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Epidemiology and risk factors for mortality in critically ill patients with pancreatic infection

Journal of Intensive Medicine 2024年第1期4卷 81-93页

作者： Marie Dejonckheere Massimo Antonelli Kostoula Arvaniti Koen Blot Ben CreaghBrown Dylan Wde Lange Jan De Waele Mieke Deschepper Yalim Dikmen George Dimopoulos Christian Eckmann Guy Francois Massimo Girardis Despoina Koulenti Sonia Labeau jeffrey lipman Fernando Lipovestky Emilio Maseda Philippe Montravers Adam Mikstacki JoseArtur Paiva Cecilia Pereyra Jordi Rello JeanFrancois Timsit Dirk Vogelaers Stijn Blot the Abdominal Sepsis Study(AbSeS)group on behalf of the Trials Group of the European Society of Intensive Care Medicine Department of Internal Medicine and Pediatrics Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium Department of Anesthesiology Intensive Care and Emergency MedicineFondazione Policlinico Universitario A.Gemelli IRCCSRomeItaly UniversitàCattolica del Sacro Cuore RomeItaly Intensive Care Unit Papageorgiou University Affiliated HospitalThessaloníkiGreece Department of Epidemiology and Public Health SciensanoIxellesBelgium Surrey Perioperative Anaesthetic Critical Care Collaborative Research Group(SPACeR) Royal Surrey County HospitalGuildfordUK Department of Clinical and Experimental Medicine University of SurreyGuildfordUK Department of Intensive Care Medicine University Medical Center UtrechtUniversity UtrechtUtrechtthe Netherlands Department of Intensive Care Medicine Ghent University HospitalGhentBelgium Data Science Institute Ghent University HospitalGhentBelgium Department of Anesthesiology and Reanimation Cerrahpasa School of MedicineIstanbul University-CerrahpasaIstanbulTurkey rd Department of Critical Care “EVGENIDIO”HospitalNational and Kapodistrian University of AthensAthensGreece Department of General Visceral and Thoracic SurgeryKlinikum Hannoversch-MuendenGoettingen UniversityGöttingenGermany Division of Scientific Affairs-Research European Society of Intensive Care MedicineBrusselsBelgium Anesthesia and Intensive Care Department University Hospital of ModenaModenaItaly UQ Centre for Clinical Research Faculty of MedicineThe University of QueenslandBrisbaneQLDAustralia nd Critical Care Department Attikon University HospitalAthensGreece Department of Nursing Faculty of EducationHealth and Social WorkUniversity College GhentGhentBelgium Jamieson Trauma Institute The University of QueenslandBrisbaneQLDAustralia Nimes University Hospital University of MontpellierNimesFrance Critical Care Department Hospital of the Interamerican Open University(UAI)Buenos AiresArgentina Surgical Critical Care Department of AnesthesiaHospital Universitario

Background:The AbSeS-classification defines specific phenotypes of patients with intra-abdominal infection based on the(1)setting of infection onset(community-acquired,early onset,or late-onset hospital-acquired),(2)presence or absence of either localized or diffuse peritonitis,and(3)severity of disease expression(infection,sepsis,or septic shock).This classification system demonstrated reliable risk stratification in intensive care unit(ICU)patients with intra-abdominal *** study aimed to describe the epidemiology of ICU patients with pancreatic infection and assess the relationship between the components of the AbSeS-classification and ***:This was a secondary analysis of an international observational study(“AbSeS”)investigating ICU patients with intra-abdominal *** patients with pancreatic infection were included in this analysis(n=165).Mortality was defined as ICU mortality within 28 days of observation for patients discharged earlier from the *** with mortality were assessed using logistic regression analysis and reported as odds ratio(OR)and 95%confidence interval(CI).Results:The overall mortality was 35.2%(n=58).The independent risk factors for mortality included older age(OR=1.03,95%CI:1.0 to 1.1 P=0.023),localized peritonitis(OR=4.4,95%CI:1.4 to 13.9 P=0.011),and persistent signs of inflammation at day 7(OR=9.5,95%CI:3.8 to 23.9,P<0.001)or after the implementation of additional source control interventions within the first week(OR=4.0,95%CI:1.3 to 12.2,P=0.013).Gramnegative bacteria were most frequently isolated(n=58,49.2%)without clinically relevant differences in microbial etiology between survivors and ***:In pancreatic infection,a challenging source/damage control and ongoing pancreatic inflammation appear to be the strongest contributors to an unfavorable short-term *** this limited series,essentials of the AbSeS-classification,such as the setting of infection onset,diffuse

关键词： Pancreatic infection Intensive care unit Mortality Intra-abdominal infection Sepsis

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Flattening the biological age curve by improving metabolic health:to taurine or not to taurine,that’s the question

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Journal of Geriatric Cardiology 2023年第11期20卷 813-823页

作者： Kwok M.Ho Anna Lee William Wu Matthew T.V.Chan Lowell Ling jeffrey lipman Jason Roberts Edward Litton Gavin M.Joynt Martin Wong Department of Intensive Care Medicine Fiona Stanley HospitalPerthAustralia Medical School The University of Western AustraliaPerthAustralia School of Veterinary&Life Sciences Murdoch UniversityPerthAustralia Department of Anaesthesia&Intensive Care Prince of Wales HospitalChinese University of Hong KongHong KongChina Jamieson Trauma Institute Royal Brisbane and Women’s HospitalBrisbaneQueenslandAustralia Division of Anaesthesiology Critical Care Emergency and Pain Medicine Nîmes University HospitalUniversity of MontpellierNîmesFrance University of Queensland Centre for Clinical Research Faculty of MedicineThe University of QueenslandBrisbaneAustralia Herston Infectious Diseases Institute(HeIDI) Metro North HealthBrisbaneAustralia Departments of Pharmacy and Intensive Care Medicine Royal Brisbane and Women’s HospitalBrisbaneAustralia JC School of Public Health and Primary Care Centre for Health Education and Health PromotionChinese University of Hong KongHong KongChina School of Public Health Peking UniversityBeijingChina School of Public Health Fudan UniversityShanghaiChina

The aging population is an important issue around the world especially in developed *** med-ical advances have substantially extended life span,the same cannot be said for the duration of health *** are seeing in-creasing numbers of elderly people who are frail and/or have multiple chronic conditions;all of these can affect the quality of life of the elderly population as well as increase the burden on the healthcare *** is mechanistically related to common medical conditions such as diabetes mellitus,ischemic heart disease,cognitive decline,and frailty.A recently accepted concept termed‘Accelerated Biological Aging’can be diagnosed when a person’s biological age—as measured by biomarkers of DNA methylation—is older than their corresponding chronological ***,a conditionally essential amino acid,has received much attention in the past few years.A substantial number of animal studies have provided a strong scientific foundation sug-gesting that this amino acid can improve cellular and metabolic health,including blood glucose control,so much that it has been labelled one of the‘longevity amino acids’.In this review article,we propose the rationale that an adequately powered random-ized-controlled-trial(RCT)is needed to confirm whether taurine can meaningfully improve metabolic and microbiome health,and biological *** trial should incorporate certain elements in order to provide the much-needed evidence to guide doctors,and also the community at large,to determine whether this promising and inexpensive amino acid is useful in improving human metabolic health.

关键词： rational meaningful Taurine

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Optimising antibiotic dosing in the ICU from bench to bedside

Optimising antibiotic dosing in the ICU from bench to bedsid...

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中国病理生理学会危重病医学专业委员会第八届全国大会暨中...

作者： jeffrey lipman Department of Anaesthesiology and Intensive Care University of QueenslandQueenslandAustralia

＜正＞Antibiotics can be divided into two groups according to their in-vitro bacterial kill characteristics-time or concentration dependent,see Fig 1.β-lactams have a characteristic slow continuous（time-dependent）kill *** contrasts with the kill characteristic of aminoglycosides,which is concentration dependent（Fig 1,Table 1）.

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Recovery rates of combination antibiotic therapy using in vitro microdialysis simulating in vivo conditions

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Journal of Pharmaceutical Analysis 2018年第6期8卷 407-412页

作者： Jayesh A.Dhanani Suzanne L.Parker jeffrey lipman Steven C.Wallis Jeremy Cohen John Fraser Adrian Barnett Michelle Chew Jason A.Roberts Burns Trauma and Critical Care Research Centre The University of Queensland UQ Centre for Clinical Research Department of Intensive Care Medicine Royal Brisbane & Women's Hospital Faculty of Health Queensland University of Technology Critical Care Research Group The University of Queensland Institute of Health and Biomedical Innovation & School of Public Health and Social Work Queensland University of Technology Department of Anaesthesiology and Intensive Care and Department of Medical and Health Sciences Link?ping University School of Pharmacy The University of Queensland Department of Pharmacy Royal Brisbane & Women's Hospital

Microdialysis is a technique used to measure the unbound antibiotic concentration in the interstitial spaces, the target site of action. In vitro recovery studies are essential to calibrating the microdialysis system for in vivo studies. The effect of a combination of antibiotics on recovery into microdialysate requires investigation. In vitro microdialysis recovery studies were conducted on a combination of vancomycin and tobramycin, in a simulated in vivo model. Comparison was made between recoveries for three different concentrations and three different perfusate flow rates. The overall relative recovery for vancomycin was lower than that of tobramycin. For tobramycin, a concentration of 20μg/mL and flow rate of 1.0μL/min had the best recovery. A concentration of 5.0μg/mL and flow rate of 1.0μL/min yielded maximal recovery for vancomycin. Large molecular size and higher protein binding resulted in lower relative recoveries for vancomycin. Perfusate flow rates and drug concentrations affected the relative recovery when a combination of vancomycin and tobramycin was tested. Low perfusate flow rates were associated with higher recovery rates. For combination antibiotic measurement which includes agents that are highly protein bound, in vitro studies performed prior to in vivo studies may ensure the reliable measurement of unbound concentrations.

关键词： Microdialysis Combination antibiotic therapy Relative recovery rate Pharmacokinetics Anti-infectives Protein binding

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Ventilation practices in burn patients—an international prospective observational cohort study

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Burns & Trauma 2021年第1期9卷 47-57页

作者： Gerie J.Glas Janneke Horn Markus W.Hollmann Benedikt Preckel Kirsten Colpaert Manu Malbrain Ary Serpa Neto Karim Asehnoune Marcello Gamma de Abreu Ignacio Martin-Loeches Paolo Pelosi Folke Sjoerg Jan M.Binnekade Berry Cleffken Nicole P.Juffermans Paul Knape Bert G.Loef David P.Mackie Perenlei Enkhbaatar Nadia Depetris Anders Perner Eva Herrero Lucia Cachafeiro Marc Jeschke jeffrey lipman Matthieu Legrand Johannes Horter Athina Lavrentieva Alex Kazemi Anne Berit Guttormsen Frederik Huss Mark Kol Helen Wong Therese Starr Luc De Crop Wilson de Oliveira Filho Joa Manoel Silva Junior Cintia M.C.Grion Marjorie Burnett Frederik Mondrup Francois Ravat Mathieu Fontaine Renan Le Floch Mathieu Jeanne Morgane Bacus Maite Chaussard Marcus Lehnhardt Bassem Daniel Mikhail Jochen Gille Aidan Sharkey Nicole Trommel Auke C.Reidinga Nadine Vieleers Anna Tilsley Henning Onarheim Maria Teresa Bouza Alexander Agrifoglio Filip Fredén Tina Palmieri Lynda E.Painting Marcus J.Schultz LAMiNAR investigators Academic Medical Center University of AmsterdamAmsterdamAZ 1105The Netherlands Department of Anaesthesia and Intensive Therapy Medical University of Lublin Aleje Racklawickie 1–20-059 Lublin–Poland AZ JAN PALFIJN GENT Watersportlaan 5–9000 Gent–Belgium ABC Medical School SaPauloBangúSP 5001Brazil Service d’Anesthésie Réanimation Chirurgicale Nantes 44093France University Hospital Carl Gustav Carus Dresden 01307Germany St James University Hospital Dublin D08 NHY1Ireland University of Genoa GenoaGE 16128Italy Linkoing University Hospital Linkoing 58185Sweden Maasstad Hospital RotterdamDZ 3079The Netherlands Red Cross Hospital BeverwijkLE 1942The Netherlands Martini Hospital GroningenNT 9728The Netherlands University of Texas Medical Branch GalvestonTX 77555USA Turin CTO Burn Center TurinTO 10126Italy Rigshospitalet Copenhagen 2100Denmark La Paz University Hospital Madrid 28046Spain Ross Tilley Burn Centre Sunnybrook Health Sciences CentreToronto M4N 3M5Canada Royal Brisbane and Women’s Hospital Queensland UniversityHerstonQLD 4029Australia Australian and New Zealand Intensive Care Research Centre.Monash University MelbourneVIC 3004Australia GH St-Louis-Lariboisière APHPParis 75010France BG Klinik Ludwigshafen Ludwigshafen 67071Germany Papanikoalou Hospital Thessaloniki 54621Greece Middlemore Hospital OtahuhuAuckland 2025New Zealand Haukeland University Hospital Bergen 5021Norway Uppsala University Hospital Uppsala 75185Sweden Concord Repatriation General Hospital NSW University of SydneyConcord 2139Australia Ziekenhuis Netwerk Antwerpen-Stuivenberg Antwerpen 2060Belgium Universidade de Sao Paulo Sao Paulo 01246-903Brazil Universidade Estadual de Londrina Londrina 86057-970Brazil Sunnybrook Health Sciences Centre Toronto M4N 3M5Canada CHU Lyon St Luc Lyon 69007France CHU Nantes Service dánesthesie reanimation chirugicale Nantes 44093France Hopital Roger Salengro CHRU LilleLille 59037France Saint-Louis Hospital Paris 75010France BG University Hospital Bergmannsheil Bo

Background:It is unknown whether lung-protective ventilation is applied in burn patients and whether they benefit from *** study aimed to determine ventilation practices in burn intensive care units(ICUs)and investigate the association between lung-protective ventilation and the number of ventilator-free days and alive at day 28(VFD-28).Methods:This is an international prospective observational cohort study including adult burn patients requiring mechanical *** tidal volume(V_(T))was defined as V_(T)≤8 mL/kg predicted body weight(PBW).Levels of positive end-expiratory pressure(PEEP)and maximum airway pressures were *** association between V_(T) and VFD-28 was analyzed using a competing risk *** settings were presented for all patients,focusing on the first day of *** also compared ventilation settings between patients with and without inhalation ***:A total of 160 patients from 28 ICUs in 16 countries were *** V_(T) was used in 74%of patients,median V_(T) size was 7.3[interquartile range(IQR)6.2–8.3]mL/kg PBW and did not differ between patients with and without inhalation trauma(p=0.58).Median VFD-28 was 17(IQR 0–26),without a difference between ventilation with low or high V_(T)(p=0.98).All patients were ventilated with PEEP levels≥5 cmH_(2)O;80%of patients had maximum airway pressures<30 cmH_(2)***:In this international cohort study we found that lung-protective ventilation is used in the majority of burn patients,irrespective of the presence of inhalation *** of low V_(T) was not associated with a reduction in *** registration:*** *** of registration:9 December 2014.

关键词： Mechanical ventilation Inhalation trauma Lung-protective Critical care

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