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Mashup Score: 0Physiology and pathophysiology of mucus and mucolytic use in critically ill patients - Critical Care - 2 hour(s) ago
Airway mucus is a highly specialised secretory fluid which functions as a physical and immunological barrier to pathogens whilst lubricating the airways and humifying atmospheric air. Dysfunction is common during critical illness and is characterised by changes in production rate, chemical composition, physical properties, and inflammatory phenotype. Mucociliary clearance, which is determined in part by mucus characteristics and in part by ciliary function, is also dysfunctional in critical illness via disease related and iatrogenic mechanisms. The consequences of mucus dysfunction are potentially devastating, contributing to prolonged ventilator dependency, increased risk of secondary pneumonia, and worsened lung injury. Mucolytic therapies are designed to decrease viscosity, improve expectoration/suctioning, and thereby promote mucus removal. Mucolytics, including hypertonic saline, dornase alfa/rhDNase, nebulised heparin, carbocisteine/N-Acetyl cysteine, are commonly used in critica
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Mashup Score: 0
Background Head computed tomography (CT) is a routinely performed examination to assess the intracranial condition of patients with traumatic brain injury (TBI), and radiological findings can help to indicate the presence of intracranial hypertension. At present, the prediction of intracranial hypertension is mainly based on manual discrimination of imaging characteristics. The aim of our study was to establish a model to predict intracranial hypertension via fully automatic CT image segmentation, rigorous radiomic feature extraction and reliable model development and validation. Methods Patients admitted to the intensive care unit (ICU) who underwent intracranial pressure (ICP) monitoring were included in our study. For the development cohort, we extracted data from the CENTER-TBI database and randomly divided the data into a training group and a test group. For the validation cohort, we extracted data from patients admitted to the Shanghai General Hospital. Patients whose initial rec
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#CritCare #OpenAccess Development and validation of intracranial hypertension prediction models based on radiomic features in patients with traumatic brain injury Read the full article: https://t.co/Szq1Pb41dY @jlvincen @ISICEM #FOAMed #FOAMcc https://t.co/V7bSqCUodl
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Mashup Score: 16An international observational study validating gene-expression sepsis immune subgroups - Critical Care - 2 day(s) ago
Background Sepsis gene-expression sub-phenotypes with prognostic and theranostic potential have been discovered. These have been identified retrospectively and have not been translated to methods that could be deployed at the bedside. We aimed to identify subgroups of septic patients at high-risk of poor outcome, using a rapid, multiplex RNA-based test. Methods Adults with sepsis, in the intensive care unit (ICU) were recruited from 17 sites in the United Kingdom, Sweden and France. Blood was collected at days 2–5 (S1), 6–8 (S2) and 13–15 (S3) after ICU admission and analyzed centrally. Patients were assigned into ‘high’ and ‘low’ risk groups using two models previously developed for the Immune-Profiling Panel prototype on the bioMérieux FilmArray® system. Results 357 patients were recruited (March 2021–November 2022). 69% were male with a median age of 67 years, APACHE II score of 21 and a 30% 90-day mortality rate. The proportions of high-risk patients decreased over the three sampli
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#CritCare #OpenAccess An international observational study validating gene-expression sepsis immune subgroups Read the full article: https://t.co/fiHl8BFMK3 @jlvincen @ISICEM #FOAMed #FOAMcc https://t.co/rYAajRsYnp
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Mashup Score: 38Venous return and mean systemic filling pressure: physiology and clinical applications - Critical Care - 4 day(s) ago
Venous return is the flow of blood from the systemic venous network towards the right heart. At steady state, venous return equals cardiac output, as the venous and arterial systems operate in series. However, unlike the arterial one, the venous network is a capacitive system with a high compliance. It includes a part of unstressed blood, which is a reservoir that can be recruited via sympathetic endogenous or exogenous stimulation. Guyton’s model describes the three determinants of venous return: the mean systemic filling pressure, the right atrial pressure and the resistance to venous return. Recently, new methods have been developed to explore such determinants at the bedside. In this narrative review, after a reminder about Guyton’s model and current methods used to investigate it, we emphasize how Guyton’s physiology helps understand the effects on cardiac output of common treatments used in critically ill patients.
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RT @NephroP: Good article to read for those following @khaycock2 ‘s masterclass. 🔗 https://t.co/ZRQD0cuutP https://t.co/DiEtzqrX1k
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Mashup Score: 35Electrical impedance tomography-guided the optimal awake prone position in a moderate ARDS patient - Critical Care - 4 day(s) ago
Awake prone positioning (APP) has gained prominence as a therapeutic intervention for acute respiratory distress syndrome (ARDS), particularly in COVID-19-related respiratory failure due to its proven survival benefits [1, 2]. However, the clinical applicability of APP in non-COVID-19 ARDS populations remains controversial, with patient tolerance and heterogeneous lung recruitment responses posing significant challenges [3]. To address these limitations, electromagnetic impedance tomography (EIT)—a
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#CritCare #OpenAccess Electrical impedance tomography-guided the optimal awake prone position in a moderate ARDS patient Read the full article: https://t.co/TsxFgGuNAO @jlvincen @ISICEM #FOAMed #FOAMcc https://t.co/b763oRfTIR
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Mashup Score: 0Lactate infusion improves cardiac function in a porcine model of ischemic cardiogenic shock - Critical Care - 22 day(s) ago
Background Cardiogenic shock (CS) is associated with high mortality and medical therapies have failed to improve survival. Treatment with lactate is associated with improved cardiac function which may benefit this condition. Comprehensive hemodynamic assessment of lactate administration in CS is lacking, and the mechanisms underlying the cardiovascular effects of lactate in CS have not yet been elucidated. In this study we aimed to study the cardiovascular and cardiometabolic effects of treatment with lactate in experimental ischemic CS. Methods In a randomized, blinded design, 20 female pigs (60 kg) were studied. Left main coronary artery microsphere injections were used to cause CS, defined as a 30% reduction in CO or mixed venous saturation (SvO2). Subjects were randomized to receive either intravenous exogenous lactate or euvolemic, equimolar saline (control) for 180 min. Positive inotropic control with dobutamine was administered on top of ongoing treatment after 180 min. Extensiv
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Lactate infusion enhances cardiac output and peripheral perfusion in ischemic cardiogenic shock without affecting heart rate or systemic blood pressure, finds a study published in @Crit_Care https://t.co/6sB4X3wZ6d
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Mashup Score: 4The green ICU: how to interpret green? A multiple perspective approach - Critical Care - 23 day(s) ago
Mitigating environmental impacts is an urgent challenge supported by (scientific) intensive care societies worldwide. However, making green choices without compromising high-quality care for critically ill patients may be challenging. The current paper describes a three-step approach towards green intensive care units. Starting with the measurement of environmental sustainability, intensive care units can identify hotspots, quantify the environmental impacts of products and procedures, and monitor sustainable progress. Subsequently, a multidisciplinary approach is proposed to improve environmental sustainability, including a collaboration of procurement specialists and healthcare professionals, using co-creation and green teams as efficient grassroots change agents. A context-specific approach for enhancing sustainable healthcare practices is key in order to fit local regulatory requirements and create support of professionals. A final step is to share results and create momentum, incl
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#CritCare #OpenAccess The green ICU: how to interpret green? A multiple perspective approach Read the full article: https://t.co/KWtEB4bFGO @jlvincen @ISICEM #FOAMed #FOAMcc https://t.co/50n7Ab0fzF
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Mashup Score: 2Advancements in imaging techniques for monitoring the respiratory muscles - Critical Care - 24 day(s) ago
This review highlights the latest advancements in imaging techniques for monitoring respiratory muscles in critically ill patients. At the bedside, conventional ultrasound has been widely adopted to measure diaphragm thickness, thickening and excursion. It has also been used to assess extradiaphragmatic respiratory muscles, including parasternal intercostal and abdominal muscles. Advanced ultrasound-derived techniques have expanded its applications, enabling the evaluation of tissue velocity (tissue Doppler imaging), stiffness (shear wave elastography), and local tissue displacement (speckle tracking). Facility-based imaging modalities such as magnetic resonance imaging and chest tomography provide complementary insights into respiratory muscles structure and function, offering valuable information for evaluating the effects of therapeutic interventions. Finally, imaging techniques have emerged as valuable tools for evaluating the metabolic demands of respiratory muscles, with advanced
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A Review published in @Crit_Care highlights the latest advancements in imaging techniques for monitoring respiratory muscles in critically ill patients. https://t.co/nfuDMHWPbn
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Mashup Score: 3Comparative evaluation and performance of large language models on expert level critical care questions: a benchmark study - Critical Care - 1 month(s) ago
Background Large language models (LLMs) show increasing potential for their use in healthcare for administrative support and clinical decision making. However, reports on their performance in critical care medicine is lacking. Methods This study evaluated five LLMs (GPT-4o, GPT-4o-mini, GPT-3.5-turbo, Mistral Large 2407 and Llama 3.1 70B) on 1181 multiple choice questions (MCQs) from the gotheextramile.com database, a comprehensive database of critical care questions at European Diploma in Intensive Care examination level. Their performance was compared to random guessing and 350 human physicians on a 77-MCQ practice test. Metrics included accuracy, consistency, and domain-specific performance. Costs, as a proxy for energy consumption, were also analyzed. Results GPT-4o achieved the highest accuracy at 93.3%, followed by Llama 3.1 70B (87.5%), Mistral Large 2407 (87.9%), GPT-4o-mini (83.0%), and GPT-3.5-turbo (72.7%). Random guessing yielded 41.5% (p < 0.001). On the practice test, all
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#CritCare #OpenAccess Comparative evaluation and performance of large language models on expert level critical care questions: a benchmark study Read the full article: https://t.co/RDHs28uB4r @jlvincen @ISICEM #FOAMed #FOAMcc https://t.co/l3tp1AYkAk
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Mashup Score: 0Pertussis infection in critically ill infants: meta-analysis and validation of a mortality score - Critical Care - 1 month(s) ago
Background Despite widespread vaccination programs, pertussis continues circulating within populations and remains a life-threatening infection in infants. While several mortality risk factors have been described, a comprehensive synthesis is lacking. We conducted a meta-analysis of studies investigating mortality risk factors in Pertussis infections and validated those factors in a large cohort. Methods Observational studies published in English were systematically searched in PubMed, EMBASE, and LiSSa databases from 01/2000 to 06/2024. The search yielded 816 unique citations. The primary outcome was mortality before discharge from the Pediatric Intensive Care Unit (PICU). Two independent reviewers assessed the risk of bias and extracted data. A REML-random effect model was used to calculate pooled prevalence and conduct the analysis. The identified risk factors were subsequently evaluated in a monocentric cohort of patients admitted to a tertiary hospital’s PICU for severe pertussis
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#CritCare #OpenAccess Pertussis infection in critically ill infants: meta-analysis and validation of a mortality score Read the full article: https://t.co/NGWgqzpALn @jlvincen @ISICEM #FOAMed #FOAMcc https://t.co/ilwId5D0C8
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A Review published in @Crit_Care summarises the physiology and pathophysiology of mucus and the existing evidence for the use of mucolytics in critically ill patients. https://t.co/0zbSEXtvkw