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Oxygenation target in acute respiratory distress syndrome

Journal of Intensive Medicine 2023年第3期3卷 220-227页

作者： Gilles Capellier Loic Barrot Hadrien Winizewski Réanimation Médicale CHU Jean MinjozBesançon 25000France Department of Health Monash UniversityMelbourne 3800Australia Equipe d’accueil EA 3920 Universitéde Franche ComteBesançon 25000France Département d’Anesthésie-Réanimation CHU Jan MinjozBesançon 25000France

Determining oxygenation targets in acute respiratory distress syndrome(ARDS)remains a *** targets have been used since ARDS was first described,they have not been investigated in ***,recent retrospective and prospective trials have evaluated the optimal oxygenation threshold in patientsadmitted to the general intensive care *** view of the lack of prospective data,clinicians continue to relyon data from the few available trials to identify the optimal oxygenation *** of the cost-benefitratio of the fraction of inspired oxygen(FiO_(2))to the partial pressure of oxygen in the arterial blood(PaO_(2))is an additional challenge.A high FiO_(2) has been found to be responsible for respiratory failure and deaths innumerous animal *** and high PaO_(2) values have also been demonstrated to be potential risk factors inexperimental and clinical *** findings from this literature review suggest that PaO_(2) values rangingbetween 80 mmHg and 90 mmHg are acceptable in patients with *** costs of rescue maneuvers needed toreach these targets have been *** recent papers have highlighted the risk of disagreement betweenarterial oxygen saturation(SaO_(2))and peripheral oxygen saturation(SpO_(2))*** order to avoid discrepanciesand hidden hypoxemia,SpO_(2) readings need to be compared with those of SaO_(2).Higher SpO_(2) values may beneeded to achieve the recommended PaO_(2) and SaO_(2) values.

关键词： Oxygen Oxygenation Acute respiratory distress syndrome Fraction of inspired oxygen(FiO_(2)) Arterial oxygen saturation Peripheral oxygen saturation(SpO_(2))

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Is COVID-19 different from other causes of acute respiratory distresssyndrome?

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Journal of Intensive Medicine 2023年第3期3卷 212-219页

作者： François M.Beloncle Medical ICU University Hospital of AngersVent’LabUniversity of AngersAngers 49033France

Coronavirus disease 2019(COVID-19)pneumonia can lead to acute hypoxemic respiratory *** mechanical ventilation is needed,almost all patients with COVID-19 pneumonia meet the criteria for acute respiratorydistress syndrome(ARDS).The question of the specificities of COVID-19-associated ARDS compared to othercauses of ARDS is of utmost importance,as it may justify changes in ventilatory *** review aims todescribe the pathophysiology of COVID-19-associated ARDS and discusses whether specific ventilatory strategiesare required in these patients.

关键词： Mechanical ventilation Respiratory mechanics Gas exchange Recruitability Dead space

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How to integrate hemodynamic variables during resuscitation of septic shock?

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Journal of Intensive Medicine 2023年第2期3卷 131-137页

作者： Jean-Louis Teboul Service de Médecine Intensive-Réanimation Hopital de BicêtreGHU AP-HPUniversitéParis-SaclayParis 94270France

Resuscitation of septic shock is a complex issue because the cardiovascular disturbances that characterize septic shock vary from one patient to another and can also change over time in the same patient. Therefore, different therapies (fluids, vasopressors, and inotropes) should be individually and carefully adapted to provide personalized and adequate treatment. Implementation of this scenario requires the collection and collation of all feasible information, including multiple hemodynamic variables. In this review article, we propose a logical stepwise approach to integrate relevant hemodynamic variables and provide the most appropriate treatment for septic shock.

关键词： Lactate Capillary refill time Central venous oxygen saturation Veno-arterial carbon dioxide gap Transpulmonary thermodilution

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Long-term assist device patients admitted to ICU: Tips and pitfalls

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Journal of Intensive Medicine 2023年第2期3卷 81-88页

作者： Michiel Morshuis Hendrik Fox Volker Lauenroth Rene Schramm Heart and Diabetes Center North Rhine-Westphalia Bad Oeynhausen 32545Germany

Left ventricular assist device(LVAD)therapy is well-established in the treatment of end-stage cardiac *** are bridge to transplant(BTT),bridge to candidacy(BTC),bridge to recovery(BTR),and destination therapy(DT).The durability and adverse event(AE)rate of LVADs have improved over the ***,due to donor shortage,the duration of support in the BTT population has increased tremendously;similarly,DT patients are on the device for a long ***,the number of readmissions of long-term LVAD patients has *** cases of severe AEs,intensive care unit(ICU)treatment can be *** complications are the most common ***,embolic or hemorrhagic strokes can occur due to foreign surfaces,acquired von Willebrand syndrome,and anticoagulation *** consequence of the coagulative status,in combination with the continuous flow,are gastrointestinal bleeding ***,in most patients,an isolated LVAD is implanted,and this involves the risk of late right heart *** of pump speed and optimization of the volume status can help solve this *** arrhythmias,pre-existing or de novo after LVAD implantation,can be a life-threatening *** medical therapy or ablation are potential treatment *** for specific LVADs,the Medtronic HeartWare TM ventricular assist device(HVAD)is not manufactured and distributed currently;however,4000 patients are still on the *** thrombosis can occur,wherein thrombolytic therapy is the first-line treatment ***,the HVAD can fail to restart after controller exchange due to technical issues,and precautions must be *** Momentum 3 trial showed superior survival without pump exchange or disabling stroke in patients treated with the HeartMate 3■(HM3;Abbott,Abbott Park,IL,USA)device in comparison to the HeartMate II(HMII).However,in a few cases,a twisted graft or bio debris formation between the outflow graft and bend reli

关键词： Heart failure Left ventricular assist device(LVAD)therapy Adverse events

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Subjective scar assessment scales in orthopaedic surgery and determinants of patient satisfaction: A systematic review of the literature

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中华创伤杂志:英文版 2023年第5期26卷 276-283页

作者： Diego A Abelleyra Lastoria Clerin K Benny Caroline B Hing Institute for Medical and Biomedical Education St George's University of LondonLondonSW17 OREUnited Kingdom Faculty of Medicine Medical University of SofiaSofia1641Bulgaria Department of Trauma and Orthopaedics St George's University Hospitals NHS Foundation TrustLondonSW17 OQTUnited Kingdom

Purpose:Scar assessment tools can be utilized during the post-operative period to monitor scar *** primary aim of this systematic review was to evaluate current subjective scar assessment scales utilized in orthopaedic *** secondary aim was to identify determinants of patients'satisfaction with their scars and evaluate current measurement ***:The preferred reporting items for systematic reviews and meta-analyses checklist was *** databases,curently registered studies,conference proceedings and the reference lists of included studies were *** were no constraints based on language or publication status.A narrative synthesis provided a description and evaluation of scales utilized in orthopaedic *** of patient satisfaction were identified along with the scales used to measure ***:A total of 6059 records were screened in the initial ***-six articles satisfied the inclusion criteria,assessing 7130 *** the literature,six validated subjective scar scales were identified,including the Vancouver scar scale,patient and observer scar assessment scale,Manchester scar scale,Stony Brook scar evaluation scale,visual analogue scale,and Hollander wound evaluation *** utilizing these scales to evaluate scars following orthopaedic procedures did so *** were total hip arthroplasty,total knee arthroplasty,and limb *** scales demonstrated satisfactory *** outcomes such as restoration of movement ranked among patients'highest *** cosmesis was found to be amongst patients'lowest ***:Subjective scar assessment scales identified in the literature were not designed specifically for orthopaedic ***,these were able to appropriately assess scars in the studies identified in this *** evidence suggests the effect of scar cosmesis on patient satisfaction with orthopaedic procedures is li

关键词： Scar Cosmesis Orthopaedics Patient satisfaction

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Metabolic and nutritional aspects in continuous renal replacement therapy

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Journal of Intensive Medicine 2023年第3期3卷 228-238页

作者： Guy Fishman Pierre Singer Department of General Intensive Care and Institute for Nutrition Research Rabin Medical CenterBeilinson HospitalThe Sackler School of MedicineTel AvivUniversityPetach Tikva 49100Israel

Nutrition is one of the foundations for supporting and treating critically ill *** support providescalories,protein,electrolytes,vitamins,and trace elements via the enteral or parenteral *** kidneyinjury(AKI)is a common and devastating problem in critically ill patients and has significant metabolic andnutritional ***,renal replacement therapy(RRT),whatever the modality used,also profoundly impacts *** and of the extracorporeal circuit impede‘effect the evaluation of a patient’senergy requirements by *** added and removed within the extracorporeal treatment are notalways taken into consideration,making treatment even more ***,evidence on nutritionalsupport during continuous renal replacement therapy(CRRT)is scarce,and there are no clinical guidelines fornutrition adaptations during CRRT in critically ill *** recommendations are based on expert *** review discusses the complex interaction between nutritional support and CRRT and presents somemilestones for nutritional support in critically ill patients on CRRT.

关键词： Acute kidney injury Continuous renal replacement therapy Nutrition Indirect calorimetry Resting energy expenditure

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Impact of initial fluid resuscitation volume on clinical outcomes in patientswith heart failure and septic shock

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Journal of Intensive Medicine 2023年第3期3卷 254-260页

作者： Adam L.Wiss Bruce A.Doepker Brittany Hoyte Logan M.Olson Kathryn A.Disney Eric M.McLaughlin Vincent Esguerra Jessica L.Elefritz Department of Pharmacy Ascension Saint Thomas Hospital WestNashvilleTN 37205USA Department of Pharmacy The Ohio State University Wexner Medical CenterColumbusOH 43210USA Department of Pharmacy Corewell HealthGrand RapidsMI 49503USA Department of Pharmacy Nebraska MedicineOmahaNE 68105USA Department of Pharmacy Huntsman Cancer Institute at the University of UtahSalt Lake CityUT 84112USA Center for Biostatistics The Ohio State UniversityColumbusOH 43210USA Division of Pulmonary AllergyCritical Careand Sleep Medicine.The Ohio State University Wexner Medical CenterColumbusOH 43210USA

Background:Fluid resuscitation is a key treatment for sepsis,but limited data exists in patients with existing heartfailure(HF)and septic *** objective of this study was to determine the impact of initial fluid resuscitationvolume on outcomes in HF patients with reduced or mildly reduced left ventricular ejection fraction(LVEF)withseptic ***:This multicenter,retrospective,cohort study included patients with known HF(LVEF≤50%)presentingwith septic *** were divided into two groups based on the volume of fluid resuscitation in the first 6 h;<30 mL/kg or≥30 mL/*** primary outcome was a composite of in-hospital mortality or renal replacementtherapy(RRT)within 7 *** outcomes included acute kidney injury(AKI),initiation of mechanicalventilation,and length of stay(LOS).All related data were collected and compared between the two groups.A generalized logistic mixed model was used to assess the association between fluid groups and the primaryoutcome while adjusting for baseline LVEF,Acute Physiology and Chronic Health Evaluation(APACHE)II score,inappropriate empiric antibiotics,and receipt of ***:One hundred and fifty-four patients were included(93 patients in<30 mL/kg group and 61 patientsin≥30 mL/kg group).The median weight-based volume in the first 6 h was 17.7(12.2–23.0)mL/kg in the<30 mL/kg group vs.40.5(34.2–53.1)mL/kg in the≥30 mL/kg group(P<0.01).No statistical difference was detected in the composite of in-hospital mortality or RRT between the<30 mL/kg group compared to the≥30 mL/kggroup(55.9%vs.45.9%,P=0.25),***<30 mL/kg group had a higher incidence of AKI,mechanicalventilation,and longer hospital ***:In patients with known reduced or mildly reduced LVEF presenting with septic shock,no differencewas detected for in-hospital mortality or RRT in patients who received≥30 mL/kg of resuscitation fluid comparedto less fluid,although this study was underpowered to detect a ***

关键词： Sepsis Septic shock Heart failure Fluid resuscitation

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Antimicrobial stewardship in the intensive care unit

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Journal of Intensive Medicine 2023年第3期3卷 244-253页

作者： Zeynep Ture Rahmet Güner Emine Alp Department of Infectious Diseases and Clinical Microbiology Faculty of MedicineErciyes UniversityKayseri 38039Turkey Department of Infectious Diseases and Clinical Microbiology Yıldırım Beyazıt UniversityAnkara 06800Turkey

High resistance rates to antimicrobials continue to be a global health *** incidence of multidrug-resistant(MDR)microorganisms in intensive care units(ICUs)is quite high compared to in the community and other unitsin the hospital because ICU patients are generally older,have higher numbers of co-morbidities and immunesuppressed;moreover,the typically high rates of invasive procedures performed in the ICU increase the risk ofinfection by MDR *** stewardship(AMS)refers to the implementation of coordinatedinterventions to improve and track the appropriate use of antibiotics while offering the best possible antibioticprescription(according to dose,duration,and route of administration).Broad-spectrum antibiotics are frequentlypreferred in ICUs because of greater infection severity and colonization and infection by MDR *** this reason,a number of studies on AMS in ICUs have increased in recent *** the use of broadspectrum antibiotics forms the basis of *** this purpose,parameters such as establishing an AMS team,limiting the use of broad-spectrum antimicrobials,terminating treatments early,using early warning systems,pursuing infection control,and providing education and feedback are *** this review,current AMS practicesin ICUs are discussed.

关键词： Intensive care unit Antimicrobial stewardship Critically ill Appropriate antimicrobial Infection control Multidrug-resistant

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Hemodynamic monitoring in cardiogenic shock

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Journal of Intensive Medicine 2023年第2期3卷 104-113页

作者： Olfa Hamzaoui Florence Boissier Service de Médecine Intensive Réanimation Hopital Robert DebréUniversitéde ReimsReims 51092France UnitéHERVI Hémostase et Remodelage Vasculaire Post-IschémieEA 3801Reims 51092France Médecine Intensive Réanimation H?pital Universitaire de PoitiersPoitiers 90577France INSERM CIC 1402(ALIVE Group) Universitéde PoitiersPoitiers 90577France

Cardiogenic shock(CS)is a life-threatening condition characterized by acute end-organ hypoperfusion due to inadequate cardiac output that can result in multiorgan failure,which may lead to *** diminished cardiac output in CS leads to systemic hypoperfusion and maladaptive cycles of ischemia,inflammation,vasoconstriction,and volume ***,the optimal management of CS needs to be readjusted in view of the predominant dysfunction,which may be guided by hemodynamic *** monitoring enables(1)characterization of the type of cardiac dysfunction and the degree of its severity,(2)very early detection of associated vasoplegia,(3)detection and monitoring of organ dysfunction and tissue oxygenation,and(4)guidance of the introduction and optimization of inotropes and vasopressors as well as the timing of mechanical *** is now well documented that early recognition,classification,and precise phenotyping via early hemodynamic monitoring(e.g.,echocardiography,invasive arterial pressure,and the evaluation of organ dysfunction and parameters derived from central venous catheterization)improve patient *** more severe disease,advanced hemodynamic monitoring with pulmonary artery catheterization and the use of transpulmonary thermodilution devices is useful to facilitate the right timing of the indication,weaning from mechanical cardiac support,and guidance on inotropic treatments,thus helping to reduce *** this review,we detail the different parameters relevant to each monitoring approach and the way they can be used to support optimal management of these patients.

关键词： Echocardiography Cardiogenic shock Hemodynamic monitoring Pulmonary artery catheter Transpulmonary thermodilution device

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Comparison of above elbow and below elbow immobilisation for conservative treatment of distal end radius fracture in adults:A systematic review and meta-analysis of randomized clinical trials

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Chinese Journal of Traumatology 2023年第4期26卷 204-210页

作者： Vikash Raj Sitanshu Barik Richa Department of Orthopedics All India Institute of Medical SciencesDeogharIndia Department of Community and Family Medicine All India Institute of Medical SciencesDeogharIndia

Purpose:The aim of this study was to analyze if any difference exists on the type of immobilisation(above elbow *** elbow)in the conservative treatment of distal end radius fractures in ***:The study was performed in accordance with Preferred Reporting Items for Systematic Reviews and *** electronic literature search was performed up to 1st October 2021 in Medline,Embase,Ovid and Cochrane database using the search terms,"distal end radius fractures OR fracture of distal radius","conservative treatment OR non-surgical treatment","above elbow immobilisation"and"below elbow immobilisation".Randomized clinical trials written in English,describing outcome of distal end radius fractures in adults by conservative or non-surgical means using above elbow immobilisation or below elbow immobilisation were included and assessed according to the risk of bias assessment(RoB2)tool by Cochrane ***-randomized clinical trials,observational studies,retrospec-tive studies,review articles,commentaries,editorials,conference presentations,operative techniques and articles without availability of full text were excluded from this *** meta-analysis was performed using Review Manager version 5.4.1(The Cochrane Collaboration,Copenhagen,Denmark).Results:Six randomized clinical trials were included for quantitative *** heterogeneity(I2>75%)was noted among all the *** standard mean difference(MD)between the disability of the arm,shoulder and hand scores in both the groups was 0.52(95%CI:-0.28 to 1.32)which was statistically *** was no statistical difference in the radial height(MD=0.10,95%CI:-0.91 to 1.12),radial inclination(MD=0.5,95%CI:-1.88 to 2.87,palmar tilt(MD=1.06,95%CI:-0.31 to 2.43)and ulnar variance(MD=0.05,95%CI:-0.74 to 0.64).It was observed that shoulder pain occurred more commonly as a complication in above elbow immobilisation and the values were statistically significant(above elbow:38/92,41.3%;b

关键词： Distal radiusfractures Conservative treatment Above elbow immobilisation Below elbow immobilisation DASH scores

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