Critical care medicine
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Critical care medicine · Jul 2021
Evolution Over Time of Ventilatory Management and Outcome of Patients With Neurologic Disease.
To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. ⋯ More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease.
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Critical care medicine · Jul 2021
Coronavirus Disease 2019 ICU Patients Have Higher-Than-Expected Acute Physiology and Chronic Health Evaluation-Adjusted Mortality and Length of Stay Than Viral Pneumonia ICU Patients.
To compare Acute Physiology and Chronic Health Evaluation-IV-adjusted mortality and length of stay outcomes of adult ICU patients who tested positive for coronavirus disease 2019 with patients admitted to ICU with other viral pneumonias including a subgroup with viral pneumonia and concurrent acute respiratory distress syndrome (viral pneumonia-acute respiratory distress syndrome). ⋯ Severity-adjusted mortality and length of stay are higher for coronavirus disease 2019 patients than for viral pneumonia patients admitted to ICU. Coronavirus disease patients also have longer time on ventilator and ICU length of stay, comparable with the subset of viral pneumonia patients with concurrent acute respiratory distress syndrome. Mortality and length of stay increase with age and higher scores in both populations, but observed to predicted mortality and length of stay are higher than expected with coronavirus disease patients across all severity of illness levels. These findings have implications for benchmarking ICU outcomes during the coronavirus disease 2019 pandemic.
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Critical care medicine · Jul 2021
Optimal Sedation in Patients Who Receive Neuromuscular Blocking Agent Infusions for Treatment of Acute Respiratory Distress Syndrome-A Retrospective Cohort Study From a New England Health Care Network.
Two previously published trials (ARDS et Curarisation Systematique [ACURASYS] and Reevaluation of Systemic Early Neuromuscular Blockade [ROSE]) presented equivocal evidence on the effect of neuromuscular blocking agent infusions in patients with acute respiratory distress syndrome (acute respiratory distress syndrome). The sedation regimen differed between these trials and also within the ROSE trial between treatment and control groups. We hypothesized that the proportion of deeper sedation is a mediator of the effect of neuromuscular blocking agent infusions on mortality. ⋯ In acute respiratory distress syndrome patients who receive neuromuscular blocking agent infusions, a prolonged, high proportion of deeper sedation is associated with increased mortality. Our data support the view that clinicians should minimize the duration of deeper sedation after recovery from neuromuscular blocking agent infusion.
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Critical care medicine · Jul 2021
Plasma Nucleosomes Are Associated With Mortality in Pediatric Acute Respiratory Distress Syndrome.
Circulating nucleosomes and their component histones have been implicated as pathogenic in sepsis and acute respiratory distress syndrome in adults. However, their role in pediatric acute respiratory distress syndrome is unknown. ⋯ Plasma nucleosomes are associated with acute respiratory distress syndrome severity, nonpulmonary organ failures, and worse outcomes in pediatric acute respiratory distress syndrome.
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Critical care medicine · Jul 2021
Exploring Patients' Perceptions on ICU Diaries: A Systematic Review and Qualitative Data Synthesis.
This study aims to summarize the current qualitative evidence on patients' experiences of reading the ICU diaries. ⋯ This qualitative synthesis shows that patients recommend having an ICU diary, enlightening benefits such as better coping with the slow recovery from critical illness, strengthening family ties, and humanizing the ICU staff. It also identifies characteristics of the diary valued by the patients, in order to standardize the ICU diary according to their perspectives, and allowing future comparability between randomized controlled trials.