Critical care : the official journal of the Critical Care Forum
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Neutrophils release neutrophil extracellular traps (NETs) as part of a healthy host immune response. NETs physically trap and kill pathogens as well as activating and facilitating crosstalk between immune cells and complement. ⋯ Here, we review the growing evidence implicating neutrophils and NETs as central players in the dysregulated host immune response. We discuss potential strategies for modifying NETs to improve patient outcomes and the need for careful patient selection.
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Passive leg raising (PLR) is a well-recognized method for assessing volume responsiveness in the intensive care unit (ICU); however, it has some limitations. The physiology of the cardiac preload induced by the Trendelenburg position and PLR is similar. The Trendelenburg position can be initiated from the supine position and then tilted downward (TRENDSUPINE) or from the reverse Trendelenburg position and then tilted further downward (TRENDrTREND). Therefore, this study aimed to compare the predictive performance of the percentage change in stroke volume index (ΔSVI) induced by TRENDSUPINE, TRENDrTREND, and PLR for volume responsiveness in mechanically ventilated patients in the ICU. ⋯ The Trendelenburg position (TRENDSUPINE and TRENDrTREND)-induced and PLR-induced percentage changes in SVI were similar in their ability to predict volume responsiveness in mechanically ventilated patients in the ICU. Considering that TRENDrTREND induced greater percentage changes in SVI, it is preferentially recommended as a reasonable alternative to PLR for predicting volume responsiveness in certain clinical scenarios.
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The application of sepsis subtypes to enhance personalized medicine in critically ill patients is hindered by the lack of validation across diverse cohorts and the absence of a simple classification model. We aimed to validate the previously identified SENECA clinical sepsis subtypes in multiple large ICU cohorts, and to develop parsimonious classifier models for δ-type adjudication in clinical practice. ⋯ The distribution and mortality rates of clinical sepsis subtypes varied between US and European cohorts. A three-variable model could accurately identify the δ-type sepsis patients.
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Observational Study
Relationship between skin microvascular blood flow and capillary refill time in critically ill patients.
Capillary refill time (CRT) and skin blood flow (SBF) have been reported to be strong predictors of mortality in critically ill patients. However, the relationship between both parameters remains unclear. ⋯ We have shown that index CRT and SBF were correlated, providing evidence that CRT is a reliable marker of microvascular blood flow. Trial registration Comité de protection des personnes Ouest II N° 2023-A02046-39.
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Review Meta Analysis
Consistency between metagenomic next-generation sequencing versus traditional microbiological tests for infective disease: systemic review and meta-analysis.
Pathogen identification is essential in sepsis and septic shock. Metagenomic next-generation sequencing (mNGS) is a novel pathogen detection method with several advantages over traditional tests. However, the consistency between mNGS and traditional pathogen tests requires further investigation. ⋯ This review demonstrates a moderate relationship between mNGS and traditional pathogen tests, indicating a complex relationship between these two methods. Sterile samples show higher consistency than non-sterile samples. Immune function deficiency may reduce the consistency between mNGS and traditional tests. Further research is needed on the use of mNGS in sepsis and septic shock.