American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Apr 2020
Randomized Controlled Trial Multicenter Study Comparative StudyOutcomes Six-Months After 100% or 70% of Enteral Calorie Requirements During Critical Illness (TARGET): A Randomized Controlled Trial.
Rationale: The long-term effects of delivering approximately 100% of recommended calorie intake via the enteral route during critical illness compared with a lesser amount of calories are unknown. Objectives: Our hypotheses were that achieving approximately 100% of recommended calorie intake during critical illness would increase quality-of-life scores, return to work, and key life activities and reduce death and disability 6 months later. Methods: We conducted a multicenter, blinded, parallel group, randomized clinical trial, with 3,957 mechanically ventilated critically ill adults allocated to energy-dense (1.5 kcal/ml) or routine (1.0 kcal/ml) enteral nutrition. ⋯ Similar numbers of participants returned to work with no difference in hours worked or effectiveness at work (n = 818). There was no observed difference in disability (n = 1,208) or participation in key life activities (n = 705). Conclusions: The delivery of approximately 100% compared with 70% of recommended calorie intake during critical illness does not improve quality of life or functional outcomes or increase the number of survivors 6 months later.
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Am. J. Respir. Crit. Care Med. · Apr 2020
ReviewTracheal Intubation in the Critically Ill: Where We Came From and Where We Should Go.
Tracheal intubation is commonly performed in critically ill patients. Unfortunately, this procedure also carries a high risk of complications; half of critically ill patients with difficult airways experience life-threatening complications. The high complication rates stem from difficulty with laryngoscopy and tube placement, consequences of physiologic derangement, and human factors, including failure to recognize and reluctance to manage the failed airway. ⋯ There are three actions that should be implemented to reduce the risk of danger: 1) preintubation assessment for potential difficulty (e.g., MACOCHA score); 2) preparation and optimization of the patient and team for difficulty-including using a checklist, acquiring necessary equipment, maximizing preoxygenation, and hemodynamic optimization; and 3) recognition and management of failure to restore oxygenation and reduce the risk of cardiopulmonary arrest. This review describes the history of emergency airway management and explores the challenges with modern emergency airway management in critically ill patients. We offer clinically relevant recommendations on the basis of current evidence, guidelines, and expert opinion.
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Am. J. Respir. Crit. Care Med. · Apr 2020
Multicenter Study Observational StudyPredictive Accuracy of the Quick Sepsis-Related Organ Failure Assessment Score in Brazil: A Prospective Multicenter Study.
Rationale: Although proposed as a clinical prompt to sepsis based on predictive validity for mortality, the Quick Sepsis-related Organ Failure Assessment (qSOFA) score is often used as a screening tool, which requires high sensitivity. Objectives: To assess the predictive accuracy of qSOFA for mortality in Brazil, focusing on sensitivity. Methods: We prospectively collected data from two cohorts of emergency department and ward patients. ⋯ Using a qSOFA score greater than or equal to 2 as a screening tool for sepsis may miss patients who ultimately die. Using a qSOFA score greater than or equal to 1 or adding lactate to a qSOFA score greater than or equal to 1 may improve sensitivity. Clinical trial registered with www.clinicaltrials.gov (NCT03158493).
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Am. J. Respir. Crit. Care Med. · Apr 2020
Comparative StudyGender Differences in Authorship of Critical Care Literature.
Rationale: Gender gaps exist in academic leadership positions in critical care. Peer-reviewed publications are crucial to career advancement, and yet little is known regarding gender differences in authorship of critical care research. Objectives: To evaluate gender differences in authorship of critical care literature. ⋯ When the senior author was female, the odds of female coauthorship rose substantially. However, female first authors tend to publish in lower-impact journals. These findings may help explain the underrepresentation of women in critical care academic leadership positions and identify targets for improvement.