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Oral health care for the critically ill: a narrative review
Lewis Winning, Fionnuala T. Lundy, Bronagh Blackwood, Daniel F. McAuley & Ikhlas El Karim
doi : 10.1186/s13054-021-03765-5
Critical Care volume 25, Article number: 353 (2021)
The link between oral bacteria and respiratory infections is well documented. Dental plaque has the potential to be colonized by respiratory pathogens and this, together with microaspiration of oral bacteria, can lead to pneumonia particularly in the elderly and critically ill. The provision of adequate oral care is therefore essential for the maintenance of good oral health and the prevention of respiratory complications.
Ceftolozane/tazobactam probability of target attainment and outcomes in participants with augmented renal clearance from the randomized phase 3 ASPECT-NP trial
Andrew F. Shorr, Christopher J. Bruno, Zufei Zhang, Erin Jensen, Wei Gao, Hwa-Ping Feng, Jennifer A. Huntington, Brian Yu, Elizabeth G. Rhee, Carisa De Anda, Sumit Basu & Marin H. Kollef
doi : 10.1186/s13054-021-03773-5
Critical Care volume 25, Article number: 354 (2021)
The randomized, double-blind, phase 3 ASPECT-NP trial evaluated the efficacy of 3 g of ceftolozane/tazobactam (C/T) versus 1 g of meropenem infused every 8 h for 8 to 14 days for treatment of adults with hospital-acquired bacterial pneumonia (HABP) or ventilator-associated bacterial pneumonia (VABP). We assessed the probability of target attainment and compared efficacy outcomes from ASPECT-NP in participants with augmented renal clearance (ARC) versus those with normal renal function.
Evolving outcomes of extracorporeal membrane oxygenation support for severe COVID-19 ARDS in Sorbonne hospitals, Paris
Matthieu Schmidt, Elise Langouet, David Hajage, Sarah Aissi James, Juliette Chommeloux, Nicolas Bréchot, Petra Barhoum, Lucie Lefèvre, Antoine Troger, Marc Pineton de Chambrun, Guillaume Hékimian, Charles-Edouard Luyt, Martin Dres, Jean-Michel Constantin, Muriel Fartoukh, Pascal Leprince, Guillaume Lebreton & Alain Combes for the GRC RESPIRE Sorbonne Université
doi : 10.1186/s13054-021-03780-6
Critical Care volume 25, Article number: 355 (2021)
Extracorporeal membrane oxygenation (ECMO) was frequently used to treat patients with severe coronavirus disease-2019 (COVID-19)-associated acute respiratory distress (ARDS) during the initial outbreak. Care of COVID-19 patients evolved markedly during the second part of 2020. Our objective was to compare the characteristics and outcomes of patients who received ECMO for severe COVID-19 ARDS before or after July 1, 2020.
Exosomal miR-30d-5p of neutrophils induces M1 macrophage polarization and primes macrophage pyroptosis in sepsis-related acute lung injury
Yang Jiao, Ti Zhang, Chengmi Zhang, Haiying Ji, Xingyu Tong, Ran Xia, Wei Wang, Zhengliang Ma & Xueyin Shi
doi : 10.1186/s13054-021-03775-3
Critical Care volume 25, Article number: 356 (2021)
Polymorphonuclear neutrophils (PMNs) play an important role in sepsis-related acute lung injury (ALI). Accumulating evidence suggests PMN-derived exosomes as a new subcellular entity acting as a fundamental link between PMN-driven inflammation and tissue damage. However, the role of PMN-derived exosomes in sepsis-related ALI and the underlying mechanisms remains unclear.
Predictive power of extubation failure diagnosed by cough strength: a systematic review and meta-analysis
Jun Duan, Xiaofang Zhang & Jianping Song
doi : 10.1186/s13054-021-03781-5
Critical Care volume 25, Article number: 357 (2021)
The predictive power of extubation failure diagnosed by cough strength varies by study. Here we summarise the diagnostic power of extubation failure tested by cough strength.
Brain–lung interactions and mechanical ventilation in patients with isolated brain injury
Mairi Ziaka & Aristomenis Exadaktylos
doi : 10.1186/s13054-021-03778-0
Critical Care volume 25, Article number: 358 (2021)
During the last decade, experimental and clinical studies have demonstrated that isolated acute brain injury (ABI) may cause severe dysfunction of peripheral extracranial organs and systems. Of all potential target organs and systems, the lung appears to be the most vulnerable to damage after brain injury (BI). The pathophysiology of these brain–lung interactions are complex and involve neurogenic pulmonary oedema, inflammation, neurodegeneration, neurotransmitters, immune suppression and dysfunction of the autonomic system. The systemic effects of inflammatory mediators in patients with BI create a systemic inflammatory environment that makes extracranial organs vulnerable to secondary procedures that enhance inflammation, such as mechanical ventilation (MV), surgery and infections. Indeed, previous studies have shown that in the presence of a systemic inflammatory environment, specific neurointensive care interventions—such as MV—may significantly contribute to the development of lung injury, regardless of the underlying mechanisms. Although current knowledge supports protective ventilation in patients with BI, it must be born in mind that ABI-related lung injury has distinct mechanisms that involve complex interactions between the brain and lungs. In this context, the role of extracerebral pathophysiology, especially in the lungs, has often been overlooked, as most physicians focus on intracranial injury and cerebral dysfunction. The present review aims to fill this gap by describing the pathophysiology of complications due to lung injuries in patients with a single ABI, and discusses the possible impact of MV in neurocritical care patients with normal lungs.
Bronchus-blocked ultrasound-guided percutaneous transthoracic needle biopsy (BUS-PTNB) for intubated patients with severe lung diseases
Yuean Zhao, Faming Jiang, He Yu, Ye Wang, Zhen Wang, Peng Sun, Zhong Ni, Weiya Wang, Lili Jiang, Junping Fan, Lanlan Zhang, Charles A. Powell & Zongan Liang
doi : 10.1186/s13054-021-03782-4
Critical Care volume 25, Article number: 359 (2021)
Examinations based on lung tissue specimen can play a significant role in the diagnosis for critically ill and intubated patients with lung infiltration. However, severe complications including tension pneumothorax and intrabronchial hemorrhage limit the application of needle biopsy.
Timing of antibiotic therapy in the ICU
Marin H. Kollef, Andrew F. Shorr, Matteo Bassetti, Jean-Francois Timsit, Scott T. Micek, Andrew P. Michelson & Jose Garnacho-Montero
doi : 10.1186/s13054-021-03787-z
Critical Care volume 25, Article number: 360 (2021)
Severe or life threatening infections are common among patients in the intensive care unit (ICU). Most infections in the ICU are bacterial or fungal in origin and require antimicrobial therapy for clinical resolution. Antibiotics are the cornerstone of therapy for infected critically ill patients. However, antibiotics are often not optimally administered resulting in less favorable patient outcomes including greater mortality. The timing of antibiotics in patients with life threatening infections including sepsis and septic shock is now recognized as one of the most important determinants of survival for this population. Individuals who have a delay in the administration of antibiotic therapy for serious infections can have a doubling or more in their mortality. Additionally, the timing of an appropriate antibiotic regimen, one that is active against the offending pathogens based on in vitro susceptibility, also influences survival. Thus not only is early empiric antibiotic administration important but the selection of those agents is crucial as well. The duration of antibiotic infusions, especially for ?-lactams, can also influence antibiotic efficacy by increasing antimicrobial drug exposure for the offending pathogen. However, due to mounting antibiotic resistance, aggressive antimicrobial de-escalation based on microbiology results is necessary to counterbalance the pressures of early broad-spectrum antibiotic therapy. In this review, we examine time related variables impacting antibiotic optimization as it relates to the treatment of life threatening infections in the ICU. In addition to highlighting the importance of antibiotic timing in the ICU we hope to provide an approach to antimicrobials that also minimizes the unnecessary use of these agents. Such approaches will increasingly be linked to advances in molecular microbiology testing and artificial intelligence/machine learning. Such advances should help identify patients needing empiric antibiotic therapy at an earlier time point as well as the specific antibiotics required in order to avoid unnecessary administration of broad-spectrum antibiotics.
Prone positioning in acute respiratory distress syndrome during venovenous extracorporeal membrane oxygenation
Shiping Zhu
doi : 10.1186/s13054-021-03760-w
Critical Care volume 25, Article number: 361 (2021)
Management of severe ARDS due to SARS-CoV-2 pneumonia using low-flow extracorporeal CO2 extraction
Rosario Molina Lobo, Beatriz Lobo-Valbuena & Federico Gordo
doi : 10.1186/s13054-021-03777-1
Critical Care volume 25, Article number: 362 (2021)
Evaluation of zinc sulfate as an adjunctive therapy in COVID-19 critically ill patients: a two center propensity-score matched study
Khalid Al Sulaiman, Ohoud Aljuhani, Abdulrahman I. Al Shaya, Abdullah Kharbosh, Raed Kensara, Alhomaidi Al Guwairy, Aisha Alharbi, Rahmah Algarni, Shmeylan Al Harbi, Ramesh Vishwakarma & Ghazwa B. Korayem
doi : 10.1186/s13054-021-03785-1
Critical Care volume 25, Article number: 363 (2021)
Zinc is a trace element that plays a role in stimulating innate and acquired immunity. The role of zinc in critically ill patients with COVID-19 remains unclear. This study aims to evaluate the efficacy and safety of zinc sulfate as adjunctive therapy in critically ill patients with COVID-19.
Lean mass as a risk factor for intensive care unit admission: an observational study
Matthew Thackeray, Mohammadreza Mohebbi, Neil Orford, Mark A. Kotowicz & Julie A. Pasco
doi : 10.1186/s13054-021-03788-y
Critical Care volume 25, Article number: 364 (2021)
Intensive care unit (ICU) survivors have reduced physical function likely due to skeletal muscle wasting and weakness acquired during critical illness. However, the contribution of pre-morbid muscle mass has not been elucidated. We aimed to examine the association between pre-ICU muscle mass and ICU admission risk. Secondary outcomes include the relationship between muscle mass and ICU outcomes.
Effects of high flow nasal cannula on the coordination between swallowing and breathing in postextubation patients, a randomized crossover study
Pornpan Rattanajiajaroen & Napplika Kongpolprom
doi : 10.1186/s13054-021-03786-0
Critical Care volume 25, Article number: 365 (2021)
Timing of swallows in relation to respiratory phases is associated with aspiration events. Oxygen therapy possibly affects the timing of swallows, which may alter airway protective mechanisms.
Longitudinal ventilatory ratio monitoring for COVID-19: its potential in predicting severity and assessing treatment response
Natsuko Kaku, Yu Nakagama, Michinori Shirano, Sari Shinomiya, Kazuhiro Shimazu, Katsuaki Yamazaki, Yoshito Maehata, Ryo Morita, Yuko Nitahara, Hiromasa Yamamoto, Yasumitsu Mizobata & Yasutoshi Kido
doi : 10.1186/s13054-021-03768-2
Critical Care volume 25, Article number: 366 (2021)
Cost impact of procalcitonin-guided decision making on duration of antibiotic therapy for suspected early-onset sepsis in neonates
A. J. L. M. Geraerds, Wendy van Herk, Martin Stocker, Salhab el Helou, Sourabh Dutta, Matteo S. Fontana, Frank A. B. A. Schuerman, Rita K. van den Tooren-de Groot, Jantien Wieringa, Jan Janota, Laura H. van der Meer-Kappelle, Rob Moonen, Sintha D. Sie, Esther de Vries, Albertine E. Donker, Urs Zimmerman, Luregn J. Schlapbach, Amerik C. de Mol, Angelique Hoffman-Haringsma, Madan Roy, Maren Tomaske, René F. Kornelisse, Juliette van Gijsel, Eline G. Visser, Annemarie M. C. van Rossum & Suzanne Polinder -Show fewer authors
doi : 10.1186/s13054-021-03789-x
Critical Care volume 25, Article number: 367 (2021)
The large, international, randomized controlled NeoPInS trial showed that procalcitonin (PCT)-guided decision making was superior to standard care in reducing the duration of antibiotic therapy and hospitalization in neonates suspected of early-onset sepsis (EOS), without increased adverse events. This study aimed to perform a cost-minimization study of the NeoPInS trial, comparing health care costs of standard care and PCT-guided decision making based on the NeoPInS algorithm, and to analyze subgroups based on country, risk category and gestational age.
Fever and hypothermia represent two populations of sepsis patients and are associated with outside temperature
Daniel O. Thomas-Rüddel, Peter Hoffmann, Daniel Schwarzkopf, Christian Scheer, Friedhelm Bach, Marcus Komann, Herwig Gerlach, Manfred Weiss, Matthias Lindner, Hendrik Rüddel, Philipp Simon, Sven-Olaf Kuhn, Reinhard Wetzker, Michael Bauer, Konrad Reinhart, Frank Bloos on behalf of the MEDUSA study group
doi : 10.1186/s13054-021-03776-2
Critical Care volume 25, Article number: 368 (2021)
Fever and hypothermia have been observed in septic patients. Their influence on prognosis is subject to ongoing debates.
The effect of opioids on gastrointestinal function in the ICU
Yun Yan, Yu Chen & Xijing Zhang
doi : 10.1186/s13054-021-03793-1
Critical Care volume 25, Article number: 371 (2021)
Gastrointestinal (GI) dysfunction is common in the critical care setting and is highly associated with clinical outcomes. Opioids increase the risk for GI dysfunction and are frequently prescribed to reduce pain in critically ill patients. However, the role of opioids in GI function remains uncertain in the ICU. This review aims to describe the effect of opioids on GI motility, their potential risk of increasing infection and the treatment of GI dysmotility with opioid antagonists in the ICU setting.
Identification of focal ARDS using ventilatory ratio
Kay Choong See, Melanie Torres Estaras & Juvel Mabao Taculod
doi : 10.1186/s13054-021-03796-y
Critical Care volume 25, Article number: 371 (2021)
Clinical spectrum and risk factors for mortality among seawater and freshwater critically ill drowning patients: a French multicenter study
Florian Reizine, Agathe Delbove, Alexandre Dos Santos, Laetitia Bodenes, Pierre Bouju, Pierre Fillâtre, Aurélien Frérou, Guillaume Halley, Olivier Lesieur, Maud Jonas, Florian Berteau, Jean Morin, David Luque-Paz, Rémy Marnai, Anthony Le Meur, Cécile Aubron, Jean Reignier, Jean-Marc Tadié & Arnaud Gacouin
doi : 10.1186/s13054-021-03792-2
Critical Care volume 25, Article number: 372 (2021)
Drowning is a global threat and one of the leading causes of injury around the world. The impact of drowning conditions including water salinity on patients’ prognosis remains poorly explored in Intensive Care Units (ICUs) patients.
Impact of tight glucose control on circulating 3-hydroxybutyrate in critically ill patients
Jan Gunst, Astrid De Bruyn, Michael P. Casaer, Sarah Vander Perre, Lies Langouche & Greet Van den Berghe
doi : 10.1186/s13054-021-03772-6
Critical Care volume 25, Article number: 373 (2021)
Recent evidence suggests a potentially protective effect of increasing ketone body availability via accepting low macronutrient intake early after onset of critical illness. The impact of blood glucose control with insulin on circulating ketones is unclear. Whereas lowering blood glucose may activate ketogenesis, high insulin concentrations may have the opposite effect. We hypothesized that the previously reported protective effects of tight glucose control in critically ill patients receiving early parenteral nutrition may have been mediated in part by activation of ketogenesis.
Comment on the article: “Prediction of the development of acute kidney injury following cardiac surgery by machine learning”
Hang Zhang, Yang Zhao & Tongtong Gu
doi : 10.1186/s13054-021-03798-w
Critical Care volume 25, Article number: 374 (2021)
Correction to: Extracorporeal membrane oxygenation for COVID-19: a systematic review and meta-analysis
Kollengode Ramanathan, Kiran Shekar, Ryan Ruiyang Ling, Ryan P. Barbaro, Suei Nee Wong, Chuen Seng Tan, Bram Rochwerg, Shannon M. Fernando, Shinhiro Takeda, Graeme MacLaren, Eddy Fan & Daniel Brodie
doi : 10.1186/s13054-021-03714-2
Critical Care volume 25, Article number: 375 (2021)
The effect of the head-up position on cardiopulmonary resuscitation: a systematic review and meta-analysis
Cheng-Chieh Huang, Kuan-Chih Chen, Zih-Yang Lin, Yu-Hsuan Chou, Wen-Liang Chen, Tsung-Han Lee, Kun-Te Lin, Pei-You Hsieh, Cheng Hsu Chen, Chu-Chung Chou & Yan-Ren Lin
doi : 10.1186/s13054-021-03797-x
Critical Care volume 25, Article number: 376 (2021)
Experimental studies of head-up positioning (HUP) during cardiopulmonary resuscitation (CPR) have had some degree of conflicting published results. The current study aim was to analyze and reconcile those discrepancies in order to better clarify the effects of HUP CPR compared to conventional supine (SUP) CPR.
Initial antimicrobial management of sepsis: increased prehospital blood lactate levels for identifying sicker patients who may benefit from prehospital antibiotic therapy initiation
Romain Jouffroy & Benoît Vivien
doi : 10.1186/s13054-021-03801-4
Critical Care volume 25, Article number: 377 (2021)
