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    707 results match your criteria Anaesthesia and Intensive Care Medicine [Journal]

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    Position paper for the organization of ECMO programs for cardiac failure in adults.
    Intensive Care Med 2018 Feb 15. Epub 2018 Feb 15.
    Division of Pulmonary, Allergy, and Critical Care, Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital, 622 W168th St, PH 8E, Room 101, New York, NY, 10032, USA.
    Extracorporeal membrane oxygenation (ECMO) has been used increasingly for both respiratory and cardiac failure in adult patients. Indications for ECMO use in cardiac failure include severe refractory cardiogenic shock, refractory ventricular arrhythmia, active cardiopulmonary resuscitation for cardiac arrest, and acute or decompensated right heart failure. Evidence is emerging to guide the use of this therapy for some of these indications, but there remains a need for additional evidence to guide best practices. Read More

    Second consensus on the assessment of sublingual microcirculation in critically ill patients: results from a task force of the European Society of Intensive Care Medicine.
    Intensive Care Med 2018 Feb 6. Epub 2018 Feb 6.
    Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
    Purpose: Hand-held vital microscopes (HVMs) were introduced to observe sublingual microcirculatory alterations at the bedside in different shock states in critically ill patients. This consensus aims to provide clinicians with guidelines for practical use and interpretation of the sublingual microcirculation. Furthermore, it aims to promote the integration of routine application of HVM microcirculatory monitoring in conventional hemodynamic monitoring of systemic hemodynamic variables. Read More

    Correction to: Polymyxin B-immobilized hemoperfusion and mortality in critically ill adult patients with sepsis/septic shock: a systematic review with meta-analysis and trial sequential analysis.
    Intensive Care Med 2018 Feb;44(2):279-280
    Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124 Clinical Sciences Building, 8440-112 ST NW, Edmonton, Canada, T6G 2B7.
    Owing to an oversight by the authors, Figure 2 in this article was not the version intended for publication. The correct Figure 2, reproduced here, features footnote symbols and Figure 2b includes three studies as described in the main text. Read More

    Polymyxin B-immobilized hemoperfusion and mortality in critically ill adult patients with sepsis/septic shock: a systematic review with meta-analysis and trial sequential analysis.
    Intensive Care Med 2018 Feb 4;44(2):167-178. Epub 2017 Dec 4.
    Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124 Clinical Sciences Building, 8440-112 ST NW, Edmonton, Canada, T6G 2B7.
    Purpose: Polymyxin B-immobilized hemoperfusion (PMX-HP) is an adjuvant therapy for sepsis or septic shock that clears circulating endotoxin. Prior trials have shown that PMX-HP improves surrogate endpoints. We aimed to conduct an evidence synthesis to evaluate the efficacy and safety of PMX-HP in critically ill adult patients with sepsis or septic shock. Read More

    Hard and fast, but within limits: is there a trade-off of stroke volume index and diastolic pressure in paediatric resuscitation?
    Intensive Care Med 2018 Feb 3;44(2):254-256. Epub 2017 Oct 3.
    Respiratory, Critical Care and Anaesthesia (RCCA) Section in Infection, Immunity and Inflammation (III) Programme, UCL Great Ormond Street Institute of Child Health, London, UK.

    Acute hypoxemic respiratory failure in immunocompromised patients: the Efraim multinational prospective cohort study.
    Intensive Care Med 2017 Dec 25;43(12):1808-1819. Epub 2017 Sep 25.
    ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153, INSERM, Paris Diderot Sorbonne University and Service de Biostatistique et Information Médicale AP-HP, Hôpital Saint-Louis, Paris, France.
    Background: In immunocompromised patients with acute hypoxemic respiratory failure (ARF), initial management aims primarily to avoid invasive mechanical ventilation (IMV).

    Methods: To assess the impact of initial management on IMV and mortality rates, we performed a multinational observational prospective cohort study in 16 countries (68 centers).

    Results: A total of 1611 patients were enrolled (hematological malignancies 51. Read More

    Lung ultrasound for daily monitoring of ARDS patients on extracorporeal membrane oxygenation: preliminary experience.
    Intensive Care Med 2018 Jan 22;44(1):123-124. Epub 2017 Sep 22.
    Anesthesia and Intensive Care, Fondazione IRCCS Policlinico S. Matteo, Rianimazione I, Viale Golgi 19, 27100, Pavia, Italy.

    Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC).
    Intensive Care Med 2017 Dec 22;43(12):1764-1780. Epub 2017 Sep 22.
    Service of Neonatology and Pediatric Intensive Care, Department of Paediatrics, University Hospital of Geneva, Geneva, Switzerland.
    Purpose: Much of the common practice in paediatric mechanical ventilation is based on personal experiences and what paediatric critical care practitioners have adopted from adult and neonatal experience. This presents a barrier to planning and interpretation of clinical trials on the use of specific and targeted interventions. We aim to establish a European consensus guideline on mechanical ventilation of critically children. Read More

    The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (≥ 80 years).
    Intensive Care Med 2017 Dec 21;43(12):1820-1828. Epub 2017 Sep 21.
    Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, Paris, France.
    Purpose: Very old critical ill patients are a rapid expanding group in the ICU. Indications for admission, triage criteria and level of care are frequently discussed for such patients. However, most relevant outcome studies in this group frequently find an increased mortality and a reduced quality of life in survivors. Read More

    The intensive care medicine research agenda for airways, invasive and noninvasive mechanical ventilation.
    Intensive Care Med 2017 Sep 7;43(9):1352-1365. Epub 2017 Aug 7.
    Punmonary and Critical Care Medicine, Regions Hospital, University of Minnesota, Minneapolis/Saint Paul, MN, USA.
    In an important sense, support of the respiratory system has been a defining characteristic of intensive care since its inception. The pace of basic and clinical research in this field has escalated over the past two decades, resulting in palpable improvement at the bedside as measured by both efficacy and outcome. As in all medical research, however, novel ideas built upon observations are continually proposed, tested, and either retained or discarded on the basis of the persuasiveness of the evidence. Read More

    Optimum support by high-flow nasal cannula in acute hypoxemic respiratory failure: effects of increasing flow rates.
    Intensive Care Med 2017 Oct 31;43(10):1453-1463. Epub 2017 Jul 31.
    Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy.
    Purpose: Limited data exist on the correlation between higher flow rates of high-flow nasal cannula (HFNC) and its physiologic effects in patients with acute hypoxemic respiratory failure (AHRF). We assessed the effects of HFNC delivered at increasing flow rate on inspiratory effort, work of breathing, minute ventilation, lung volumes, dynamic compliance and oxygenation in AHRF patients.

    Methods: A prospective randomized cross-over study was performed in non-intubated patients with patients AHRF and a PaO/FiO(arterial partial pressure of oxygen/fraction of inspired oxygen) ratio of ≤300 mmHg. Read More

    The intensive care delirium research agenda: a multinational, interprofessional perspective.
    Intensive Care Med 2017 Sep 13;43(9):1329-1339. Epub 2017 Jun 13.
    Division of Pediatric Cardiac Anesthesia, Department of Anesthesiology and Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
    Delirium, a prevalent organ dysfunction in critically ill patients, is independently associated with increased morbidity. This last decade has witnessed an exponential growth in delirium research in hospitalized patients, including those critically ill, and this research has highlighted that delirium needs to be better understood mechanistically to help foster research that will ultimately lead to its prevention and treatment. In this invited, evidence-based paper, a multinational and interprofessional group of clinicians and researchers from within the fields of critical care medicine, psychiatry, pediatrics, anesthesiology, geriatrics, surgery, neurology, nursing, pharmacy, and the neurosciences sought to address five questions: (1) What is the current standard of care in managing ICU delirium? (2) What have been the major recent advances in delirium research and care? (3) What are the common delirium beliefs that have been challenged by recent trials? (4) What are the remaining areas of uncertainty in delirium research? (5) What are some of the top study areas/trials to be done in the next 10 years? Herein, we briefly review the epidemiology of delirium, the current best practices for management of critically ill patients at risk for delirium or experiencing delirium, identify recent advances in our understanding of delirium as well as gaps in knowledge, and discuss research opportunities and barriers to implementation, with the goal of promoting an integrated research agenda. Read More

    Current research priorities in perioperative intensive care medicine.
    Intensive Care Med 2017 Sep 8;43(9):1173-1186. Epub 2017 Jun 8.
    Queen Mary University London, London, UK.
    Introduction: Surgical treatments are offered to more patients than ever before, and increasingly to older patients with chronic disease. High-risk patients frequently require critical care either in the immediate postoperative period or after developing complications. The purpose of this review was to identify and prioritise themes for future research in perioperative intensive care medicine. Read More

    External validation of a biomarker and clinical prediction model for hospital mortality in acute respiratory distress syndrome.
    Intensive Care Med 2017 Aug 7;43(8):1123-1131. Epub 2017 Jun 7.
    Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University, T1218 MCN, 1161 21st Avenue S., Nashville, TN, 37232-2650, USA.
    Purpose: Mortality prediction in ARDS is important for prognostication and risk stratification. However, no prediction models have been independently validated. A combination of two biomarkers with age and APACHE III was superior in predicting mortality in the NHLBI ARDSNet ALVEOLI trial. Read More

    Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017 : Expert opinion of the Working Group on Prevention, AKI section, European Society of Intensive Care Medicine.
    Intensive Care Med 2017 Jun 2;43(6):730-749. Epub 2017 Jun 2.
    Clinical Department and Laboratory of Intensive Care Medicine, Division of Cellular and Molecular Medicine, KU Leuven University, Leuven, Belgium.
    Background: Acute kidney injury (AKI) in the intensive care unit is associated with significant mortality and morbidity.

    Objectives: To determine and update previous recommendations for the prevention of AKI, specifically the role of fluids, diuretics, inotropes, vasopressors/vasodilators, hormonal and nutritional interventions, sedatives, statins, remote ischaemic preconditioning and care bundles.

    Method: A systematic search of the literature was performed for studies published between 1966 and March 2017 using these potential protective strategies in adult patients at risk of AKI. Read More

    The effect of high-dose cholecalciferol on bioavailable vitamin D levels in critically ill patients: a post hoc analysis of the VITdAL-ICU trial.
    Intensive Care Med 2017 11 26;43(11):1732-1734. Epub 2017 May 26.
    Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.

    Critical care for migrants : Discussion on "Migrants crossing the Mediterranean Sea: an opportunity or a duty?"
    Intensive Care Med 2017 07 8;43(7):1069-1070. Epub 2017 May 8.
    Cardiac Surgery and Heart Transplantation Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via Tricomi 5, 90127, Palermo, Italy.

    Effect of a multifaceted educational intervention for anti-infectious measures on sepsis mortality: a cluster randomized trial.
    Intensive Care Med 2017 Nov 2;43(11):1602-1612. Epub 2017 May 2.
    Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany.
    Purpose: Guidelines recommend administering antibiotics within 1 h of sepsis recognition but this recommendation remains untested by randomized trials. This trial was set up to investigate whether survival is improved by reducing the time before initiation of antimicrobial therapy by means of a multifaceted intervention in compliance with guideline recommendations.

    Methods: The MEDUSA study, a prospective multicenter cluster-randomized trial, was conducted from July 2011 to July 2013 in 40 German hospitals. Read More

    Renal recovery after acute kidney injury.
    Intensive Care Med 2017 Jun 2;43(6):855-866. Epub 2017 May 2.
    Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
    Acute kidney injury (AKI) is a frequent complication of critical illness and carries a significant risk of short- and long-term mortality, chronic kidney disease (CKD) and cardiovascular events. The degree of renal recovery from AKI may substantially affect these long-term endpoints. Therefore maximising recovery of renal function should be the goal of any AKI prevention and treatment strategy. Read More

    Diagnostic work-up and specific causes of acute kidney injury.
    Intensive Care Med 2017 Jun 25;43(6):829-840. Epub 2017 Apr 25.
    Division of Cellular and Molecular Medicine, Clinical Department and Laboratory of Intensive Care Medicine, KU Leuven University, Herestraat 49, B3000, Louvain, Belgium.
    Acute kidney injury (AKI) is common in critically ill patients and associated with grim short- and long-term outcome. Although in the vast majority of cases AKI is multifactorial, with sepsis, shock and nephrotoxicity accounting for most episodes, specific causes of AKI are not uncommon. Despite remaining uncertainties regarding their prevalence in the ICU, prompt recognition of specific aetiologies of AKI is likely to ensure timely management, limit worsening of renal dysfunction, and ultimately limit renal and systemic consequences of AKI. Read More

    Immunoglobulin G for patients with necrotising soft tissue infection (INSTINCT): a randomised, blinded, placebo-controlled trial.
    Intensive Care Med 2017 Nov 18;43(11):1585-1593. Epub 2017 Apr 18.
    Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
    Purpose: The aim of the INSTINCT trial was to assess the effect of intravenous polyspecific immunoglobulin G (IVIG) compared with placebo on self-reported physical function in intensive care unit (ICU) patients with necrotising soft tissue infection (NSTI).

    Methods: We randomised 100 patients with NSTI 1:1 to masked infusion of 25 g of IVIG (Privigen, CSL Behring) or an equal volume of 0.9% saline once daily for the first 3 days of ICU admission. Read More

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