Critical care medicine
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Critical care medicine · Sep 2020
Multicenter StudySepsis and the Obesity Paradox: Size Matters in More Than One Way.
Multiple studies have demonstrated an obesity paradox such that obese ICU patients have lower mortality and better outcomes. We conducted this study to determine if the mortality benefit conferred by obesity is affected by baseline serum lactate and mean arterial pressure. ⋯ Our retrospective analysis suggests that although patient size (i.e., body mass index) is a predictor of in-hospital death among all-comers with sepsis-providing further evidence to the obesity paradox-it adds that illness severity is critically important whether quantified as higher lactate or by Acute Physiology and Chronic Health Evaluation III score. Our results highlight that the obesity paradox is more than a simple association between body mass index and mortality and reinforces the importance of illness severity.
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Critical care medicine · Sep 2020
Randomized Controlled TrialProspective Randomized Controlled Trial of Video- Versus Recall-Assisted Reflection in Simulation-Based Teaching on Acquisition and Retention of Airway Skills Among Trainees Intubating Critically Ill Patients.
Conventionally, simulation-based teaching involves reflection on recalled events (recall-assisted reflection). Instead of recall, video-assisted reflection may reduce recall bias and improve skills retention by contributing to visual memory. Here, we test the hypothesis that when compared with recall, video-assisted reflection results in higher acquisition and retention of skills involved in airway management among junior critical care doctors. ⋯ When compared with recall, video-assisted reflection resulted in similar improvement in airway skills, but better retention over time.
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Critical care medicine · Sep 2020
Multicenter StudyOxygenation Strategy During Acute Respiratory Failure in Critically-Ill Immunocompromised Patients.
To assess the response to initial oxygenation strategy according to clinical variables available at admission. ⋯ Some clinical characteristics at ICU admission including etiology and severity of acute respiratory failure enable to identify patients at high risk for intubation.
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Critical care medicine · Sep 2020
Inhibitory Immune Checkpoint Molecule Expression in Clinical Sepsis Studies: A Systematic Review.
Checkpoint inhibitors have been proposed for sepsis following reports of increased checkpoint molecule expression in septic patients. To determine whether clinical studies investigating checkpoint molecule expression provide strong evidence supporting trials of checkpoint inhibitors for sepsis. ⋯ Although sepsis may increase some checkpoint molecule expression compared with healthy controls, the data are limited and inconsistent. Further, data from the more informative patient comparisons are potentially confounded by severity of illness. These clinical checkpoint molecule expression studies do not yet provide a strong rationale for trials of checkpoint inhibitor therapy for sepsis.
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Critical care medicine · Sep 2020
Endothelial Activation, Acute Kidney Injury, and Cognitive Impairment in Pediatric Severe Malaria.
Evaluate the relationship between endothelial activation, malaria complications, and long-term cognitive outcomes in severe malaria survivors. ⋯ These data support angiopoietin-2 as a measure of disease severity and a risk factor for long-term cognitive injury in children with severe malaria.