Journal of critical care
-
Journal of critical care · Oct 2023
ReviewAntimicrobial resistance and outcome in the critically ill patient: An opinion paper.
Antimicrobial resistance (AMR) is associated with increased mortality and resources consumption in critically ill patients. However, the causality of AMR in this mortality remains unclear. This opinion paper aims to overview the effects of multidrug resistant (MDR) pathogens on the outcomes of critically ill patients, considering different variables as appropriateness of empirical antimicrobial therapy, severity of sepsis, comorbid conditions and frailty. ⋯ However, the patients carrying MDR pathogens, as compared with those carrying non-MDR pathogens, are those with co-morbid conditions, high risk of frailty and invasive procedures. In addition, inappropriate empirical antibiotics are more often used in these patients as well as withholding and withdrawing of life-sustained therapy. Future studies on AMR should report the rate of appropriateness of empirical antimicrobial therapy, withholding and withdrawing of life-sustained therapy.
-
Journal of critical care · Oct 2023
Multicenter Study Observational StudyCharacteristics, management, and outcomes of patients with infectious encephalitis requiring intensive care: A prospective multicentre observational study.
Infectious encephalitis (IE) is a severe disease which requires intensive care unit (ICU) admission in up to 50% of cases. We aimed to describe characteristics, management and outcomes of IE patients who required ICU admission. ⋯ HSV is the primary cause of IE requiring ICU admission. IE patients admitted in ICU have a poor prognosis with 11% of in-hospital mortality and 15% of severe disabilities in survivors at discharge.
-
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.
-
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.