Journal of intensive care
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The COVID-19 global pandemic has placed unprecedented strain on healthcare and critical care services around the world. Whilst most resources have focused on the acute phase of the disease, there is likely to be an untold burden of patients chronically affected. ⋯ Here, we propose an A to E approach to consider the potential long-term effects of COVID-19 following critical care admission. Anxiety and other mental health diagnosesBreathlessnessCentral nervous system impairmentDietary insufficiency and malnutritionEmbolic eventsDeveloping strategies to mitigate these during admission and providing follow-up, assessment and treatment of persistent multiple organ dysfunction will be essential to improve morbidity, mortality and patient quality of life.
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Journal of intensive care · Mar 2021
Dynamic change of heart rate in the acute phase and clinical outcomes after intracerebral hemorrhage: a cohort study.
Dynamic change of heart rate in the acute phase and clinical outcomes after intracerebral hemorrhage (ICH) remains unknown. We aimed to investigate the associations of heart rate trajectories and variability with functional outcome and mortality in patients with acute ICH. ⋯ Persistently high heart rate and higher variability in the acute phase were associated with increased risk of unfavorable functional outcome in patients with acute ICH.
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Journal of intensive care · Mar 2021
Predictors of failure with high-flow nasal oxygen therapy in COVID-19 patients with acute respiratory failure: a multicenter observational study.
We aimed to describe the use of high-flow nasal oxygen (HFNO) in patients with COVID-19 acute respiratory failure and factors associated with a shift to invasive mechanical ventilation. ⋯ Among adult critically ill patients with COVID-19 initially treated with HFNO, the SOFA score and the ROX index may help to identify patients with higher likelihood of intubation.
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Journal of intensive care · Jan 2021
ReviewThe discovery of biological subphenotypes in ARDS: a novel approach to targeted medicine?
The acute respiratory distress syndrome (ARDS) is a severe lung disorder with a high morbidity and mortality which affects all age groups. Despite active research with intense, ongoing attempts in developing pharmacological agents to treat ARDS, its mortality rate remains unaltered high and treatment is still only supportive. Over the years, there have been many attempts to identify meaningful subgroups likely to react differently to treatment among the heterogenous ARDS population, most of them unsuccessful. ⋯ Even though it is now widely accepted that each ARDS subphenotype has distinct functional, biological, and mechanistic differences, there are crucial gaps in our knowledge, hindering the translation to bedside application. First of all, the underlying driving biological factors are still largely unknown, and secondly, there is currently no option for fast and easy identification of ARDS subphenotypes. This narrative review aims to summarize the evidence in biological subphenotyping in ARDS and tries to point out the current issues that will need addressing before translation of biological subohenotypes into clinical practice will be possible.
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Journal of intensive care · Jan 2021
ReviewEnergy expenditure and indirect calorimetry in critical illness and convalescence: current evidence and practical considerations.
The use of indirect calorimetry is strongly recommended to guide nutrition therapy in critically ill patients, preventing the detrimental effects of under- and overfeeding. However, the course of energy expenditure is complex, and clinical studies on indirect calorimetry during critical illness and convalescence are scarce. Energy expenditure is influenced by many individual and iatrogenic factors and different metabolic phases of critical illness and convalescence. ⋯ However, the superiority of IC-guided nutritional therapy has not yet been unequivocally proven in clinical trials and many practical aspects and pitfalls should be taken into account when measuring energy expenditure in critically ill patients. Furthermore, the contribution of endogenously produced energy cannot be measured. Nevertheless, routine use of indirect calorimetry to aid personalized nutrition has strong potential to improve nutritional status and consequently, the long-term outcome of critically ill patients.