Critical care medicine
-
Critical care medicine · Nov 2024
Effect of a Machine Learning-Derived Early Warning Tool With Treatment Protocol on Hypotension During Cardiac Surgery and ICU Stay: The Hypotension Prediction 2 (HYPE-2) Randomized Clinical Trial.
Cardiac surgery is associated with perioperative complications, some of which might be attributable to hypotension. The Hypotension Prediction Index (HPI), a machine-learning-derived early warning tool for hypotension, has only been evaluated in noncardiac surgery. We investigated whether using HPI with diagnostic guidance reduced hypotension during cardiac surgery and in the ICU. ⋯ Using HPI combined with diagnostic guidance on top of standard care significantly decreased hypotension severity in elective cardiac surgery patients compared with standard care.
-
Critical care medicine · Nov 2024
Ketamine Versus Etomidate for Rapid Sequence Intubation: A Systematic Review and Meta-Analysis of Randomized Trials.
To compare the safety and efficacy of ketamine and etomidate as induction agents to facilitate emergent endotracheal intubation. ⋯ Compared with etomidate, ketamine probably results in more hemodynamic instability during the peri-intubation period and appears to have no effect on successful intubation on the first attempt or mortality. However, ketamine results in decreased need for the initiation of vasopressor use and decreases adrenal suppression compared with etomidate.
-
Critical care medicine · Nov 2024
Intestinal Drug Absorption After Subarachnoid Hemorrhage and Elective Neurosurgery: Insights From Esomeprazole Pharmacokinetics.
Subarachnoid hemorrhage (SAH) may critically impair cardiovascular, metabolic, and gastrointestinal function. Previous research has demonstrated compromised drug absorption in this group of patients. This study aimed to examine the impact of SAH on gastrointestinal function and its subsequent effect on the absorption of enterally administered drugs, using esomeprazole as a probe drug. ⋯ Following SAH, significantly reduced drug absorption may be attributed to decreased intestinal motility and compromised intestinal mucosal function. Clinicians should anticipate the reduced effectiveness of enterally administered medications for at least seven days after high-grade SAH.
-
Critical care medicine · Nov 2024
The Need for Institutional Policies for Innovative Therapy: Existing Approaches and Key Elements.
Innovative therapy is common in many areas of medicine. Yet, it is unknown whether medical centers have policies to ensure innovative therapy is conducted appropriately. ⋯ A majority of leading U.S. medical centers do not have a policy for innovative therapy. In addition, existing policies lack important elements, especially with respect to reporting patient outcomes and coordinating innovative therapy with research. Based on the existing policies and recommendations in the literature, we thus identify eight key elements that should be included in policies for innovative therapy. Future research should assess whether these elements can be feasibly implemented and whether, in practice, they offer patients appropriate protection.
-
Critical care medicine · Nov 2024
Performance of the Healthy Aging Brain Care Monitor Self Report in Monitoring Post-Intensive Care Syndrome Among Acute Respiratory Failure Survivors.
To describe the performance of the Healthy Aging Brain Care Monitor Self Report (HABC-M SR) in assessment of post-intensive care syndrome (PICS) among Acute Respiratory Failure ICU survivors. ⋯ While HABC-M SR correlated with mood, physical, and sleep symptoms, the cognitive subscale was less sensitive compared with standardized scales.