Journal of critical care
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Journal of critical care · Feb 2025
Multicenter Study Comparative Study Observational StudyA tidal volume of 7 mL/kg PBW or higher may be safe for COVID-19 patients.
The novel coronavirus disease (COVID-19) has revived the debate on the optimal tidal volume during acute respiratory distress syndrome (ARDS). Some experts recommend 6 mL/kg of predicted body weight (PBW) for all patients, while others suggest 7-9 mL/kg PBW for those with compliance >50 mL/cmH2O. We investigated whether a tidal volume ≥ 7 ml/kg PBW may be safe in COVID-19 patients, particularly those with compliance >50 mL/cmH2O. ⋯ A tidal volume ≥ 7 (up to 9) mL/kg PBW was associated with lower ICU mortality in these COVID-19 patients, including those with compliance <40 mL/cmH2O. This finding should be interpreted cautiously due to the retrospective study design.
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Journal of critical care · Feb 2025
ReviewUnderstanding ventilator-induced lung injury: The role of mechanical power.
Mechanical ventilation stands as a life-saving intervention in the management of respiratory failure. However, it carries the risk of ventilator-induced lung injury. Despite the adoption of lung-protective ventilation strategies, including lower tidal volumes and pressure limitations, mortality rates remain high, leaving room for innovative approaches. ⋯ To overcome the constraints of measuring static respiratory parameters, dynamic mechanical power is proposed for all patients, regardless of their ventilation mode. However, establishing a causal relationship is crucial for its potential implementation, and requires further research. The objective of this review is to explore the role of mechanical power in ventilator-induced lung injury, its association with patient outcomes, and the challenges and potential benefits of implementing a ventilation strategy based on mechanical power.
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Journal of critical care · Feb 2025
Multicenter StudyAnalysis of factors associated with favorable neurological outcomes in patients with initial PEA who underwent ECPR - A secondary analysis of the SAVE-J II study.
This study aimed to investigate the factors of favorable neurological outcomes in patients with initial pulseless electrical activity (PEA) who underwent extracorporeal cardiopulmonary resuscitation (ECPR). ⋯ This study provides an overview of patients with PEA who underwent ECPR. Since several factors are associated with favorable neurological outcomes, patients with PEA may be candidates for ECPR if these factors are met.
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Journal of critical care · Feb 2025
Meta AnalysisProtective effect of intravenous amino acid on kidney function: A systematic review and meta-analysis of randomized controlled trials.
Acute kidney injury (AKI) is a common complication in critically ill and cardiac surgery patients. Intravenous amino acids can increase renal perfusion and replenish renal functional reserves. However, the exact therapeutic efficacy of intravenous amino acids in reducing the incidence of AKI remains uncertain. Therefore, this study aims to comprehensively review the existing evidence to assess the potential of intravenous amino acids in kidney protection. ⋯ Intravenous amino acids protect renal function in patients at high risk of AKI, particularly after cardiac surgery. It reduces the incidence of AKI and increases urine output, but has no significant effect on KRT and mortality.
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Journal of critical care · Feb 2025
Multicenter Study Observational StudyImpact of mild hypercapnia in critically ill patients with metabolic acidosis.
Clinical trials focusing on critically ill patients with metabolic acidosis, a common exclusion criterion is the presence of a PaCO2 > 45 mmHg. The aim of this study was to assess the impact of mild hypercapnia on patient characteristics, severity, and clinical outcomes in critically ill patients with metabolic acidosis. ⋯ In patients with metabolic acidosis, after adjustment for potential confounders, mild hypercapnia does not increase the MAKE-30 rate and does not have a major impact on pH.