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

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    Acute hypoxemic respiratory failure in immunocompromised patients: the Efraim multinational prospective cohort study.
    Intensive Care Med 2017 Sep 25. 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 2017 Sep 22. 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 Sep 22. 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 Sep 21. 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 Aug 7. 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 PaO2/FiO2 (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 Jun 13. 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 Jun 8. 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 Nov 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 Jul 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

    Acute kidney injury in sepsis.
    Intensive Care Med 2017 Jun 31;43(6):816-828. Epub 2017 Mar 31.
    Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
    Acute kidney injury (AKI) and sepsis carry consensus definitions. The simultaneous presence of both identifies septic AKI. Septic AKI is the most common AKI syndrome in ICU and accounts for approximately half of all such AKI. Read More

    Effects of restricting perioperative use of intravenous chloride on kidney injury in patients undergoing cardiac surgery: the LICRA pragmatic controlled clinical trial.
    Intensive Care Med 2017 Jun 25;43(6):795-806. Epub 2017 Mar 25.
    Monash University, Commercial Road, Melbourne, VIC, 3004, Australia.
    Purpose: The administration of chloride-rich intravenous (IV) fluid and hyperchloraemia have been associated with perioperative renal injury. The aim of this study was to determine whether a comprehensive perioperative protocol for the administration of chloride-limited IV fluid would reduce perioperative renal injury in adults undergoing cardiac surgery.

    Methods: From February 2014 through to December 2015, all adult patients undergoing cardiac surgery within a single academic medical center received IV fluid according to the study protocol. Read More

    A multi-faceted strategy to reduce ventilation-associated mortality in brain-injured patients. The BI-VILI project: a nationwide quality improvement project.
    Intensive Care Med 2017 Jul 18;43(7):957-970. Epub 2017 Mar 18.
    Intensive Care Unit, Anesthesia and Critical Care Department, Hôtel Dieu-HME-University Hospital of Nantes , Centre Hospitalier Universitaire (CHU) de Nantes, Nantes, France.
    Purpose: We assessed outcomes in brain-injured patients after implementation of a multi-faceted approach to reduce respiratory complications in intensive care units.

    Methods: Prospective nationwide before-after trial. Consecutive adults with acute brain injury requiring mechanical ventilation for ≥24 h in 20 French intensive care units (ICUs) were included. Read More

    A randomized clinical trial of ultrasound-guided infra-clavicular cannulation of the subclavian vein in cardiac surgical patients: short-axis versus long-axis approach.
    Intensive Care Med 2017 Nov 13;43(11):1594-1601. Epub 2017 Mar 13.
    Anaesthesia and Intensive Care Unit, E.O. Ospedali Galliera, Mura Della Cappuccine 14, 16128, Genoa, Italy.
    Purpose: The aim of this study was to compare the success rate and safety of short-axis versus long-axis approaches to ultrasound-guided subclavian vein cannulation.

    Methods: A total of 190 patients requiring central venous cannulation following cardiac surgery were randomized to either short-axis or long-axis ultrasound-guided cannulation of the subclavian vein. Each cannulation was performed by anesthesiologists with at least 3 years' experience of ultrasound-guided central vein cannulation (>150 procedures/year, 50% short-axis and 50% long-axis). Read More

    The ICM research agenda on intensive care unit-acquired weakness.
    Intensive Care Med 2017 Mar 13. Epub 2017 Mar 13.
    Division of Pulmonary and Critical Care Medicine, Outcomes After Critical Illness and Surgery (OACIS) Group, Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA.
    We present areas of uncertainty concerning intensive care unit-acquired weakness (ICUAW) and identify areas for future research. Age, pre-ICU functional and cognitive state, concurrent illness, frailty, and health trajectories impact outcomes and should be assessed to stratify patients. In the ICU, early assessment of limb and diaphragm muscle strength and function using nonvolitional tests may be useful, but comparison with established methods of global and specific muscle strength and physical function and determination of their reliability and normal values would be important to advance these techniques. Read More

    Intensive care medicine research agenda on cardiac arrest.
    Intensive Care Med 2017 Mar 11. Epub 2017 Mar 11.
    Medical ICU, Cochin Hospital (AP-HP), Paris-Cardiovascular-Research-Centre, INSERM U970 (Sudden Death Expertize Centre), Université Paris-Descartes-Sorbonne-Paris-Cité, Paris, France.
    Over the last 15 years, treatment of comatose post-cardiac arrest patients has evolved to include therapeutic strategies such as urgent coronary angiography with percutaneous coronary intervention (PCI), targeted temperature management (TTM)-requiring mechanical ventilation and sedation-and more sophisticated and cautious prognostication. In 2015, collaboration between the European Resuscitation Council (ERC) and the European Society for Intensive Care Medicine (ESICM) resulted in the first European guidelines on post-resuscitation care. This review addresses the major recent advances in the treatment of cardiac arrest, recent trials that have challenged current practice and the remaining areas of uncertainty. Read More

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