Intensive care medicine
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Intensive care medicine · Jan 2025
ReviewWhat intensivists need to know about cytomegalovirus infection in immunocompromised ICU patients.
Advances in therapeutic care are leading to an increase in the number of patients living with overt immunosuppression. These patients are at risk of cytomegalovirus (CMV) infection and disease that can lead to or develop during ICU admission. This manuscript aims to describe the clinical presentation, risk factors, and management of CMV infection and disease in this patient population. ⋯ CMV infection and disease in critically ill immunocompromised patients pose a unique challenge for intensivists. The broad spectrum of clinical presentations and the difficulty in distinguishing CMV-related symptoms from other causes require a high level of clinical suspicion. Accurate interpretation of nucleic acid load levels and careful evaluation of CMV's pathogenic role when it is found are critical. Further studies focusing specifically on CMV infection and disease in critically ill immunocompromised patients are needed to optimize management strategies.
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Intensive care medicine · Jan 2025
Best clinical model predicting extubation failure: a diagnostic accuracy post hoc analysis.
Predicting extubation failure remains a clinical challenge. This study aimed to determine diagnostic accuracy of models used at the bed side. ⋯ Based on these results, the 3-factors model reported a very low diagnostic accuracy, and the 4 or 11-factors models showed similar low accuracy. No improvement was observed after adjusting for other aspects of weaning.
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Intensive care medicine · Jan 2025
Sepsis subtypes and differential treatment response to vitamin C: biological sub-study of the LOVIT trial.
We hypothesised that the biological heterogeneity of sepsis may highlight sepsis subtypes with differences in response to intravenous vitamin C treatment in the Lessening Organ Dysfunction with VITamin C (LOVIT) trial. Our aims were to identify sepsis subtypes and to test whether sepsis subtypes have differences in treatment effect to vitamin C and describe putative biological effects of vitamin C treatment. ⋯ We report three sepsis subtypes based on inflammatory response profile. No subtype benefitted from vitamin C treatment in the LOVIT trial, with heterogeneity of treatment effect in the magnitude of harm.
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Intensive care medicine · Jan 2025
Benzodiazepine and z-drug prescribing in critical care survivors and the risk of rehospitalisation or death due to falls/trauma and due to any cause: a retrospective matched cohort study using the UK Clinical Practice Research Datalink.
Benzodiazepines and z-drugs are often prescribed to critical care survivors due to high prevalence of mental health problems and insomnia. However, their safety has not been studied in this population. ⋯ Community benzodiazepine and z-drug prescribing was associated with increased risk of all-cause, but not falls/trauma-related, rehospitalisations and deaths in critical care survivors who had not been prescribed these before hospitalisation. Clinicians should balance the possible benefits with the likely harms of prescribing these drugs in this potentially vulnerable patient group.
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Intensive care medicine · Jan 2025
Left ventricular diastolic dysfunction is prevalent but not associated with mortality in patients with septic shock.
Prognostic impact of left ventricular diastolic dysfunction (LVDD) in septic shock patients has not been determined using current diagnostic guidelines. We assessed the relation between LVDD during the first 3 days following intensive care unit (ICU) admission for septic shock and Day-28 mortality. ⋯ LVDD was highly prevalent in patients with septic shock but not associated with mortality. It appeared improving in one-third of survivors.