peet DL, Girbes ARJ, Jasper JR, Malik FI, Stienen GJM, Hartemink KJ, Paul MA, Ottenheijm CAC. Diaphragm fiber strength is reduced in critically ill patients and restored by a troponin activator. Am J Respir Crit Care Med 2014; 189:863-5. [PMID: 24684359 DOI: 10.1164/rccm.201312-2260le] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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