المؤلفون: Neus Montserrat, Joaquim Sol, Javier Trujillano, Mariona Badia, Luis Serviá, Manuel Portero-Otin, Mariona Jové, Reinald Pamplona

المصدر: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Vol 27, Iss 1, Pp 1-10 (2019)
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Repositorio Abierto de la UdL
Universitad de Lleida
Recercat. Dipósit de la Recerca de Catalunya
instname

مصطلحات موضوعية: Male, Myristic acid, Pilot Projects, Critical Care and Intensive Care Medicine, Gastroenterology, law.invention, chemistry.chemical_compound, Plasma, Catecholamines, Traumatic brain injury, law, Prospective Studies, Original Research, chemistry.chemical_classification, Trauma Severity Indices, Fatty Acids, Tryptophan, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Middle Aged, Intensive care unit, Intensive Care Units, Epinephrine, Treatment Outcome, Emergency Medicine, Metabolome, Biomarker (medicine), Female, Multiple traumatism, Metabolic Networks and Pathways, medicine.drug, Adult, medicine.medical_specialty, Sensitivity and Specificity, Metabolomics, Internal medicine, medicine, Humans, Mortality, Aged, business.industry, Fatty acid, Odds ratio, Biomarker, lcsh:RC86-88.9, chemistry, Spain, Wounds and Injuries, business, Biomarkers, Chromatography, Liquid

الوصف: Background: We wanted to define metabolomic patterns in plasma to predict a negative outcome in severe trauma patients. Methods: A prospective pilot study was designed to evaluate plasma metabolomic patterns, established by liquid chromatography coupled to mass spectrometry, in patients allocated to an intensive care unit (in the University Hospital Arnau de Vilanova, Lleida, Spain) in the first hours after a severe trauma (n = 48). Univariate and multivariate statistics were employed to establish potential predictors of mortality. Results: Plasma of patients non surviving to trauma (n = 5) exhibited a discriminating metabolomic pattern, involving basically metabolites belonging to fatty acid and catecholamine synthesis as well as tryptophan degradation pathways. Thus, concentration of several metabolites exhibited an area under the receiver operating curve (ROC) higher than 0.84, including 3-indolelactic acid, hydroxyisovaleric acid, phenylethanolamine, cortisol, epinephrine and myristic acid. Multivariate binary regression logistic revealed that patients with higher myristic acid concentrations had a non-survival odds ratio of 2.1 (CI 95% 1.1–3.9). Conclusions: Specific fatty acids, catecholamine synthesis and tryptophan degradation pathways could be implicated in a negative outcome after trauma. The metabolomic study of severe trauma patients could be helpful for biomarker proposal. This work has been partially supported by the IRBLleida biobank and RETICS BIOBANCOS RD09/0076/00059, the Spanish Ministry of Economy and Competitiveness, Institute of Health Carlos III (PI 17–00134) and the Generalitat of Catalonia (2017SGR969). FEDER Funds are also acknowledged: “A way to make Europe”. MJ is a professor under the Serra Hunter program (Generalitat de Catalunya).

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::4ad6ec2bb7944132ca7120c4b1f80547Test
http://link.springer.com/article/10.1186/s13049-019-0631-5Test

المؤلفون: Pasquale Nardelli, Roberto Kalil Filho, Rafael Alves Franco, Ludhmila Abrahão Hajjar, Giovanni Landoni, Isabela Bispo Santos da Silva Costa, Thomas Scheeren, Fabio Biscegli Jatene, C Park, Juliano Pinheiro de Almeida, Suely Zefferino, Gisele Queiroz de Oliveira, Elisandra Cristina Trevisan Calvo Arita, Marilde de Albuquerque Piccioni, Ligia Cristina Camara Cunha, Filomena Regina Barbosa Gomes Galas, Julia Tizue Fukushima

المساهمون: Franco, R. A., de Almeida, J. P., Landoni, G., Scheeren, T. W. L., Galas, F. R. B. G., Fukushima, J. T., Zefferino, S., Nardelli, P., de Albuquerque Piccioni, M., Arita, E. C. T. C., Park, C. H. L., Cunha, L. C. C., de Oliveira, G. Q., Costa, I. B. S. S., Kalil Filho, R., Jatene, F. B., Hajjar, L. A., Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE)

المصدر: Annals of Intensive Care, 11(1):15. SpringerOpen
Annals of Intensive Care
Annals of Intensive Care, Vol 11, Iss 1, Pp 1-9 (2021)

مصطلحات موضوعية: Cardiac output, medicine.medical_specialty, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, Dobutamine, Inotropes, medicine, Myocardial infarction, Low cardiac output syndrome, Mortality, Stroke, Ejection fraction, Goal-directed therapy, business.industry, Research, Major cardiovascular events, lcsh:Medical emergencies. Critical care. Intensive care. First aid, 030208 emergency & critical care medicine, lcsh:RC86-88.9, Cardiac surgery, medicine.disease, Intensive care unit, Cardiology, Inotrope sparing, Randomized clinical trial, business, medicine.drug

الوصف: Background The detrimental effects of inotropes are well-known, and in many fields they are only used within a goal-directed therapy approach. Nevertheless, standard management in many centers includes administering inotropes to all patients undergoing cardiac surgery to prevent low cardiac output syndrome and its implications. Randomized evidence in favor of a patient-tailored, inotrope-sparing approach is still lacking. We designed a randomized controlled noninferiority trial in patients undergoing cardiac surgery with normal ejection fraction to assess whether an dobutamine-sparing strategy (in which the use of dobutamine was guided by hemodynamic evidence of low cardiac output associated with signs of inadequate tissue perfusion) was noninferior to an inotrope-to-all strategy (in which all patients received dobutamine). Results A total of 160 patients were randomized to the dobutamine-sparing strategy (80 patients) or to the dobutamine-to-all approach (80 patients). The primary composite endpoint of 30-day mortality or occurrence of major cardiovascular complications (arrhythmias, acute myocardial infarction, low cardiac output syndrome and stroke or transient ischemic attack) occurred in 25/80 (31%) patients of the dobutamine-sparing group (p = 0.74) and 27/80 (34%) of the dobutamine-to-all group. There were no significant differences between groups regarding the incidence of acute kidney injury, prolonged mechanical ventilation, intensive care unit or hospital length of stay. Discussion Although it is common practice in many centers to administer inotropes to all patients undergoing cardiac surgery, a dobutamine-sparing strategy did not result in an increase of mortality or occurrence of major cardiovascular events when compared to a dobutamine-to-all strategy. Further research is needed to assess if reducing the administration of inotropes can improve outcomes in cardiac surgery. Trial registration ClinicalTrials.gov, NCT02361801. Registered Feb 2nd, 2015. https://clinicaltrials.gov/ct2/show/NCT02361801Test

وصف الملف: application/pdf

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::c1ad9b019c18b224166de3d85bb758c0Test

المؤلفون: Julien Textoris, Kada Klouche, Erika Parmentier, Daniel Mathieu, François Barbier, Nicolas Terzi, Dominique Demeure Dit Latte, Camille Thieffry, Aubin Kpodji, Bertrand Sauneuf, Damien du Cheyron, Emmanuel Pontis, Alexandre Herbland, Clément Hoffmann, François Dépret, Emmanuel Guerot, Sandrine Wiramus, Jean-Michel Constantin, Romain Pirracchio, Vincent Mallet, Matthieu Legrand, Guillaume Schnell, Laure Monplaisir, Bruno Mégarbane, Laura Daoud, Jules Creveaux, Florian Robin, Thomas Leclerc, Djillali Annane, Thomas Lafon, Thomas Clavier

المساهمون: F-CRIN, INICRCT network, Paris, Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Burn Center, Percy Military Teaching Hospital, BP 406, 101, avenue Henri-Barbusse, 92141, Clamart, Intensive Care Unit and Hyperbaric Center, Lille University Hospital, F-59037, Lille, Service médical des soins intensifs [CHU Raymond Poincaré], Hôpital Raymond Poincaré [AP-HP], University of Versailles SQY and INSERM, 104 Boulevard Raymond Poincaré, 92380, Garches, Service Anesthésie et Réanimation [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Centre de traitement des grands brûlés Hopital de la Conception APHM, 147 boulevard Baille, 13005, Marseille, Centre hospitalier universitaire de Nantes (CHU Nantes), Intensive Care Unit, Anaesthesia and Critical Care Department, Hôtel Dieu-HME, CHU Nantes, Nantes, Centre de traitement des grands brûlés Hopital de Mercy,1 Allée du Château, 57245 Ars-Laquenexy-C.H.R Metz-, Thionville, Physiopathologie de l'immunodépression associée aux réponses inflammatoires systémiques - EA 7426 (PI3), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, Anesthesiology and Critical Care Medicine, CHU Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Intensive Care Medicine Department, CHU de Rennes, 2 rue Henri Le Guilloux, 35033, Rennes CEDEX 9, Service de réanimation médico-chirurgicale, Groupe Hospitalier du Havre-Hôpital Jacques Monod, Montivilliers, Institut de Recherche en Horticulture et Semences (IRHS), Université d'Angers (UA)-Institut National de la Recherche Agronomique (INRA)-AGROCAMPUS OUEST, Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro), Génétique, Reproduction et Développement (GReD ), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020]), Service de réanimation médicale [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), CHU Grenoble, Centre Hospitalier Public du Cotentin (CHPC), Service de réanimation médicale [CHU HEGP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Centre d'Investigation Clinique de Limoges (CIC1435), CHU Limoges-Institut National de la Santé et de la Recherche Médicale (INSERM), Hopital saint louis (LA ROCHELLE - Hôpital Saint Louis), CH La Rochelle, Variabilité de réponse aux Psychotropes (VariaPsy - U1144), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Descartes - Paris 5 (UPD5), Institut de Physique du Globe de Paris (IPGP), Centre National de la Recherche Scientifique (CNRS)-Université de La Réunion (UR)-Université Paris Diderot - Paris 7 (UPD7)-IPG PARIS-Institut national des sciences de l'Univers (INSU - CNRS), Institut Cochin (UMR_S567 / UMR 8104), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Anesthésie-Réanimation, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Université Paris Diderot - Paris 7 (UPD7), AP-HP, GH Saint Louis-Lariboisière, Paris, AP-HP Hôpital Raymond Poincaré [Garches], Anesthesiology and Critical Care Medicine, Hospices Civils de Lyon-Université Claude Bernard Lyon 1, Lyon, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Génétique, Reproduction et Développement - Clermont Auvergne (GReD ), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Clermont Auvergne (UCA)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Public du Cotentin [Cherbourg-Octeville] (CHPC), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Optimisation Thérapeutique en Neuropsychopharmacologie (VariaPsy - U1144), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5), Institut national des sciences de l'Univers (INSU - CNRS)-IPG PARIS-Université Paris Diderot - Paris 7 (UPD7)-Université de La Réunion (UR)-Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Descartes - Paris 5 (UPD5), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Lariboisière-Université Paris Diderot - Paris 7 (UPD7), Physiopathologie de l'immunodépression associée aux réponses inflammatoires systémiques / Pathophysiology of Injury-induced Immunosuppression (PI3), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS), CH Centre Hospitalier Public du Cotentin (CHPC), Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut national des sciences de l'Univers (INSU - CNRS)-Université Paris Diderot - Paris 7 (UPD7)-Université de La Réunion (UR)-Institut de Physique du Globe de Paris (IPG Paris)-Centre National de la Recherche Scientifique (CNRS), MORNET, Dominique

المصدر: Critical Care
Critical Care, Vol 23, Iss 1, Pp 1-10 (2019)
Critical care (London, England), vol 23, iss 1
Critical Care, BioMed Central, 2019, 23 (1), pp.421. ⟨10.1186/s13054-019-2706-0⟩
Critical Care, 2019, 23 (1), pp.421. ⟨10.1186/s13054-019-2706-0⟩

مصطلحات موضوعية: Male, Kidney Disease, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Critical Care and Intensive Care Medicine, Medical and Health Sciences, law.invention, 0302 clinical medicine, law, Hydroxocobalamin, Smoke, Odds Ratio, Acute kidney injury, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Acute Kidney Injury, Middle Aged, Smoke Inhalation Injury, Intensive care unit, 3. Good health, [SDV] Life Sciences [q-bio], Intensive Care Units, Female, France, medicine.drug, Adult, medicine.medical_specialty, Smoke inhalation, Clinical Trials and Supportive Activities, Renal and urogenital, Burn, 03 medical and health sciences, Clinical Research, Intensive care, Internal medicine, medicine, Humans, Mortality, Retrospective Studies, business.industry, Research, 030208 emergency & critical care medicine, Retrospective cohort study, Odds ratio, lcsh:RC86-88.9, medicine.disease, Emergency & Critical Care Medicine, Good Health and Well Being, Hematinics, Cyanide poisoning, business

الوصف: Background The use of hydroxocobalamin has long been advocated for treating suspected cyanide poisoning after smoke inhalation. Intravenous hydroxocobalamin has however been shown to cause oxalate nephropathy in a single-center study. The impact of hydroxocobalamin on the risk of acute kidney injury (AKI) and survival after smoke inhalation in a multicenter setting remains unexplored. Methods We conducted a multicenter retrospective study in 21 intensive care units (ICUs) in France. We included patients admitted to an ICU for smoke inhalation between January 2011 and December 2017. We excluded patients discharged at home alive within 24 h of admission. We assessed the risk of AKI (primary endpoint), severe AKI, major adverse kidney (MAKE) events, and survival (secondary endpoints) after administration of hydroxocobalamin using logistic regression models. Results Among 854 patients screened, 739 patients were included. Three hundred six and 386 (55.2%) patients received hydroxocobalamin. Mortality in ICU was 32.9% (n = 243). Two hundred eighty-eight (39%) patients developed AKI, including 186 (25.2%) who developed severe AKI during the first week. Patients who received hydroxocobalamin were more severe and had higher mortality (38.1% vs 27.2%, p = 0.0022). The adjusted odds ratio (95% confidence interval) of AKI after intravenous hydroxocobalamin was 1.597 (1.055, 2.419) and 1.772 (1.137, 2.762) for severe AKI; intravenous hydroxocobalamin was not associated with survival or MAKE with an adjusted odds ratio (95% confidence interval) of 1.114 (0.691, 1.797) and 0.784 (0.456, 1.349) respectively. Conclusion Hydroxocobalamin was associated with an increased risk of AKI and severe AKI but was not associated with survival after smoke inhalation. Trial registration ClinicalTrials.gov, NCT03558646

وصف الملف: application/pdf

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::48d242633efc8f890f1b91861e38f6d6Test
https://pubmed.ncbi.nlm.nih.gov/31870461Test

المؤلفون: Yoshihiko Nakamura, Taisuke Kitamura, Fumiaki Kiyomi, Mineji Hayakawa, Kota Hoshino, Yasumasa Kawano, Reiko Yamasaki, Takeshi Nishida, Mariko Mizunuma, Hiroyasu Ishikura, Japan Septic Disseminated Intravascular Coagulation (JSEPTIC DIC) study group

المصدر: Critical Care, Vol 21, Iss 1, Pp 1-9 (2017)
Critical Care

مصطلحات موضوعية: medicine.medical_specialty, medicine.medical_treatment, Polymyxin B hemoperfusion, Critical Care and Intensive Care Medicine, law.invention, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, law, Internal medicine, Septic shock, Propensity score matching, medicine, Clinical endpoint, Humans, 030212 general & internal medicine, Intensive care unit-free days, Mortality, Polymyxin B, business.industry, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, 030208 emergency & critical care medicine, Odds ratio, lcsh:RC86-88.9, Hemoperfusion, medicine.disease, Shock, Septic, Intensive care unit, Confidence interval, Anti-Bacterial Agents, Surgery, Endotoxins, business, medicine.drug

الوصف: Background The purpose of this study was to investigate whether polymyxin B hemoperfusion (PMX-HP) improves the survival of patients with septic shock. Methods This was a retrospective, multicenter study conducted on patients treated during a 3-year period. We performed propensity-score analyses of the Japan Septic Disseminated Intravascular Coagulation (JSEPTIC DIC) study database. The study included data on 1723 patients with septic shock aged 16 years or older. Furthermore, we divided patients into to PMX-HP- and non-PMX-HP-treated groups. The primary endpoint was all-cause hospital mortality; secondary endpoints included intensive care unit (ICU) mortality and number of ICU-free days (ICUFDs) in the first 28 days. Results Of 1,723 eligible patients, 522 had received PMX-HP. Propensity score matching created 262 matched pairs (i.e., 262 patients in each of the non-PMX-HP and PMX-HP groups). The proportion of all-cause hospital mortality was significantly lower in the PMX-HP group than in the non-PMX-HP group (32.8% vs. 41.2%; odds ratio (OR): 0.681; 95% confidence interval (CI): 0.470–0.987; P = 0.042). The number of ICUFD in the first 28 days was significantly higher in the PMX-HP group than in the non-PMX-HP group (18 (0-22) vs. 14 (0-22) days, respectively; P = 0.045). On the other hand, there was no significant difference in ICU mortality between the two groups (21.8% vs. 24.4%; OR: 0.844; CI: 0.548–1.300; P = 0.443). Conclusions Our results strongly suggest that PMX-HP reduces all-cause hospital mortality and length of ICU stay in patients with septic shock. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1712-3) contains supplementary material, which is available to authorized users.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::52c4a26ebc0bfb877327a65f97237e74Test
http://link.springer.com/article/10.1186/s13054-017-1712-3Test

المؤلفون: In Ae Song, Hee-Joon Bae, Jae Ho Lee, You Hwan Jo, Tak Kyu Oh, Young Tae Jeon, Cheong Lim

المصدر: Annals of Intensive Care
Annals of Intensive Care, Vol 9, Iss 1, Pp 1-8 (2019)

مصطلحات موضوعية: medicine.medical_specialty, Population, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, Glucocorticoid, law, Internal medicine, Medicine, Intensive care unit, Mortality, education, education.field_of_study, business.industry, Proportional hazards model, Research, Hazard ratio, lcsh:Medical emergencies. Critical care. Intensive care. First aid, 030208 emergency & critical care medicine, Retrospective cohort study, lcsh:RC86-88.9, Confidence interval, 030228 respiratory system, Methylprednisolone, Prednisolone, business, medicine.drug

الوصف: Background This study aimed to investigate the association between preadmission glucocorticoid (GC) therapy and 30-day mortality in critically ill patients following admission to an intensive care unit (ICU). We aimed to determine whether this association differed according to daily GC dosage and type. We conducted a retrospective cohort study of adult patients admitted to a single tertiary academic hospital ICU from January 2012 to December 2017. We classified the patients regularly undergoing oral GC therapy as preadmission GC users, and those with no history of GC use were classified as non-GC users. Results The study included 24,929 patients, of whom 816 (3.3%) were preadmission GC users. Thirty-day mortality in preadmission GC users (173 of 816 patients) was 21.2% compared to 8.8% (2113 of 24,113 patients) in non-GC users. Multivariate Cox regression analysis showed that preadmission GC users had a 1.62-fold increase in 30-day mortality compared to non-GC users [hazard ratio (HR) 1.62, 95% confidence interval (CI) 1.29–2.03, P 5 mg of prednisolone in preadmission GC users showed 1.45-fold (HR 1.45, 95% CI 1.03–2.03, P = 0.033) and 1.67-fold (HR 1.67, 95% CI 1.25–2.24, P = 0.001) increases, respectively, in 30-day mortality after ICU admission. Moreover, prednisolone, methylprednisolone, and dexamethasone users in the preadmission GC users group showed 1.56-fold (HR 1.56, 95% CI 1.21–2.01, P = 0.001), 1.90-fold (HR 1.90, 95% CI 1.12–3.25, P = 0.018), and 1.30-fold (HR 1.30, 95% CI 1.05–1.50, P = 0.042) increases, respectively, in 30-day mortality compared to non-GC users. Conclusion Preadmission GC use among critically ill patients was associated with an increased 30-day mortality after ICU admission compared to non-GC use. This association was more prevalent in preadmission GC users with diabetes mellitus and in preadmission GC users who took > 5 mg/day of prednisolone and methylprednisolone. Electronic supplementary material The online version of this article (10.1186/s13613-019-0489-8) contains supplementary material, which is available to authorized users.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::633c7c21b013833bb1c385b7a297e6dbTest
http://europepmc.org/articles/PMC6338611Test

المؤلفون: Jérôme Allyn, Romain Persichini, Nicolas Allou, Olivier Martinet, David Vandroux, Thomas Aujoulat, Cyril Ferdynus, Hugo Lo Pinto, Bruno Bouchet, Eric Braunberger, Shamir Vally

المصدر: Annals of Intensive Care
Annals of Intensive Care, Vol 9, Iss 1, Pp 1-9 (2019)

مصطلحات موضوعية: Levosimendan, medicine.medical_treatment, Weaning, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Extracorporeal membrane oxygenation, Medicine, Mortality, Ejection fraction, business.industry, Cardiogenic shock, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, 030208 emergency & critical care medicine, Retrospective cohort study, lcsh:RC86-88.9, medicine.disease, Intensive care unit, 030228 respiratory system, Anesthesia, Propensity score matching, business, medicine.drug

الوصف: Background Few data are available on the impact of levosimendan in refractory cardiogenic shock patients undergoing peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO). The aim of this study was to evaluate the impact of levosimendan on VA-ECMO weaning in patients hospitalized in intensive care unit (ICU). Methods This retrospective cohort study was conducted in a French university hospital from 2010 to 2017. All patients hospitalized in ICU undergoing VA-ECMO were consecutively evaluated. Results A total of 150 patients undergoing VA-ECMO were eligible for the study. Thirty-eight propensity-matched patients were evaluated in the levosimendan group and 65 in the non-levosimendan group. In patients treated with levosimendan, left ventricular ejection fraction had increased from 21.5 ± 9.1% to 30.7 ± 13.5% (P

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::d17a3c4ceaf5aa71a02d40f433de82a8Test
https://pubmed.ncbi.nlm.nih.gov/30707314Test

المؤلفون: Annemieke Oude Lansink-Hartgring, Lara Hessels, Miriam Zeillemaker-Hoekstra, Maarten W. N. Nijsten

المساهمون: Microbes in Health and Disease (MHD), Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE)

المصدر: Annals of Intensive Care
Annals of Intensive Care, Vol 8, Iss 1, Pp 1-8 (2018)
Annals of Intensive Care, 8:97. SpringerOpen

مصطلحات موضوعية: NA+ STORAGE, HYPERNATREMIA, Sodium, chemistry.chemical_element, BLOOD-PRESSURE, 030204 cardiovascular system & hematology, TISSUE SODIUM, Critical Care and Intensive Care Medicine, Chloride, CAPACITY, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Extracellular fluid, medicine, Intensive care unit, RETENTION, Perspiration, HYPERTENSION, business.industry, Research, MORTALITY, lcsh:Medical emergencies. Critical care. Intensive care. First aid, HUMANS, 030208 emergency & critical care medicine, lcsh:RC86-88.9, Intracellular volume, medicine.disease, Blood pressure, chemistry, Anesthesia, Hypernatremia, medicine.symptom, business, Extracellular volume, SKIN, medicine.drug, Kidney disease

الوصف: Background Nonosmotic sodium storage has been reported in animals, healthy individuals and patients with hypertension, hyperaldosteronism and end-stage kidney disease. Sodium storage has not been studied in ICU patients, who frequently receive large amounts of sodium chloride-containing fluids. The objective of our study was to estimate sodium that cannot be accounted for by balance studies in critically ill patients. Chloride was also studied. We used multiple scenarios and assumptions for estimating sodium and chloride balances. Methods We retrospectively analyzed patients admitted to the ICU after cardiothoracic surgery with complete fluid, sodium and chloride balance data for the first 4 days of ICU treatment. Balances were obtained from meticulously recorded data on intake and output. Missing extracellular osmotically active sodium (MES) was calculated by subtracting the expected change in plasma sodium from the observed change in plasma sodium derived from balance data. The same method was used to calculate missing chloride (MEC). To address considerable uncertainties on the estimated extracellular volume (ECV) and perspiration rate, various scenarios were used in which the size of the ECV and perspiration were varied. Results A total of 38 patients with 152 consecutive ICU days were analyzed. In our default scenario, we could not account for 296 ± 35 mmol of MES in the first four ICU days. The range of observed MES in the five scenarios varied from 111 ± 27 to 566 ± 41 mmol (P

وصف الملف: application/pdf

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::4a52f7feb846ac785f48424553b1a16eTest
https://doi.org/10.1186/s13613-018-0442-2Test

المؤلفون: Shutang Han, Qiuhua Chen, Jun Lu, Mingqi Chen, Hua Jiang, Lu Cheng, Jing Yan

المصدر: Critical Care
Critical Care, Vol 23, Iss 1, Pp 1-14 (2019)

مصطلحات موضوعية: medicine.medical_specialty, Vasopressins, Dopamine, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, Norepinephrine, 0302 clinical medicine, Catecholamines, Randomized controlled trial, law, Internal medicine, Sepsis, Septic shock, Odds Ratio, Medicine, Humans, Myocardial infarction, Hemodynamic, Mortality, Adverse effect, Vasoactive agent, Randomized Controlled Trials as Topic, business.industry, Incidence (epidemiology), Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, 030208 emergency & critical care medicine, lcsh:RC86-88.9, medicine.disease, Intensive care unit, Shock, Septic, Dobutamine, business, Terlipressin, Vasopressin, medicine.drug

الوصف: Background Catecholamines, especially norepinephrine, are the most frequently used vasopressors for treating patients with septic shock. During the recent decades, terlipressin, vasopressin V1A agonist, and even Ca2+ sensitizer were increasingly used by physicians. The aim of this study is to compare the efficacy of such different kinds of vasoactive medications on mortality among patients with septic shock. Methods Relevant randomized controlled trials were identified by searching PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials updated to February 22, 2018. A network meta-analysis was performed to evaluate the effect of different types of vasoactive medications. The primary outcome was 28-day mortality. Intensive care unit (ICU) mortality, hospital and ICU length of stay (LOS), and adverse events were also assessed. Results A total of 43 trials with 5767 patients assessing 17 treatment modalities were included. Treatments ranking based on surface under the cumulative ranking curve values from largest to smallest were NE/DB 85.9%, TP 75.1%, NE/EP 74.6%, PI 74.1%, EP 72.5%, VP 66.1%, NE 59.8%, PE 53.0%, DA 42.1%, DX 38.2%, SP 27.0%, PA 24.3%, EX 22.8%, LE 21.5%, and DB 13.3% for 28-day mortality. Treatments ranking for ICU mortality were TP/NE 86.4%, TP 80.3%, TP/DB/NE 65.7%, VP/NE 62.8%, NE 57.4%, VP 56.5%, PE 48.4%, DA 33.0%, PA 27.5%, LE 22.1%, and DB 9.9%. The incidence of myocardial infarction was reported with NE/EP 3.33% (n = 1 of 30), followed by EP 3.11% (n = 5 of 161), and then VP 3.10% (n = 19 of 613), NE 3.03% (n = 43 of 1417), DA 2.21% (n = 19 of 858), NE/DB 2.01% (n = 4 of 199), LE 1.16% (n = 3 of 258), and PA 0.39% (n = 1 of 257). The incidence of arrhythmia was reported with DA 26.01% (n = 258 of 992), followed by EP 22.98% (n = 37 of 161), and then NE/DB 20.60% (n = 41 of 199), NE/EP 20.0% (n = 6 of 30), NE 8.33% (n = 127 of 1525), LE 5.81% (n = 15 of 258), PA 2.33% (n = 6 of 257), and VP 1.67% (n = 10 of 600). Conclusions The use of norepinephrine plus dobutamine was associated with lower 28-day mortality for septic shock, especially among patients with lower cardiac output. Electronic supplementary material The online version of this article (10.1186/s13054-019-2427-4) contains supplementary material, which is available to authorized users.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::c8d0b5c552ec6decb2c3d44e1af64feaTest
https://pubmed.ncbi.nlm.nih.gov/31088524Test

المؤلفون: Graziela dos Santos Rocha Ferreira, Gisele Queiroz de Oliveira, C Park, Filomena Regina Barbosa Gomes Galas, Claudia Marques Simões, Ulysses Ribeiro, Evgeny Fominskiy, Patricia Inês Cândido, R Nakamura, Giovanni Landoni, Roberto Kalil Filho, Elisangela Pinto Marinho de Almeida, Rafael Alves Franco, Stephanie Itala Rizk, Juliano Pinheiro de Almeida, L Camara, A Gerent, Ludhmila Abrahão Hajjar, Cintia Rosa Tavares, Julia Tizue Fukushima

المساهمون: Gerent, Aline Rejane Muller, Almeida, Juliano Pinheiro, Fominskiy, Evgeny, Landoni, Giovanni, de Oliveira, Gisele Queiroz, Rizk, Stephanie Itala, Fukushima, Julia Tizue, Simoes, Claudia Marque, Ribeiro, Ulysse, Park, Clarice Lee, Nakamura, Rosana Ely, Franco, Rafael Alve, Cândido, Patricia Inê, Tavares, Cintia Rosa, Camara, Ligia, dos Santos Rocha Ferreira, Graziela, de Almeida, Elisangela Pinto Marinho, Filho, Roberto Kalil, Galas, Filomena Regina Barbosa Gome, Hajjar, Ludhmila Abrahão

المصدر: Repositório Institucional da USP (Biblioteca Digital da Produção Intelectual)
Universidade de São Paulo (USP)
instacron:USP
Critical Care
Critical Care, Vol 22, Iss 1, Pp 1-11 (2018)

مصطلحات موضوعية: Male, Risk, High-risk surgery, Cardiac index, SEPSE, Hemodynamics, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Heart Rate, Dobutamine, Neoplasms, Medicine, Humans, Meta-analysi, 030212 general & internal medicine, Postoperative Period, Mortality, Cancer, Aged, Aged, 80 and over, Goal-directed therapy, business.industry, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, 030208 emergency & critical care medicine, lcsh:RC86-88.9, Perioperative, Middle Aged, Intensive care unit, Meta-analysis, Treatment Outcome, Relative risk, Anesthesia, Female, Randomized clinical trial, business, Goals, medicine.drug

الوصف: Background Perioperative goal-directed hemodynamic therapy (GDHT) has been advocated in high-risk patients undergoing noncardiac surgery to reduce postoperative morbidity and mortality. We hypothesized that using cardiac index (CI)-guided GDHT in the postoperative period for patients undergoing high-risk surgery for cancer treatment would reduce 30-day mortality and postoperative complications. Methods A randomized, parallel-group, superiority trial was performed in a tertiary oncology hospital. All adult patients undergoing high-risk cancer surgery who required intensive care unit admission were randomly allocated to a CI-guided GDHT group or to a usual care group. In the GDHT group, postoperative therapy aimed at CI ≥ 2.5 L/min/m2 using fluids, inotropes and red blood cells during the first 8 postoperative hours. The primary outcome was a composite endpoint of 30-day all-cause mortality and severe postoperative complications during the hospital stay. A meta-analysis was also conducted including all randomized trials of postoperative GDHT published from 1966 to May 2017. Results A total of 128 patients (64 in each group) were randomized. The primary outcome occurred in 34 patients of the GDHT group and in 28 patients of the usual care group (53.1% vs 43.8%, absolute difference 9.4 (95% CI, − 7.8 to 25.8); p = 0.3). During the 8-h intervention period more patients in the GDHT group received dobutamine when compared to the usual care group (55% vs 16%, p

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::5a6fdca2564804f7d07de5a5aefa6b52Test

المؤلفون: Ruiqiang Zheng, Jiangquan Yu, Qi-hong Chen, Hua Lin, Hua-Ling Wang, Jun Shao

المصدر: Critical Care
Critical Care, Vol 21, Iss 1, Pp 1-11 (2017)

مصطلحات موضوعية: Adult, medicine.medical_specialty, Levosimendan, medicine.medical_treatment, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, 030202 anesthesiology, law, Internal medicine, Medicine, Humans, Renal replacement therapy, Mortality, Adverse effect, Simendan, Randomized Controlled Trials as Topic, Adult patients, business.industry, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Hydrazones, lcsh:RC86-88.9, Cardiac surgery, Prognosis, Intensive care unit, Pyridazines, Meta-analysis, Meta-analyses, Cardiology, business, medicine.drug

الوصف: Background Small trials suggest that levosimendan is associated with a favorable outcome in patients undergoing cardiac surgery. However, recently published larger-scale trials did not provide evidence for a similar benefit from levosimendan. We performed a meta-analysis to assess the survival benefits of levosimendan in patients undergoing cardiac surgery and to investigate its effects in subgroups of patients with preoperative low-ejection fraction (EF). Methods We identified randomized clinical trials through 20 April 2017 that investigated levosimendan therapy versus control in patients undergoing cardiac surgery. Individual patient data from each study were compiled. Meta-analyses were performed for primary outcomes, secondary outcomes and serious adverse events, and subgroup analyses according to the preoperative EF of enrolled patients were also conducted. The risk of bias was assessed using the Cochrane risk-of-bias tool. Results Seventeen studies involving a total of 2756 patients were included. Levosimendan therapy was associated with a significant reduction in 30-day mortality (RR 0.67; 95% CI, 0.49 to 0.93; p = 0.02) and reduced the risk of death in single-center trials (RR 0.49; 95% CI, 0.30 to 0.79; p = 0.004) and in subgroup trials of inferior quality (RR 0.39; 95% CI, 0.17 to 0.92; p = 0.02); however, in multicenter and in high-quality subgroup-analysis trials, no significant difference in mortality was observed between patients who received levosimendan therapy and controls (p > 0.05). However, in high-quality subgroup trials, levosimendan therapy was associated with reduced mortality in patients in a preoperative low-EF subgroup (RR 0.58; 95% CI, 0.38 to 0.88; p = 0.01). Similarly, only patients in the preoperative low-EF subgroup benefited in terms of reduced risk of renal replacement therapy (RR 0.54; 95% CI, 0.34 to 0.85; p = 0.007). Furthermore, levosimendan therapy was associated with a significant reduction in intensive care unit (ICU) length of stay (MDR −17.19; 95% CI, −34.43 to −2.94; p = 0.02). Conclusions In patients undergoing cardiac surgery, the benefit of levosimendan in terms of survival was not shown in multicenter or in high-quality trials; however, levosimendan therapy was associated with reduced mortality in patients with preoperative ventricular systolic dysfunction. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1848-1) contains supplementary material, which is available to authorized users.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::97620395942255b0493fc8d13f2ee9e6Test
http://europepmc.org/articles/PMC5645931Test