Journal of critical care
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Journal of critical care · Oct 2023
Meta AnalysisaPTT-guided anticoagulation monitoring during ECMO support: A systematic review and meta-analysis.
The initiation of the extracorporeal membrane oxygenation (ECMO) is associated with complex coagulatory and inflammatory processes and consequently needed anticoagulation. Systemic anticoagulation bears an additional risk of serious bleeding, and its monitoring is of immense importance. Therefore, our work aims to analyze the association of anticoagulation monitoring with bleeding during ECMO support. ⋯ The aPTT-guided anticoagulation is still the standard of care in ECMO patients. We did not find strong evidence supporting the aPTT-guided monitoring during ECMO. Based on the weight of the available evidence, further randomized trials are crucial to clarify the best monitoring strategy.
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Journal of critical care · Oct 2023
Multicenter StudyDisparities between randomized clinical trial participants and sepsis patients in real-world.
The external validity or "generalizability" of randomized controlled trials (RCTs) often needs be considered when making treatment decisions. We evaluate whether participants in large multicenter RCTs investigating sepsis were similar in age, disease severity, comorbidities, and mortality to the general population of sepsis patients. ⋯ On average, trial participants were younger than the general sepsis patient population. Commercial support influenced patient selection. Efforts to understand and address the above-described patient disparities are necessary to improve the generalizability of RCT results.
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Journal of critical care · Oct 2023
The impact of timing of initiating invasive mechanical ventilation in COVID-19-related respiratory failure.
Optimal timing of initiating invasive mechanical ventilation (IMV) in coronavirus disease 2019 (COVID-19)-related respiratory failure is unclear. We hypothesized that a strategy of IMV as opposed to continuing high flow oxygen or non-invasive mechanical ventilation each day after reaching a high FiO2 threshold would be associated with worse in-hospital mortality. ⋯ Initiation of IMV on each day after patients reach high FiO2 threshold was associated with higher inpatient mortality after adjusting for time-varying confounders. Remaining on high flow nasal cannula or non-invasive ventilation does not appear to be harmful compared to IMV. Prospective evaluation is needed.
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Journal of critical care · Oct 2023
Psychiatric patients' intensive care admission characteristics, weaning from mechanical ventilation and sedative drug use: A single center retrospective case-control study.
To describe the characteristics, treatment and outcome, in particular weaning from mechanical ventilation (MV), of critically ill Patients with prior psychiatric conditions (PPC). ⋯ Critically ill PPC had higher mortality rates than their matched counterparts. They also had higher MV rates and were more difficult to wean.