Articles: critical-illness.
-
Acta Anaesthesiol Scand · Apr 2022
Review Meta AnalysisTreatments of new-onset atrial fibrillation in critically ill patients: a systematic review with meta-analysis.
New-onset atrial fibrillation (NOAF) is common in hospitalised patients with critical illness and associated with worse outcomes. Several interventions are available in the management of NOAF, but the overall effectiveness and safety of these interventions compared with placebo or no treatment are unknown. ⋯ The existing data are insufficient to firmly conclude on effects of any intervention against NOAF on any outcome in hospitalised patients with critical illness. Randomised trials of the most frequently used interventions against NOAF are warranted in these patients.
-
Semin Respir Crit Care Med · Apr 2022
New Insights in the Pathophysiology of Hospital- and Ventilator-Acquired Pneumonia: A Complex Interplay between Dysbiosis and Critical-Illness-Related Immunosuppression.
Both hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) have long been considered as diseases resulting from the invasion by pathogens of a previously sterile lung environment. Based on this historical understanding of their pathophysiology, our approaches for the prevention and treatment have significantly improved the outcomes of patients, but treatment failures remain frequent. Recent studies have suggested that the all-antimicrobial therapy-based treatment of pneumonia has reached a glass ceiling. ⋯ We proposed that HAP and VAP should be considered as a state of dysbiosis, defined as the emergence of a dominant pathogen thriving at the same time from the catastrophic collapse of the fragile ecosystem of the lower respiratory tract and from the development of critical-illness-related immunosuppression. This multidimensional approach to the pathophysiology of HAP and VAP holds the potential to achieve future successes in research and critical care. Microbiome and mucosal immunity can indeed be manipulated and used as adjunctive therapies or targets to prevent or treat pneumonia.
-
Critical care medicine · Apr 2022
Observational StudyThe Association Between the Decision to Withdraw Life-Sustaining Therapy and Patient Mortality in U.K. ICUs.
Differences in decisions to limit life-sustaining therapy are often supported by perceptions that patients receive unnecessary and expensive treatment which provide negligible survival benefit. However, the assumption behind those beliefs-that is, that life-sustaining therapy provides no significant marginal survival benefit-remains unproven. Our objective was to quantify the effects of variations in decisions to withdraw or withhold life-sustaining treatment on 180-day mortality in critically ill patients. ⋯ Decision to withdraw or withhold life-sustaining treatment in critically ill adults in the United Kingdom was associated with increased 180-day mortality in the marginal patients. The increased mortality from a decision to withdraw or withhold life-sustaining treatment in the marginal patient may be informative when establishing patients' preferences and evaluating the cost-effectiveness of intensive treatments.
-
Observational Study
Enteral nutrition interruptions in the intensive care unit: A prospective study.
The aim of this study was to provide insight into the causes, frequency, and periods of enteral nutrition interruption (ENI) that occur in the intensive care unit (ICU). ⋯ The prevalence of unplanned ENIs in ICU patients is highest in the first 3 d of admission. The main cause of ENIs was diagnostic reasons. The ENIs resulted in an average of approximately 25% of patients failing to meet calculated caloric and protein requirements during the first 4 d of admission.