Articles: critical-illness.
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The effect of ramelteon, a melatonin receptor agonist, on survival in septic patients remains unknown. The purpose of this retrospective cohort study was to explore the relationship between ramelteon exposure and survival outcomes in septic patients. ⋯ This exploratory, retrospective study suggests an association between ramelteon exposure and reduced 30-day and 90-day mortality in septic patients compared with the non-exposure group. Considering the limitations of the retrospective design and the potential for unmeasured confounding, well-designed prospective studies and randomized controlled trials will be needed to confirm these findings.
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Randomized Controlled Trial
Use of continuous infusion technique with pre-filled elastic pumps for prevention of centrally inserted central catheter occlusion in critically ill patients: A feasibility study.
Flushing catheter seems to be a crucial procedure for preventing centrally inserted central catheter (CICC) occlusion, which can flush the liquid and blood attached to the lumen into the bloodstream. The continuous infusion technique is characterized by continuous perfusion of flushing fluid and maintaining positive pressure in the lumen, which has been demonstrated to effectively prevent peripheral indwelling needle occlusion. However, the use of continuous infusion technique in CICC care among critically ill patients has been rarely described. ⋯ In this study, continuous infusion technique with pre-filled elastic pumps was successfully used in critically ill patients for prevention of CICC occlusion, without major undesired effects. A larger cohort and a randomized clinical trial are warranted in order to establish its absolute efficacy in CICC care.
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Critical care medicine · Dec 2024
Sex-Specific Obesity Paradox in Critically Ill Patients With Severe Acute Kidney Injury: A Retrospective Analysis.
Although obesity is typically correlated with adverse outcomes in various diseases, certain acute critical illnesses exhibit a phenomenon known as the obesity paradox. This study evaluated sex-specific differences in the prognostic implications of the body mass index (BMI) of patients with severe acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT). ⋯ There were sex differences in the association between BMI and mortality in critically ill patients with severe AKI. Although the precise distribution of fat mass and muscle mass was not identified, obese male patients had a more favorable prognosis, which was not evident among female patients. These findings highlight the importance of considering sex-specific factors in understanding the complex relationship between obesity and mortality in critically ill patients with AKI.
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Observational Study
Lactate, lactate clearance, and lactate-to-albumin ratio in predicting mortality in patients with critical polytrauma: A retrospective observational study.
Lactate is a product of anaerobic metabolism used to determine prognosis in critically ill trauma patients. This study investigates the mortality-predictive performance of lactate, lactate clearance, and lactate-to-albumin ratio (LAR) on admission in patients with polytrauma in a tertiary center's intensive care unit (ICU). Polytrauma patients in the ICU between June 2019 and June 2022 were evaluated. ⋯ In receiver operating characteristics curve analysis, the cutoff value of lactate was ≥5.4, the area under the curve (AUC) was 0.75 (95% confidence interval [CI], 0.66-0.84), the cutoff value of lactate clearance was ≤39.2, AUC was 0.60, (95% CI, 0.51-0.69), and the cutoff value of LAR was value ≥1.50, AUC 0.83 (95% CI, 0.75-0.90). In critically ill polytrauma patients, LAR on ICU admission is an independent predictor of mortality and has acceptable prognostic value. LAR is superior to lactate and 24-hour lactate clearance in predicting mortality.