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Kreitmann L, Helms J, Martin-Loeches I, Salluh J, Poulakou G, Pène F, Nseir S. ICU-acquired infections in immunocompromised patients. Intensive Care Med 2024; 50:332-349. [PMID: 38197931 DOI: 10.1007/s00134-023-07295-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/25/2023] [Indexed: 01/11/2024]
Abstract
Immunocompromised patients account for an increasing proportion of the typical intensive care unit (ICU) case-mix. Because of the increased availability of new drugs for cancer and auto-immune diseases, and improvement in the care of the most severely immunocompromised ICU patients (including those with hematologic malignancies), critically ill immunocompromised patients form a highly heterogeneous patient population. Furthermore, a large number of ICU patients with no apparent immunosuppression also harbor underlying conditions altering their immune response, or develop ICU-acquired immune deficiencies as a result of sepsis, trauma or major surgery. While infections are associated with significant morbidity and mortality in immunocompromised critically ill patients, little specific data are available on the incidence, microbiology, management and outcomes of ICU-acquired infections in this population. As a result, immunocompromised patients are usually excluded from trials and guidelines on the management of ICU-acquired infections. The most common ICU-acquired infections in immunocompromised patients are ventilator-associated lower respiratory tract infections (which include ventilator-associated pneumonia and tracheobronchitis) and bloodstream infections. Recently, several large observational studies have shed light on some of the epidemiological specificities of these infections-as well as on the dynamics of colonization and infection with multidrug-resistant bacteria-in these patients, and these will be discussed in this review. Immunocompromised patients are also at higher risk than non-immunocompromised hosts of fungal and viral infections, and the diagnostic and therapeutic management of these infections will be covered. Finally, we will suggest some important areas of future investigation.
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Affiliation(s)
- Louis Kreitmann
- Department of Intensive Care Medicine, Imperial College Healthcare NHS Trust, London, UK
- Centre for Antimicrobial Optimisation, Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, W12 0HS, UK
| | - Julie Helms
- Service de Médecine Intensive-Réanimation, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, 1, Place de l'Hôpital, 67091, Strasbourg Cedex, France
- ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, LabEx TRANSPLANTEX, Centre de Recherche d'Immunologie et d'Hématologie, Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Fédération Hospitalo-Universitaire (FHU) OMICARE, Université de Strasbourg (UNISTRA), Strasbourg, France
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), Leinster, D08NYH1, Dublin, Ireland
- Pulmonary Intensive Care Unit, Respiratory Institute, Hospital Clinic of Barcelona, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), University of Barcelona, ICREA CIBERes, 08380, Barcelona, Spain
| | - Jorge Salluh
- D'Or Institute for Research and Education (IDOR), Rua Diniz Cordeiro, 30, Rio de Janeiro, RJ, 22281-100, Brazil
| | - Garyphallia Poulakou
- Third Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Sotiria General Hospital, Athens, Greece
| | - Frédéric Pène
- Médecine Intensive-Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Institut Cochin, INSERM U1016, CNRS UMR8104, Université Paris Cité, Paris, France
| | - Saad Nseir
- Médecine Intensive-Réanimation, CHU de Lille, 59000, Lille, France.
- Inserm U1285, Université de Lille, CNRS, UMR 8576-UGSF, 59000, Lille, France.
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McLarty J, Litton E, Beane A, Aryal D, Bailey M, Bendel S, Burghi G, Christensen S, Christiansen CF, Dongelmans DA, Fernandez AL, Ghose A, Hall R, Haniffa R, Hashmi M, Hashimoto S, Ichihara N, Kumar Tirupakuzhi Vijayaraghavan B, Lone NI, Arias López MDP, Mat Nor MB, Okamoto H, Priyadarshani D, Reinikainen M, Soares M, Pilcher D, Salluh J. Non-COVID-19 intensive care admissions during the pandemic: a multinational registry-based study. Thorax 2024; 79:120-127. [PMID: 37225417 DOI: 10.1136/thorax-2022-219592] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 04/05/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND The COVID-19 pandemic resulted in a large number of critical care admissions. While national reports have described the outcomes of patients with COVID-19, there is limited international data of the pandemic impact on non-COVID-19 patients requiring intensive care treatment. METHODS We conducted an international, retrospective cohort study using 2019 and 2020 data from 11 national clinical quality registries covering 15 countries. Non-COVID-19 admissions in 2020 were compared with all admissions in 2019, prepandemic. The primary outcome was intensive care unit (ICU) mortality. Secondary outcomes included in-hospital mortality and standardised mortality ratio (SMR). Analyses were stratified by the country income level(s) of each registry. FINDINGS Among 1 642 632 non-COVID-19 admissions, there was an increase in ICU mortality between 2019 (9.3%) and 2020 (10.4%), OR=1.15 (95% CI 1.14 to 1.17, p<0.001). Increased mortality was observed in middle-income countries (OR 1.25 95% CI 1.23 to 1.26), while mortality decreased in high-income countries (OR=0.96 95% CI 0.94 to 0.98). Hospital mortality and SMR trends for each registry were consistent with the observed ICU mortality findings. The burden of COVID-19 was highly variable, with COVID-19 ICU patient-days per bed ranging from 0.4 to 81.6 between registries. This alone did not explain the observed non-COVID-19 mortality changes. INTERPRETATION Increased ICU mortality occurred among non-COVID-19 patients during the pandemic, driven by increased mortality in middle-income countries, while mortality decreased in high-income countries. The causes for this inequity are likely multi-factorial, but healthcare spending, policy pandemic responses, and ICU strain may play significant roles.
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Affiliation(s)
- Joshua McLarty
- Alfred Hospital, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Edward Litton
- St John of God Hospital Subiaco, Perth, Western Australia, Australia
- The University of Western Australia School of Medicine and Pharmacology, Perth, Western Australia, Australia
| | - Abigail Beane
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Department of Clinical Medicine, University of Oxford Nuffield, Oxford, UK
| | - Diptesh Aryal
- Nepal Intensive Care Research Foundation (NICRF), Kathmandu, Nepal
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Stepani Bendel
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
- Department of Anaesthesiology and Intensive Care, University of Eastern Finland, Joensuu, Finland
| | | | - Steffen Christensen
- Department of Anaesthesia and Intensive Care Medicine, Aarhus University Hospital, Skejby, Denmark
| | | | - Dave A Dongelmans
- Department of Intensive Care Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- National Intensive Care Evaluation (NICE) foundation, Amsterdam, The Netherlands
| | - Ariel L Fernandez
- SATI-Q program, Sociedad Argentina de Terapia Intensiva, Buenos Aires, Argentina
| | - Aniruddha Ghose
- Department of Internal Medicine, Chittagong Medical College & Hospital (CMCH), Chittagong, Bangladesh
| | - Ros Hall
- Public Health Scotland, Edinburgh, UK
| | - Rashan Haniffa
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Department of Clinical Medicine, University of Oxford Nuffield, Oxford, UK
| | | | - Satoru Hashimoto
- Division of Intensive Care, Department of Anesthesiology & Intensive Care Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Japanese Intensive Care PAtient Database (JIPAD), Tokyo, Japan
| | | | | | - Nazir I Lone
- Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Maria Del Pilar Arias López
- Sociedad Argentina de Terapia Intensiva, Buenos Aires, Argentina
- PICU, Hospital de Ninos R Gutierres, Buenos Aires, Argentina
| | - Mohamed Basri Mat Nor
- Department of Anaesthesiology and Intensive Care, Kulliyyah (School) of Medicine, International Islamic University Malaysia, Kuala Lumpur, Malaysia
| | | | | | - Matti Reinikainen
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
- Department of Anaesthesiology and Intensive Care, University of Eastern Finland, Joensuu, Finland
| | - Marcio Soares
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - David Pilcher
- Alfred Hospital, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Jorge Salluh
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
- Postgraduate Program of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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3
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Rashan A, Beane A, Ghose A, Dondorp AM, Kwizera A, Vijayaraghavan BKT, Biccard B, Righy C, Thwaites CL, Pell C, Sendagire C, Thomson D, Done DG, Aryal D, Wagstaff D, Nadia F, Putoto G, Panaru H, Udayanga I, Amuasi J, Salluh J, Gokhale K, Nirantharakumar K, Pisani L, Hashmi M, Schultz M, Ghalib MS, Mukaka M, Mat-Nor MB, Siaw-frimpong M, Surenthirakumaran R, Haniffa R, Kaddu RP, Pereira SP, Murthy S, Harris S, Moonesinghe SR, Vengadasalam S, Tripathy S, Gooden TE, Tolppa T, Pari V, Waweru-Siika W, Minh YL. Mixed methods study protocol for combining stakeholder-led rapid evaluation with near real-time continuous registry data to facilitate evaluations of quality of care in intensive care units. Wellcome Open Res 2023; 8:29. [PMID: 37954925 PMCID: PMC10638482 DOI: 10.12688/wellcomeopenres.18710.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 11/14/2023] Open
Abstract
Background Improved access to healthcare in low- and middle-income countries (LMICs) has not equated to improved health outcomes. Absence or unsustained quality of care is partly to blame. Improving outcomes in intensive care units (ICUs) requires delivery of complex interventions by multiple specialties working in concert, and the simultaneous prevention of avoidable harms associated with the illness and the treatment interventions. Therefore, successful design and implementation of improvement interventions requires understanding of the behavioural, organisational, and external factors that determine care delivery and the likelihood of achieving sustained improvement. We aim to identify care processes that contribute to suboptimal clinical outcomes in ICUs located in LMICs and to establish barriers and enablers for improving the care processes. Methods Using rapid evaluation methods, we will use four data collection methods: 1) registry embedded indicators to assess quality of care processes and their associated outcomes; 2) process mapping to provide a preliminary framework to understand gaps between current and desired care practices; 3) structured observations of processes of interest identified from the process mapping and; 4) focus group discussions with stakeholders to identify barriers and enablers influencing the gap between current and desired care practices. We will also collect self-assessments of readiness for quality improvement. Data collection and analysis will be led by local stakeholders, performed in parallel and through an iterative process across eight countries: Kenya, India, Malaysia, Nepal, Pakistan, South Africa, Uganda and Vietnam. Conclusions The results of our study will provide essential information on where and how care processes can be improved to facilitate better quality of care to critically ill patients in LMICs; thus, reduce preventable mortality and morbidity in ICUs. Furthermore, understanding the rapid evaluation methods that will be used for this study will allow other researchers and healthcare professionals to carry out similar research in ICUs and other health services.
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Affiliation(s)
- The Collaboration for Research, Implementation and Training in Critical Care in Asia and Africa (CCAA)
- Institute of Health Informatics, University College London, London, UK
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- Department of Medicine, Chittagong Medical College Hospital, Chattogram, Bangladesh
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Anaesthesia and Intensive Care Medicine, Makerere University, Kampala, Uganda
- Department of Critical Care Medicine, Apollo Hospitals Educational and Research Foundation, Chennai, India
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
- National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Oxford University Clinical Research Unit, University of Oxford, Ho Chi Minh City, Vietnam
- Uganda Heart Institute, University of Makerere, Makerere, Uganda
- D'Or Institute for Research and Education, Sao Paulo, Brazil
- Nat-Intensive Care Surveillance, Mahidol Oxford Tropical Medicine Research Unit, Colombo, Sri Lanka
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Department of Critical Care, Nepal Intensive Care Research Foundation, Kathmandu, Nepal
- Centre for Preoperative Medicine, University College London, London, UK
- Department of Intensive Care Anaesthesiology, International Islamic University Malaysia, Kuala Lumpur, Malaysia
- Department of Planning and Operational Research, Doctors with Africa CUAMM, Padova, Italy
- Department of Global Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Critical Care Medicine, Ziauddin University, Karachi, Pakistan
- Intensive Care Medicine, University of Amsterdam, Amsterdam, The Netherlands
- General Surgery, Wazir Akbar Khan Hospital, Kabul, Afghanistan
- Department of Anaesthesiology and Intensive care, Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Department of Community and Family Medicine, University of Jaffna, Jaffna, Sri Lanka
- Department of Anaesthesia, The Aga Khan University, Nairobi, Kenya
- Department of Targeted Intervention, University College London, London, UK
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Department of Critical Care, University College London Hospitals NHS Foundation Trust, London, UK
- Teaching Hospital Jaffna, Jaffna, Sri Lanka
- AII India Institute of Medical Sciences, New Delhi, India
- Chennai Critical Care Consultants Private Limited, Chennai, India
| | - Aasiyah Rashan
- Institute of Health Informatics, University College London, London, UK
| | - Abi Beane
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Aniruddha Ghose
- Department of Medicine, Chittagong Medical College Hospital, Chattogram, Bangladesh
| | - Arjen M Dondorp
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Arthur Kwizera
- Department of Anaesthesia and Intensive Care Medicine, Makerere University, Kampala, Uganda
| | | | - Bruce Biccard
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - Cassia Righy
- National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - C. Louise Thwaites
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford University Clinical Research Unit, University of Oxford, Ho Chi Minh City, Vietnam
| | - Christopher Pell
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Cornelius Sendagire
- Uganda Heart Institute, University of Makerere, Makerere, Uganda
- D'Or Institute for Research and Education, Sao Paulo, Brazil
| | - David Thomson
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - Dilanthi Gamage Done
- Nat-Intensive Care Surveillance, Mahidol Oxford Tropical Medicine Research Unit, Colombo, Sri Lanka
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Diptesh Aryal
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- D'Or Institute for Research and Education, Sao Paulo, Brazil
- Department of Critical Care, Nepal Intensive Care Research Foundation, Kathmandu, Nepal
| | - Duncan Wagstaff
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Preoperative Medicine, University College London, London, UK
| | - Farah Nadia
- Department of Intensive Care Anaesthesiology, International Islamic University Malaysia, Kuala Lumpur, Malaysia
| | - Giovanni Putoto
- Department of Planning and Operational Research, Doctors with Africa CUAMM, Padova, Italy
| | - Hem Panaru
- Department of Critical Care, Nepal Intensive Care Research Foundation, Kathmandu, Nepal
| | - Ishara Udayanga
- Nat-Intensive Care Surveillance, Mahidol Oxford Tropical Medicine Research Unit, Colombo, Sri Lanka
| | - John Amuasi
- Department of Global Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Jorge Salluh
- D'Or Institute for Research and Education, Sao Paulo, Brazil
| | - Krishna Gokhale
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Luigi Pisani
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Madiha Hashmi
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Department of Critical Care Medicine, Ziauddin University, Karachi, Pakistan
| | - Marcus Schultz
- Intensive Care Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Mavuto Mukaka
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Mohammed Basri Mat-Nor
- Department of Intensive Care Anaesthesiology, International Islamic University Malaysia, Kuala Lumpur, Malaysia
| | - Moses Siaw-frimpong
- Department of Anaesthesiology and Intensive care, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Rashan Haniffa
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Nat-Intensive Care Surveillance, Mahidol Oxford Tropical Medicine Research Unit, Colombo, Sri Lanka
| | - Ronnie P Kaddu
- Department of Anaesthesia, The Aga Khan University, Nairobi, Kenya
| | | | - Srinivas Murthy
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Steve Harris
- Department of Critical Care, University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | - Swagata Tripathy
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
- AII India Institute of Medical Sciences, New Delhi, India
| | - Tiffany E Gooden
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Timo Tolppa
- Nat-Intensive Care Surveillance, Mahidol Oxford Tropical Medicine Research Unit, Colombo, Sri Lanka
| | - Vrindha Pari
- Chennai Critical Care Consultants Private Limited, Chennai, India
| | | | - Yen Lam Minh
- Oxford University Clinical Research Unit, University of Oxford, Ho Chi Minh City, Vietnam
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Kurtz P, Bastos LSL, Ranzani OT, Soares M, Zampieri F, Hamacher S, Salluh J, Bozza FA. Variants of concern and clinical outcomes in critically ill COVID-19 patients. Intensive Care Med 2023; 49:697-699. [PMID: 37067557 PMCID: PMC10108805 DOI: 10.1007/s00134-023-07039-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 04/18/2023]
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Póvoa P, Nseir S, Salluh J. Severe community-acquired pneumonia: in search of the guiding star. Intensive Care Med 2023; 49:656-658. [PMID: 37100928 PMCID: PMC10132953 DOI: 10.1007/s00134-023-07063-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/28/2023]
Affiliation(s)
- Pedro Póvoa
- NOVA Medical School, CHRC, New University of Lisbon, Lisbon, Portugal.
- Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark Centre for Clinical Epidemiology, Odense University Hospital, Odense, Denmark.
- Department of Intensive Care, ICU-4, São Francisco Xavier Hospital, CHLO, Estrada Do Forte Do Alto Do Duque, 1449-005, Lisbon, Portugal.
| | - Saad Nseir
- CHU de Lille, Centre de Réanimation, 59000, Lille, France
- Team Fungal Associated Invasive & Inflammatory Diseases, Université de Lille, INSERM U995, Lille Inflammation Research International Center, Lille, France
| | - Jorge Salluh
- Postgraduate Program, D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
- Postgraduate Program of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, UFRJ, Brazil
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6
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Rashan A, Beane A, Ghose A, Dondorp AM, Kwizera A, Vijayaraghavan BKT, Biccard B, Righy C, Thwaites CL, Pell C, Sendagire C, Thomson D, Done DG, Aryal D, Wagstaff D, Nadia F, Putoto G, Panaru H, Udayanga I, Amuasi J, Salluh J, Gokhale K, Nirantharakumar K, Pisani L, Hashmi M, Schultz M, Ghalib MS, Mukaka M, Mat-Nor MB, Siaw-frimpong M, Surenthirakumaran R, Haniffa R, Kaddu RP, Pereira SP, Murthy S, Harris S, Moonesinghe SR, Vengadasalam S, Tripathy S, Gooden TE, Tolppa T, Pari V, Waweru-Siika W, Minh YL. Mixed methods study protocol for combining stakeholder-led rapid evaluation with near real-time continuous registry data to facilitate evaluations of quality of care in intensive care units. Wellcome Open Res 2023. [DOI: 10.12688/wellcomeopenres.18710.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Background: Improved access to healthcare in low- and middle-income countries (LMICs) has not equated to improved health outcomes. Absence or unsustained quality of care is partly to blame. Improving outcomes in intensive care units (ICUs) requires delivery of complex interventions by multiple specialties working in concert, and the simultaneous prevention of avoidable harms associated with the illness and the treatment interventions. Therefore, successful design and implementation of improvement interventions requires understanding of the behavioural, organisational, and external factors that determine care delivery and the likelihood of achieving sustained improvement. We aim to identify care processes that contribute to suboptimal clinical outcomes in ICUs located in LMICs and to establish barriers and enablers for improving the care processes. Methods: Using rapid evaluation methods, we will use four data collection methods: 1) registry embedded indicators to assess quality of care processes and their associated outcomes; 2) process mapping to provide a preliminary framework to understand gaps between current and desired care practices; 3) structured observations of processes of interest identified from the process mapping and; 4) focus group discussions with stakeholders to identify barriers and enablers influencing the gap between current and desired care practices. We will also collect self-assessments of readiness for quality improvement. Data collection and analysis will be performed in parallel and through an iterative process across eight countries: Kenya, India, Malaysia, Nepal, Pakistan, South Africa, Uganda and Vietnam. Conclusions: The results of our study will provide essential information on where and how care processes can be improved to facilitate better quality of care to critically ill patients in LMICs; thus, reduce preventable mortality and morbidity in ICUs. Furthermore, understanding the rapid evaluation methods that will be used for this study will allow other researchers and healthcare professionals to carry out similar research in ICUs and other health services.
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7
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Póvoa P, Coelho L, Dal-Pizzol F, Ferrer R, Huttner A, Conway Morris A, Nobre V, Ramirez P, Rouze A, Salluh J, Singer M, Sweeney DA, Torres A, Waterer G, Kalil AC. How to use biomarkers of infection or sepsis at the bedside: guide to clinicians. Intensive Care Med 2023; 49:142-153. [PMID: 36592205 PMCID: PMC9807102 DOI: 10.1007/s00134-022-06956-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 12/08/2022] [Indexed: 01/03/2023]
Abstract
Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. In this context, biomarkers could be considered as indicators of either infection or dysregulated host response or response to treatment and/or aid clinicians to prognosticate patient risk. More than 250 biomarkers have been identified and evaluated over the last few decades, but no biomarker accurately differentiates between sepsis and sepsis-like syndrome. Published data support the use of biomarkers for pathogen identification, clinical diagnosis, and optimization of antibiotic treatment. In this narrative review, we highlight how clinicians could improve the use of pathogen-specific and of the most used host-response biomarkers, procalcitonin and C-reactive protein, to improve the clinical care of patients with sepsis. Biomarker kinetics are more useful than single values in predicting sepsis, when making the diagnosis and assessing the response to antibiotic therapy. Finally, integrated biomarker-guided algorithms may hold promise to improve both the diagnosis and prognosis of sepsis. Herein, we provide current data on the clinical utility of pathogen-specific and host-response biomarkers, offer guidance on how to optimize their use, and propose the needs for future research.
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Affiliation(s)
- Pedro Póvoa
- NOVA Medical School, New University of Lisbon, Lisbon, Portugal
- Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark
- Department of Critical Care Medicine, Hospital de São Francisco Xavier, CHLO, Estrada do Forte do Alto do Duque, 1449-005 Lisbon, Portugal
| | - Luís Coelho
- NOVA Medical School, New University of Lisbon, Lisbon, Portugal
- Department of Critical Care Medicine, Hospital de São Francisco Xavier, CHLO, Estrada do Forte do Alto do Duque, 1449-005 Lisbon, Portugal
| | - Felipe Dal-Pizzol
- Laboratory of Experimental Pathophysiology, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, Brazil
- Clinical Research Center, São José Hospital, Criciúma, Brazil
| | - Ricard Ferrer
- Servei de Medicina Intensiva, Hospital Universitari Vall d’Hebron, Institut de Recerca Vall d’Hebron, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBER), Madrid, Spain
| | - Angela Huttner
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
- Center for Clinical Research, Geneva University Hospitals, Geneva, Switzerland
| | - Andrew Conway Morris
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
- Division of Immunology, Department of Pathology, University of Cambridge, Cambridge, UK
- JVF Intensive Care Unit, Addenbrooke’s Hospital, Cambridge, UK
| | - Vandack Nobre
- School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Paula Ramirez
- Department of Critical Care Medicine, Hospital Universitario Y Politécnico La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red‑Enfermedades Respiratorias (CibeRes), Madrid, Spain
| | - Anahita Rouze
- CNRS, Inserm, CHU Lille, UMR 8576 - U1285 - UGSF - Unité de Glycobiologie Structurale et Fonctionnelle, Service de Médecine Intensive - Réanimation, Université de Lille, 59000 Lille, France
| | - Jorge Salluh
- Postgraduate Program, D’Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
- Postgraduate Program of Internal Medicine, Federal University of Rio de Janeiro, (UFRJ), Rio de Janeiro, Brazil
| | | | - Daniel A. Sweeney
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California, La Jolla, San Diego, CA USA
| | - Antoni Torres
- Servei de Pneumologia, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Institut d’Investigacions August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomedica En Red–Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Grant Waterer
- University of Western Australia, Royal Perth Hospital, Perth, Australia
| | - Andre C. Kalil
- Department of Internal Medicine, Division of Infectious Diseases, College of Public Health, University of Nebraska Medical Center, Omaha, NE USA
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Rashan A, Beane A, Ghose A, Dondorp AM, Kwizera A, Vijayaraghavan BKT, Biccard B, Righy C, Thwaites CL, Pell C, Sendagire C, Thomson D, Done DG, Aryal D, Wagstaff D, Nadia F, Putoto G, Panaru H, Udayanga I, Amuasi J, Salluh J, Gokhale K, Nirantharakumar K, Pisani L, Hashmi M, Schultz M, Ghalib MS, Mukaka M, Mat-Nor MB, Siaw-frimpong M, Surenthirakumaran R, Haniffa R, Kaddu RP, Pereira SP, Murthy S, Harris S, Moonesinghe SR, Vengadasalam S, Tripathy S, Gooden TE, Tolppa T, Pari V, Waweru-Siika W, Minh YL. Mixed methods study protocol for combining stakeholder-led rapid evaluation with near real-time continuous registry data to facilitate evaluations of quality of care in intensive care units. Wellcome Open Res 2023. [DOI: 10.12688/wellcomeopenres.18710.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Improved access to healthcare in low- and middle-income countries (LMICs) has not equated to improved health outcomes. Absence or unsustained quality of care is partly to blame. Improving outcomes in intensive care units (ICUs) requires delivery of complex interventions by multiple specialties working in concert, and the simultaneous prevention of avoidable harms associated with the illness and the treatment interventions. Therefore, successful design and implementation of improvement interventions requires understanding of the behavioural, organisational, and external factors that determine care delivery and the likelihood of achieving sustained improvement. We aim to identify care processes that contribute to suboptimal clinical outcomes in ICUs located in LMICs and to establish barriers and enablers for improving the care processes. Methods: Using rapid evaluation methods, we will use four data collection methods: 1) registry embedded indicators to assess quality of care processes and their associated outcomes; 2) process mapping to provide a preliminary framework to understand gaps between current and desired care practices; 3) structured observations of processes of interest identified from the process mapping and; 4) focus group discussions with stakeholders to identify barriers and enablers influencing the gap between current and desired care practices. We will also collect self-assessments of readiness for quality improvement. Data collection and analysis will be performed in parallel and through an iterative process across eight countries: Kenya, India, Malaysia, Nepal, Pakistan, South Africa, Uganda and Vietnam. Conclusions: The results of our study will provide essential information on where and how care processes can be improved to facilitate better quality of care to critically ill patients in LMICs; thus, reduce preventable mortality and morbidity in ICUs. Furthermore, understanding the rapid evaluation methods that will be used for this study will allow other researchers and healthcare professionals to carry out similar research in ICUs and other health services.
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Luz M, Brandão Barreto B, de Castro REV, Salluh J, Dal-Pizzol F, Araujo C, De Jong A, Chanques G, Myatra SN, Tobar E, Gimenez-Esparza Vich C, Carini F, Ely EW, Stollings JL, Drumright K, Kress J, Povoa P, Shehabi Y, Mphandi W, Gusmao-Flores D. Practices in sedation, analgesia, mobilization, delirium, and sleep deprivation in adult intensive care units (SAMDS-ICU): an international survey before and during the COVID-19 pandemic. Ann Intensive Care 2022; 12:9. [PMID: 35122204 PMCID: PMC8815719 DOI: 10.1186/s13613-022-00985-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/16/2022] [Indexed: 12/16/2022] Open
Abstract
Background Since the publication of the 2018 Clinical Guidelines about sedation, analgesia, delirium, mobilization, and sleep deprivation in critically ill patients, no evaluation and adequacy assessment of these recommendations were studied in an international context. This survey aimed to investigate these current practices and if the COVID-19 pandemic has changed them. Methods This study was an open multinational electronic survey directed to physicians working in adult intensive care units (ICUs), which was performed in two steps: before and during the COVID-19 pandemic. Results We analyzed 1768 questionnaires and 1539 (87%) were complete. Before the COVID-19 pandemic, we received 1476 questionnaires and 292 were submitted later. The following practices were observed before the pandemic: the Visual Analog Scale (VAS) (61.5%), the Behavioral Pain Scale (BPS) (48.2%), the Richmond Agitation Sedation Scale (RASS) (76.6%), and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) (66.6%) were the most frequently tools used to assess pain, sedation level, and delirium, respectively; midazolam and fentanyl were the most frequently used drugs for inducing sedation and analgesia (84.8% and 78.3%, respectively), whereas haloperidol (68.8%) and atypical antipsychotics (69.4%) were the most prescribed drugs for delirium treatment; some physicians regularly prescribed drugs to induce sleep (19.1%) or ordered mechanical restraints as part of their routine (6.2%) for patients on mechanical ventilation; non-pharmacological strategies were frequently applied for pain, delirium, and sleep deprivation management. During the COVID-19 pandemic, the intensive care specialty was independently associated with best practices. Moreover, the mechanical ventilation rate was higher, patients received sedation more often (94% versus 86.1%, p < 0.001) and sedation goals were discussed more frequently in daily rounds. Morphine was the main drug used for analgesia (77.2%), and some sedative drugs, such as midazolam, propofol, ketamine and quetiapine, were used more frequently. Conclusions Most sedation, analgesia and delirium practices were comparable before and during the COVID-19 pandemic. During the pandemic, the intensive care specialty was a variable that was independently associated with the best practices. Although many findings are in accordance with evidence-based recommendations, some practices still need improvement. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-00985-y.
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Affiliation(s)
- Mariana Luz
- Intensive Care Unit of the Hospital da Mulher, Rua Barão de Cotegipe, 1153, Roma, Salvador, BA, CEP: 40411-900, Brazil. .,Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil. .,Intensive Care Unit, Hospital Universitário Professor Edgard Santos, Salvador, Brazil.
| | - Bruna Brandão Barreto
- Intensive Care Unit of the Hospital da Mulher, Rua Barão de Cotegipe, 1153, Roma, Salvador, BA, CEP: 40411-900, Brazil.,Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Roberta Esteves Vieira de Castro
- Departamento de Pediatria, Hospital Universitário Pedro Ernesto, Universidade Do Estado Do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jorge Salluh
- Department of Critical Care and Postgraduate Program in Translational Medicine, D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil.,Programa de Pós-Graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Felipe Dal-Pizzol
- Laboratório de Fisiopatologia Experimental, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, Santa Catarina, Brazil
| | - Caio Araujo
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Audrey De Jong
- Department of Anesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, INSERM U1046, CNRS UMR, 9214, Montpellier, CEDEX 5, France
| | - Gérald Chanques
- Department of Anesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, INSERM U1046, CNRS UMR, 9214, Montpellier, CEDEX 5, France
| | - Sheila Nainan Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Eduardo Tobar
- Internal Medicine Department, Critical Care Unit, Hospital Clínico Universidad de Chile, Santiago, Chile
| | | | - Federico Carini
- Intensive Care Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Eugene Wesley Ely
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA.,Center for Quality Aging, Vanderbilt University Medical Center, Nashville, TN, USA.,Geriatric Research Education and Clinical Center (GRECC) Service at the Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, USA.,Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joanna L Stollings
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kelly Drumright
- Tennessee Valley Healthcare System VA Medical Center, Nashville, TN, USA
| | - John Kress
- Division of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL, USA
| | - Pedro Povoa
- Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, CHLO, Lisbon, Portugal.,CHRC, CEDOC, NOVA Medical School, New University of Lisbon, Lisbon, Portugal.,Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark
| | - Yahya Shehabi
- Department of Critical Care and Perioperative Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
| | - Wilson Mphandi
- Intensive Care Unit, Hospital Américo Boavida, Luanda, Angola
| | - Dimitri Gusmao-Flores
- Intensive Care Unit of the Hospital da Mulher, Rua Barão de Cotegipe, 1153, Roma, Salvador, BA, CEP: 40411-900, Brazil.,Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
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Pisani L, Algera AG, Neto AS, Azevedo L, Pham T, Paulus F, de Abreu MG, Pelosi P, Dondorp AM, Bellani G, Laffey JG, Schultz MJ, Martinez A, Leal L, Jorge Pereira A, de Oliveira Maia M, Neto JA, Piras C, Caser EB, Moreira CL, Braga Gusman P, Dalcomune DM, Ribeiro de Carvalho AG, Gondim LAR, Castelo Branco Reis LM, da Cunha Ribeiro D, de Assis Simões L, Campos RS, Fernandez Versiani dos Anjos JC, Bruzzi Carvalho F, Alves RA, Nunes LB, Réa-Neto Á, de Oliveira MC, Tannous L, Cardoso Gomes B, Rodriguez FB, Abelha P, Lugarinho ME, Japiassu A, de Melo HK, Lopes EA, Varaschin P, de Souza Dantas VC, Freitas Knibel M, Ponte M, de Azambuja Rodrigues PM, Costa Filho RC, Saddy F, Wanderley Castellões TF, Silva SA, Osorio LAG, Mannarino D, Espinoza R, Righy C, Soares M, Salluh J, Tanaka L, Aragão D, Tavares ME, Kehdi MGP, Rezende VMC, Carbonell RCC, Teixeira C, de Oliveira RP, Maccari JG, Castro PS, Berto P, Schwarz P, Torelly AP, Lisboa T, Moraes E, Dal-Pizzol F, Tomasi Damiani C, Ritter C, Ferreira JC, Teixeira Costa R, Caruso P, Amendola CP, de Oliveira AMRR, Silva UVA, Sanches LC, Almeida RDS, Azevedo LC, Park M, Schettino G, Assunção MS, Silva E, Barboza CE, Junior APN, Marzocchi Tierno PFGM, Malbouisson LM, Oliveira L, Cristovao D, Neto ML, Rego Ê, Fernandes FE, Romano MLP, Cavalcanti AB, de Souza Barros D, Rodgers H, Dixon B, Smith R, Kol M, Wong H, Schmid W, Hermans G, Ceunen H, Bourgeois M, Anquez N, Suzumura ÉA, Decruyenaere J, DeCrop L, Neto AS, Souza dos Santos R, Beraldo D, dos Santos MC, Pellegrini JAS, Piras C, Oliveira V, Munhoz C, Meira KL, Peçanha AC, da Silva Ramos FJ, Maia I, Bahl M, Biondi R, Prado D, Pinto SF, Salgado J, Falcão LF, Macruz T, de Oliveira GA, Cavalcanti AB, Romano MLP, Ruas K, Mecatti GC, Caser EB, Gava IA, Carreño N, Morales M, Avendaño R, Aguirre S, Luciano PM, Sribar A, Klaric V, Skilijic S, Dvorscak MB, Krkusek M, Jurjevic M, Karanovic N, Simurina T, Stourac P, Kratochvil M, Pacheco ED, Máca J, Wrigge H, Schlegel C, Treschan TA, Schaefer M, Aytulun A, Kienbaum P, Clarkson K, Jaafar R, Collins D, Mazza BF, Plant R, Melchionda G, Di Lauro E, Cortegiani A, Russotto V, Caione R, Mestria D, Volta CA, Spadaro S, Botteri M, Machado FR, Seghelini E, Brazzi L, Sales G, D'Antini D, Molin A, Severgnini P, Bacuzzi A, Peluso L, Verrastro P, Raimondo P, Ferreira E, Gecaj-Gashi A, Simonis FD, Tuinman PR, Alberts E, van den Hul I, Kuiper M, de Wilde RBP, Koopmans M, Kose I, Zincircioglu Ç, dos Santos RB, Dogan N, Aydin D, Denker AS, Buyukkocak U, Akgun N, Turan G, Senturk E, Demirtürk Z, Özcan PE, Ekinci O, Colombo AS, Saylan S, Eren G, Ulger F, Dilek A, Ulusoy H, Goktas U, Soyoral L, Toman H, Orak Y, Kahveci F, Nogueira AC, Mills GH, Pinder A, Walker R, Harrison J, Snell J, Seasman C, Pearson R, Sharman M, Kaloo C, Bynorth N, Fernandes JB, Matthews K, Hughes C, Rose A, Simeson K, Niska L, Huneke N, Adderly J, Padilla-Harris C, Oliver R, Brohi F, Nóbrega RS, Wilson N, Talbot H, Wilson D, Smith D, Dark P, Evans T, Fisher N, Montgomery J, Fitzell P, Muench C, do CS Martins B, Hugill K, Cirstea E, Bentley A, Lynch K, White I, Cooper J, Brazier M, Devile M, Parris M, Gill P, Soriano F, Patel T, Criswell J, Trodd D, Griffin D, Martin J, Wreybrown C, Bewley J, Sweet K, Grimmer L, Kozlowski M, Morsch RD, James S, Limb J, Cowton A, Rogerson D, Downes C, Melbourne S, Humphries R, Pulletz M, Moreton S, Janes S, Nunes ALB, Corner A, Linnett V, Ritzema J, Watters M, Windebank S, Chenna S, Howard-Griffin R, Turner K, Suresh S, Blaylock H, de Almeida JP, Bell S, Blenk K, Everett L, Hopkins P, Mellis C, Hadfield D, Harris C, Chan A, Birch S, Pegg C, Hajjar L, Plowright C, Cooper L, Hatton T, McCullagh I, Wright S, Scott C, Boyd C, Holliday M, Poultney U, Crowther H, Moulin S, Thornthwaite S, Hollister N, Hunt J, Skinner A, Matsa R, Salt R, Matthews C, Reschreiter H, Camsooksai J, Venner N, Giannini FP, Barcraft-Barnes H, Tbaily L, Pogson D, Mouland J, Rose S, Lamb N, Tarmey N, Knighton J, Giles J, Weller D, Baptiston Nunes AL, Reed I, Hormis A, Pearson S, Harris M, Howe J, Paddle J, Burt K, Welters I, Walker A, Youds L, Rios F, Hendry S, Shaw D, Williams K, Hollands R, Carnahan M, Stickley J, Miller C, Donaldson D, Tonks L, Creagh-Brown B, Van Haren F, Hull D, Boyd O, Ortiz-Ruiz L, Gopal S, Metherell S, Spencer H, Frey C, Brown C, Clifford G, Leaver S, Sottiaux T, Ryan C, Mellinghoff JM, Prudden SP, Green HG, Roy AR, Furneval JF, Bell AB, Lakhani SL, Fasting LF, Murray LM, Lora FS, Preller K, McInerney A, Beavis S, Whileman A, Toms J, Glenn S, Ramali M, Ghosh A, Bullock C, Barrell L, Azevedo LC, Young E, Robertson H, Faulkner M, MacNaughton P, Tyson S, Pulak P, Sewell TA, Smalley C, Jacob R, Santos C, Depuydt P, Alzugaray P, Vidal Melo MF, Joyce K, Needleman J, Ahsan A, Faiz A, Alam AKMS, Khatoon SN, Nath RK, Rahman Chowdhury MA, Fan E, Banik D, Mondol MK, Bhuiyan SR, Nazneed S, Sultana R, Hamid T, Hossain M, Reza ST, Asaduzzaman M, Salim M, Bugedo G, Mostafa Kamal AH, Taher SM, Taohid TM, Karmaker P, Roy S, Das S, Sarkar SA, Dutta ML, Roy P, Iyer S, Qiu H, Krishna B, Sampath S, Pattnaik R, Kasi CK, Shah J, Dongre A, Reza Hashemian SM, Nooraei N, Raessi Estabragh R, Malekmohammad M, Gonzalez M, Khoundabi B, Mobasher M, Mohd Yunos N, Kassim M, Voon CM, Das SS, Azauddin SNS, Dorasamy D, Tai LL, Mat Nor MB, Silesky J, Zarudin N, Hasan MS, Jamaluddin MFH, Othman Jailani MI, Kayashta G, Adhikari A, Pangeni R, Hashmi M, Joseph S, Akhtar A, Cerny V, Qadeer A, Memon I, Ali SM, Idrees F, Kamal S, Hanif S, Rehman AU, Taqi A, Hussain T, Farooq A, Nielsen J, Khaskheli S, Hayat M, Indraratna K, Beane A, Haniffa R, Samaranayake U, Mathanalagan S, Gunaratne A, Mithraratne N, Thilakasiri K, Jibaja M, Pilimatalawwe C, Dilhani YAH, Fernando M, Ranatunge K, Samarasinghe L, Vaas M, Edirisooriya M, Sigera C, Arumoli J, De Silva K, Pham T, Kudavidanage B, Pinto V, Dissanayake L, Chittawatanarat K, Kongpolprom N, Silachamroon U, Pornsuriyasak P, Petnak T, Singhatas P, Tangsujaritvijit V, Wrigge H, Rungruanghiranya S, Piriyapatsom A, Juntaping K, Trongtrakul K, Thungtitigul P, Tajarernmuang P, Chatmongkolchart S, Bhurayanontachai R, Akaraborworn O, Navasakulpong A, Matamis D, Surasit K, Thwaites L, Nadjm B, Vu Quoc D, Nguyen Thi Thanh H, Nguyen Van K, Duong Bich T, Lam Minh Y, Ranero JL, Hashemian SM, Amin P, Clarkson K, Bellani G, Kurahashi K, Villagomez A, Zeggwagh AA, Heunks LM, Laake JH, Palo JE, do Vale Fernandes A, Sandesc D, Arabi Y, Bumbasierevic V, Lorente JA, Larsson A, Piquilloud L, Abroug F, McAuley DF, McNamee L, Hurtado J, Bajwa E, Démpaire G, Francois GM, Sula H, Nunci L, Cani A, Zazu A, Dellera C, Insaurralde CS, Alejandro RV, Daldin J, Vinzio M, Fernandez RO, Cardonnet LP, Bettini LR, Bisso MC, Osman EM, Setten MG, Lovazzano P, Alvarez J, Villar V, Milstein C, Pozo NC, Grubissich N, Plotnikow GA, Vasquez DN, Ilutovich S, Tiribelli N, Chena A, Pellegrini CA, Saenz MG, Estenssoro E, Brizuela M, Gianinetto H, Gomez PE, Cerrato VI, Bezzi MG, Borello SA, Loiacono FA, Fernandez AM, Knowles S, Reynolds C, Inskip DM, Miller JJ, Kong J, Whitehead C, Bihari S, Seven A, Krstevski A, Rodgers HJ, Millar RT, Mckenna TE, Bailey IM, Hanlon GC, Aneman A, Lynch JM, Azad R, Neal J, Woods PW, Roberts BL, Kol MR, Wong HS, Riss KC, Staudinger T, Wittebole X, Berghe C, Bulpa PA, Dive AM, Verstraete R, Lebbinck H, Depuydt P, Vermassen J, Meersseman P, Ceunen H, Rosa JI, Beraldo DO, Piras C, Ampinelli AMR, Nassar Jr AP, Mataloun S, Moock M, Thompson MM, Gonçalves CH, Antônio ACP, Ascoli A, Biondi RS, Fontenele DC, Nobrega D, Sales VM, Shindhe S, Ismail DMABPH, Laffey J, Beloncle F, Davies KG, Cirone R, Manoharan V, Ismail M, Goligher EC, Jassal M, Nishikawa E, Javeed A, Curley G, Rittayamai N, Parotto M, Ferguson ND, Mehta S, Knoll J, Pronovost A, Canestrini S, Bruhn AR, Garcia PH, Aliaga FA, Farías PA, Yumha JS, Ortiz CA, Salas JE, Saez AA, Vega LD, Labarca EF, Martinez FT, Carreño NG, Lora P, Liu H, Qiu H, Liu L, Tang R, Luo X, An Y, Zhao H, Gao Y, Zhai Z, Ye ZL, Wang W, Li W, Li Q, Zheng R, Yu W, Shen J, Li X, Yu T, Lu W, Wu YQ, Huang XB, He Z, Lu Y, Han H, Zhang F, Sun R, Wang HX, Qin SH, Zhu BH, Zhao J, Liu J, Li B, Liu JL, Zhou FC, Li QJ, Zhang XY, Li-Xin Z, Xin-Hua Q, Jiang L, Gao YN, Zhao XY, Li YY, Li XL, Wang C, Yao Q, Yu R, Chen K, Shao H, Qin B, Huang QQ, Zhu WH, Hang AY, Hua MX, Li Y, Xu Y, Di YD, Ling LL, Qin TH, Wang SH, Qin J, Han Y, Zhou S, Vargas MP, Silesky Jimenez JI, González Rojas MA, Solis-Quesada JE, Ramirez-Alfaro CM, Máca J, Sklienka P, Gjedsted J, Christiansen A, Nielsen J, Villamagua BG, Llano M, Burtin P, Buzancais G, Beuret P, Pelletier N, Mortaza S, Mercat A, Chelly J, Jochmans S, Terzi N, Daubin C, Carteaux G, de Prost N, Chiche JD, Daviaud F, Pham T, Fartoukh M, Barberet G, Biehler J, Dellamonica J, Doyen D, Arnal JM, Briquet A, Hraiech S, Papazian L, Follin A, Roux D, Messika J, Kalaitzis E, Dangers L, Combes A, Au SM, Béduneau G, Carpentier D, Zogheib EH, Dupont H, Ricome S, Santoli FL, Besset SL, Michel P, Gelée B, Danin PE, Goubaux B, Crova PJ, Phan NT, Berkelmans F, Badie JC, Tapponnier R, Gally J, Khebbeb S, Herbrecht JE, Schneider F, Declercq PLM, Rigaud JP, Duranteau J, Harrois A, Chabanne R, Marin J, Bigot C, Thibault S, Ghazi M, Boukhazna M, Ould Zein S, Richecoeur JR, Combaux DM, Grelon F, Le Moal C, Sauvadet EP, Robine A, Lemiale V, Reuter D, Dres M, Demoule A, Goldgran-Toledano D, Baboi L, Guérin C, Lohner R, Kraßler J, Schäfer S, Zacharowski KD, Meybohm P, Reske AW, Simon P, Hopf HBF, Schuetz M, Baltus T, Papanikolaou MN, Papavasilopoulou TG, Zacharas GA, Ourailogloy V, Mouloudi EK, Massa EV, Nagy EO, Stamou EE, Kiourtzieva EV, Oikonomou MA, Avila LE, Cortez CA, Citalán JE, Jog SA, Sable SD, Shah B, Gurjar M, Baronia AK, Memon M, Muthuchellappan R, Ramesh VJ, Shenoy A, Unnikrishnan R, Dixit SB, Rhayakar RV, Ramakrishnan N, Bhardwaj VK, Mahto HL, Sagar SV, Palaniswamy V, Ganesan D, Mohammadreza Hashemian S, Jamaati H, Heidari F, Meaney EA, Nichol A, Knapman KM, O'Croinin D, Dunne ES, Breen DM, Clarkson KP, Jaafar RF, Dwyer R, Amir F, Ajetunmobi OO, O'Muircheartaigh AC, Black CS, Treanor N, Collins DV, Altaf W, Zani G, Fusari M, Spadaro S, Volta CA, Graziani R, Brunettini B, Palmese S, Formenti P, Umbrello M, Lombardo A, Pecci E, Botteri M, Savioli M, Protti A, Mattei A, Schiavoni L, Tinnirello A, Todeschini M, Giarratano A, Cortegiani A, Sher S, Rossi A, Antonelli MM, Montini LM, Casalena P, Scafetti S, Panarello G, Occhipinti G, Patroniti N, Pozzi M, Biscione RR, Poli MM, Raimondi F, Albiero D, Crapelli G, Beck E, Pota V, Schiavone V, Molin A, Tarantino F, Monti G, Frati E, Mirabella L, Cinnella G, Fossali T, Colombo R, Terragni P, Pattarino I, Mojoli F, Braschi A, Borotto EE, Cracchiolo AN, Palma DM, Raponi F, Foti G, Vascotto ER, Coppadoro A, Brazzi L, Floris L, Iotti GA, Venti A, Yamaguchi O, Takagi S, Maeyama HN, Watanabe E, Yamaji Y, Shimizu K, Shiozaki K, Futami S, Ryosuke S, Saito K, Kameyama Y, Ueno K, Izawa M, Okuda N, Suzuki H, Harasawa T, Nasu M, Takada T, Ito F, Nunomiya S, Koyama K, Abe T, Andoh K, Kusumoto K, Hirata A, Takaba A, Kimura H, Matsumoto S, Higashijima U, Honda H, Aoki N, Imai H, Ogino Y, Mizuguchi I, Ichikado K, Nitta K, Mochizuki K, Hashida T, Tanaka H, Nakamura T, Niimi D, Ueda T, Kashiwa Y, Uchiyama A, Sabelnikovs O, Oss P, Haddad Y, Liew KY, Ñamendys-Silva SA, Jarquin-Badiola YD, Sanchez-Hurtado LA, Gomez-Flores SS, Marin MC, Villagomez AJ, Lemus JS, Fierro JM, Cervantes MR, Mejia FJF, Gonzalez DR, Dector DM, Estrella CR, Sanchez-Medina JR, Ramirez-Gutierrez A, George FG, Aguirre JS, Buensuseso JA, Poblano M, Dendane T, Zeggwagh AA, Balkhi H, Elkhayari M, Samkaoui N, Ezzouine H, Benslama A, Amor M, Maazouzi W, Cimic N, Beck O, Bruns MM, Schouten JA, Rinia M, Raaijmakers M, Heunks LM, Van Wezel HM, Heines SJ, Buise MP, Simonis FD, Schultz MJ, Goodson JC, rowne TSB, Navarra L, Hunt A, Hutchison RA, Bailey MB, Newby L, Mcarthur C, Kalkoff M, Mcleod A, Casement J, Hacking DJ, Andersen FH, Dolva MS, Laake JH, Barratt-Due A, Noremark KAL, Søreide E, Sjøbø BÅ, Guttormsen AB, Yoshido HHL, Aguilar RZ, Oscanoa FAM, Alisasis AU, Robles JB, Pasanting-Lim RAB, Tan BC, Andruszkiewicz P, Jakubowska K, Cox CM, Alvarez AM, Oliveira BS, Montanha GM, Barros NC, Pereira CS, Messias AM, Monteiro JM, Araujo AM, Catorze NT, Marum SM, Bouw MJ, Gomes RM, Brito VA, Castro S, Estilita JM, Barros FM, Serra IM, Martinho AM, Tomescu DR, Marcu A, Bedreag OH, Papurica M, Corneci DE, Negoita SI, Grigoriev E, Gritsan AI, Gazenkampf AA, Almekhlafi G, Albarrak MM, Mustafa GM, Maghrabi KA, Salahuddin N, Aisa TM, Al Jabbary AS, Tabhan E, Arabi YM, Trinidad OA, Al Dorzi HM, Tabhan EE, Bolon S, Smith O, Mancebo J, Aguirre-Bermeo H, Lopez-Delgado JC, Esteve F, Rialp G, Forteza C, De Haro C, Artigas A, Albaiceta GM, De Cima-Iglesias S, Seoane-Quiroga L, Ceniceros-Barros A, Ruiz-Aguilar AL, Claraco-Vega LM, Soler JA, Lorente MDC, Hermosa C, Gordo F, Prieto-González M, López-Messa JB, Perez MP, Pere CP, Allue RM, Roche-Campo F, Ibañez-Santacruz M, Temprano S, Pintado MC, De Pablo R, Gómez PRA, Ruiz SR, Moles SI, Jurado MT, Arizmendi A, Piacentini EA, Franco N, Honrubia T, Perez Cheng M, Perez Losada E, Blanco J, Yuste LJ, Carbayo-Gorriz C, Cazorla-Barranquero FG, Alonso JG, Alda RS, Algaba Á, Navarro G, Cereijo E, Diaz-Rodriguez E, Marcos DP, Montero LA, Para LH, Sanchez RJ, Blasco Navalpotro MA, Abad RD, Montiel González R, Toribio DP, Castro AG, Artiga MJD, Penuelas O, Roser TP, Olga MF, Curto EG, Sánchez RM, Imma VP, Elisabet GM, Claverias L, Magret M, Pellicer AM, Rodriguez LL, Sánchez-Ballesteros J, González-Salamanca Á, Jimenez AG, Huerta FP, Diaz JCJS, Lopez EB, Moya DDL, Alfonso AAT, Eugenio Luis PS, Cesar PS, Rafael SI, Virgilio CG, Recio NN, Adamsson RO, Rylander CC, Holzgraefe B, Broman LM, Wessbergh J, Persson L, Schiöler F, Kedelv H, Tibblin AO, Appelberg H, Hedlund L, Helleberg J, Eriksson KE, Glietsch R, Larsson N, Nygren I, Nunes SL, Morin AK, Kander T, Adolfsson A, Piquilloud L, Zender HO, Leemann-Refondini C, Elatrous S, Bouchoucha S, Chouchene I, Ouanes I, Ben Souissi A, Kamoun S, Demirkiran O, Aker M, Erbabacan E, Ceylan I, Girgin NK, Ozcelik M, Ünal N, Meco BC, Akyol OO, Derman SS, Kennedy B, Parhar K, Srinivasa L, McNamee L, McAuley D, Steinberg J, Hopkins P, Mellis C, Stansil F, Kakar V, Hadfield D, Brown C, Vercueil A, Bhowmick K, Humphreys SK, Ferguson A, Mckee R, Raj AS, Fawkes DA, Watt P, Twohey L, Thomas RRJM, Morton A, Kadaba V, Smith MJ, Hormis AP, Kannan SG, Namih M, Reschreiter H, Camsooksai J, Kumar A, Rugonfalvi S, Nutt C, Oneill O, Seasman C, Dempsey G, Scott CJ, Ellis HE, Mckechnie S, Hutton PJ, Di Tomasso NN, Vitale MN, Griffin RO, Dean MN, Cranshaw JH, Willett EL, Ioannou N, Gillis S, Csabi P, Macfadyen R, Dawson H, Preez PD, Williams AJ, Boyd O, De Gordoa LOR, Bramall J, Symmonds S, Chau SK, Wenham T, Szakmany T, Toth-Tarsoly P, Mccalman KH, Alexander P, Stephenson L, Collyer T, Chapman R, Cooper R, Allan RM, Sim M, Wrathall DW, Irvine DA, Zantua KS, Adams JC, Burtenshaw AJ, Sellors GP, Welters ID, Williams KE, Hessell RJ, Oldroyd MG, Battle CE, Pillai S, Kajtor I, Sivashanmugave M, Okane SC, Donnelly A, Frigyik AD, Careless JP, May MM, Stewart R, Trinder TJ, Hagan SJ, Wise MP, Cole JM, MacFie CC, Dowling AT, Hurtado J, Nin N, Hurtado J, Nuñez E, Pittini G, Rodriguez R, Imperio MC, Santos C, França AG, Ebeid A, Deicas A, Serra C, Uppalapati A, Kamel G, Banner-Goodspeed VM, Beitler JR, Mukkera SR, Kulkarni S, Lee J, Mesar T, Shinn Iii JO, Gomaa D, Tainter C, Mesar T, Cowley RA, Yeatts DJ, Warren J, Lanspa MJ, Miller RR, Grissom CK, Brown SM, Bauer PR, Gosselin RJ, Kitch BT, Cohen JE, Beegle SH, Gueret RM, Tulaimat A, Choudry S, Stigler W, Batra H, Huff NG, Lamb KD, Oetting TW, Mohr NM, Judy C, Saito S, Kheir FM, Schlichting AB, Delsing A, Elmasri M, Crouch DR, Ismail D, Blakeman TC, Dreyer KR, Gomaa D, Baron RM, Grijalba CQ, Hou PC, Seethala R, Aisiku I, Henderson G, Frendl G, Hou SK, Owens RL, Schomer A, Bumbasirevic V, Jovanovic B, Surbatovic M, Veljovic M, Van Haren F. Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies. The Lancet Global Health 2022; 10:e227-e235. [PMID: 34914899 PMCID: PMC8766316 DOI: 10.1016/s2214-109x(21)00485-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/05/2021] [Accepted: 10/01/2021] [Indexed: 12/19/2022] Open
Abstract
Background Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference –1·69 [–9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5–8] vs 6 [5–8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52–23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75–0·86]; p<0·0001). Interpretation Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding No funding.
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Jawad I, Rashan S, Sigera C, Salluh J, Dondorp AM, Haniffa R, Beane A. A scoping review of registry captured indicators for evaluating quality of critical care in ICU. J Intensive Care 2021; 9:48. [PMID: 34353360 PMCID: PMC8339165 DOI: 10.1186/s40560-021-00556-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/23/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Excess morbidity and mortality following critical illness is increasingly attributed to potentially avoidable complications occurring as a result of complex ICU management (Berenholtz et al., J Crit Care 17:1-2, 2002; De Vos et al., J Crit Care 22:267-74, 2007; Zimmerman J Crit Care 1:12-5, 2002). Routine measurement of quality indicators (QIs) through an Electronic Health Record (EHR) or registries are increasingly used to benchmark care and evaluate improvement interventions. However, existing indicators of quality for intensive care are derived almost exclusively from relatively narrow subsets of ICU patients from high-income healthcare systems. The aim of this scoping review is to systematically review the literature on QIs for evaluating critical care, identify QIs, map their definitions, evidence base, and describe the variances in measurement, and both the reported advantages and challenges of implementation. METHOD We searched MEDLINE, EMBASE, CINAHL, and the Cochrane libraries from the earliest available date through to January 2019. To increase the sensitivity of the search, grey literature and reference lists were reviewed. Minimum inclusion criteria were a description of one or more QIs designed to evaluate care for patients in ICU captured through a registry platform or EHR adapted for quality of care surveillance. RESULTS The search identified 4780 citations. Review of abstracts led to retrieval of 276 full-text articles, of which 123 articles were accepted. Fifty-one unique QIs in ICU were classified using the three components of health care quality proposed by the High Quality Health Systems (HQSS) framework. Adverse events including hospital acquired infections (13.7%), hospital processes (54.9%), and outcomes (31.4%) were the most common QIs identified. Patient reported outcome QIs accounted for less than 6%. Barriers to the implementation of QIs were described in 35.7% of articles and divided into operational barriers (51%) and acceptability barriers (49%). CONCLUSIONS Despite the complexity and risk associated with ICU care, there are only a small number of operational indicators used. Future selection of QIs would benefit from a stakeholder-driven approach, whereby the values of patients and communities and the priorities for actionable improvement as perceived by healthcare providers are prioritized and include greater focus on measuring discriminable processes of care.
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Affiliation(s)
- Issrah Jawad
- National Intensive Care Surveillance-MORU, Borella, Colombo, Western Province 08 Sri Lanka
| | - Sumayyah Rashan
- National Intensive Care Surveillance-MORU, Borella, Colombo, Western Province 08 Sri Lanka
| | - Chathurani Sigera
- National Intensive Care Surveillance-MORU, Borella, Colombo, Western Province 08 Sri Lanka
| | - Jorge Salluh
- Department of Critical Care and Graduate Program in Translational Medicine, D’Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Arjen M. Dondorp
- Critical Care, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Central Thailand 10400 Thailand
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Rashan Haniffa
- Critical Care, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Central Thailand 10400 Thailand
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Abi Beane
- Critical Care, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Central Thailand 10400 Thailand
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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12
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Dumas G, Lemiale V, Rathi N, Cortegiani A, Pène F, Bonny V, Salluh J, Albaiceta GM, Soares M, Soubani AO, Canet E, Hanane T, Kouatchet A, Mokart D, Lebiedz P, Türkoğlu M, Coudroy R, Jeon K, Demoule A, Mehta S, Caruso P, Frat JP, Yang KY, Roca O, Laffey J, Timsit JF, Azoulay E, Darmon M. Survival in Immunocompromised Patients Ultimately Requiring Invasive Mechanical Ventilation: A Pooled Individual Patient Data Analysis. Am J Respir Crit Care Med 2021; 204:187-196. [PMID: 33751920 DOI: 10.1164/rccm.202009-3575oc] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Rationale: Acute respiratory failure (ARF) is associated with high mortality in immunocompromised patients, particularly when invasive mechanical ventilation is needed. Therefore, noninvasive oxygenation/ventilation strategies have been developed to avoid intubation, with uncertain impact on mortality, especially when intubation is delayed. Objectives: We sought to report trends of survival over time in immunocompromised patients receiving invasive mechanical ventilation. The impact of delayed intubation after failure of noninvasive strategies was also assessed. Methods: Systematic review and meta-analysis using individual patient data of studies that focused on immunocompromised adult patients with ARF requiring invasive mechanical ventilation. Studies published in English were identified through PubMed, Web of Science, and Cochrane Central (2008-2018). Individual patient data were requested from corresponding authors for all identified studies. We used mixed-effect models to estimate the effect of delayed intubation on hospital mortality and described mortality rates over time. Measurements and Main Results: A total of 11,087 patients were included (24 studies, three controlled trials, and 21 cohorts), of whom 7,736 (74%) were intubated within 24 hours of ICU admission (early intubation). The crude mortality rate was 53.2%. Adjusted survivals improved over time (from 1995 to 2017, odds ratio [OR] for hospital mortality per year, 0.96 [0.95-0.97]). For each elapsed day between ICU admission and intubation, mortality was higher (OR, 1.38 [1.26-1.52]; P < 0.001). Early intubation was significantly associated with lower mortality (OR, 0.83 [0.72-0.96]), regardless of initial oxygenation strategy. These results persisted after propensity score analysis (matched OR associated with delayed intubation, 1.56 [1.44-1.70]). Conclusions: In immunocompromised intubated patients, survival has improved over time. Time between ICU admission and intubation is a strong predictor of mortality, suggesting a detrimental effect of late initial oxygenation failure.
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Affiliation(s)
- Guillaume Dumas
- Medical ICU, Saint-Louis Teaching Hospital, Paris, France.,ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Université de Paris, Paris, France
| | - Virginie Lemiale
- Medical ICU, Saint-Louis Teaching Hospital, Paris, France.,ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Université de Paris, Paris, France
| | - Nisha Rathi
- Department of Critical Care, MD Anderson Cancer Center, Houston, Texas
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Frédéric Pène
- Medical ICU, Cochin Teaching Hospital, Paris, France
| | - Vincent Bonny
- Medical ICU, Saint-Louis Teaching Hospital, Paris, France.,ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Université de Paris, Paris, France
| | - Jorge Salluh
- The Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Guillermo M Albaiceta
- Instituto de Investigación Sanitaria del Principado de Asturias, Unidad de Cuidados Intensivos Cardiológicos, Hospital Universitario Central de Asturias, Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain.,CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Marcio Soares
- The Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Ayman O Soubani
- Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | | | - Tarik Hanane
- Department of Critical Care, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Pia Lebiedz
- ICU, Evangelisches Krankenhaus, Oldenburg, Germany
| | - Melda Türkoğlu
- Medical ICU, Gazi University School of Medicine, Ankara, Turkey
| | - Rémi Coudroy
- CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France.,INSERM CIC1402, groupe ALIVE, Université de Poitiers, Poitiers, France
| | - Kyeongman Jeon
- Department of Critical Care Medicine and.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro, Gangnam-gu, Seoul, Korea
| | - Alexandre Demoule
- APHP Sorbonne Université site Pitié-Salpêtrière, Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S) and INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France
| | - Sangeeta Mehta
- Medical Surgical ICU, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Pedro Caruso
- Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil
| | - Jean-Pierre Frat
- CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France.,INSERM CIC1402, groupe ALIVE, Université de Poitiers, Poitiers, France
| | - Kuang-Yao Yang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Oriol Roca
- CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.,Servei de Medicina Intensiva, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - John Laffey
- Department of Anesthesia and.,Department of Intensive Care Medicine, NUI Galway, Ireland; and
| | - Jean-François Timsit
- Medical and Infectious Diseases ICU, Bichat-Claude Bernard Hospital, UMR 1137 Inserm, Université de Paris, IAME, Paris, France
| | - Elie Azoulay
- Medical ICU, Saint-Louis Teaching Hospital, Paris, France.,ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Université de Paris, Paris, France
| | - Michael Darmon
- Medical ICU, Saint-Louis Teaching Hospital, Paris, France.,ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Université de Paris, Paris, France
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Arabi YM, Azoulay E, Al-Dorzi HM, Phua J, Salluh J, Binnie A, Hodgson C, Angus DC, Cecconi M, Du B, Fowler R, Gomersall CD, Horby P, Juffermans NP, Kesecioglu J, Kleinpell RM, Machado FR, Martin GS, Meyfroidt G, Rhodes A, Rowan K, Timsit JF, Vincent JL, Citerio G. How the COVID-19 pandemic will change the future of critical care. Intensive Care Med 2021; 47:282-291. [PMID: 33616696 PMCID: PMC7898492 DOI: 10.1007/s00134-021-06352-y] [Citation(s) in RCA: 110] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 01/11/2021] [Indexed: 01/28/2023]
Abstract
Coronavirus disease 19 (COVID-19) has posed unprecedented healthcare system challenges, some of which will lead to transformative change. It is obvious to healthcare workers and policymakers alike that an effective critical care surge response must be nested within the overall care delivery model. The COVID-19 pandemic has highlighted key elements of emergency preparedness. These include having national or regional strategic reserves of personal protective equipment, intensive care unit (ICU) devices, consumables and pharmaceuticals, as well as effective supply chains and efficient utilization protocols. ICUs must also be prepared to accommodate surges of patients and ICU staffing models should allow for fluctuations in demand. Pre-existing ICU triage and end-of-life care principles should be established, implemented and updated. Daily workflow processes should be restructured to include remote connection with multidisciplinary healthcare workers and frequent communication with relatives. The pandemic has also demonstrated the benefits of digital transformation and the value of remote monitoring technologies, such as wireless monitoring. Finally, the pandemic has highlighted the value of pre-existing epidemiological registries and agile randomized controlled platform trials in generating fast, reliable data. The COVID-19 pandemic is a reminder that besides our duty to care, we are committed to improve. By meeting these challenges today, we will be able to provide better care to future patients.
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Affiliation(s)
- Yaseen M Arabi
- Intensive Care Department, Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.
| | - Elie Azoulay
- Medical Intensive Care Unit, Saint Louis University Hospital and Paris 7 University, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - Hasan M Al-Dorzi
- Intensive Care Department, Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Jason Phua
- FAST and Chronic Programmes, Alexandra Hospital, Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore
| | - Jorge Salluh
- Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Alexandra Binnie
- Critical Care Department, William Osler Health System, Etobicoke, ON, Canada
- Faculty of Medicine and Biomedical Sciences, University of Algarve, Faro, Portugal
| | - Carol Hodgson
- Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia
- The Alfred Hospital, Melbourne, Australia
- Monash University, Melbourne, Australia
- Monash Partners Academic Health Science Centre, Prahran, Australia
| | - Derek C Angus
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Maurizio Cecconi
- Deparment of Anaesthesia and Intensive Care, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milano, Italy
| | - Bin Du
- State Key Laboratory of Complex, Severe and Rare Diseases, and Medical ICU, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rob Fowler
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Critical Care Medicine, Sunnybrook Hospital, Toronto, Canada
- Department of Medicine, Sunnybrook Hospital, Toronto, Canada
| | - Charles D Gomersall
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Peter Horby
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Nicole P Juffermans
- Department of Intensive Care, OLVG Hospital and Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jozef Kesecioglu
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ruth M Kleinpell
- Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN, 37203, USA
| | - Flavia R Machado
- Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo, São Paulo, Brazil
| | - Greg S Martin
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Emory Critical Care Center and Grady Memorial Hospital, Atlanta, GA, USA
| | - Geert Meyfroidt
- Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Andrew Rhodes
- Adult Critical Care, St George's University Hospitals NHS Foundation Trust and St George's University of London, London, UK
| | - Kathryn Rowan
- Intensive Care National Audit and Research Centre (ICNARC), Napier House, 24 High Holborn, London, WC1V 6AZ, UK
| | - Jean-François Timsit
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM, 75018, Paris, France
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Giuseppe Citerio
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Neurointensive Care Unit, San Gerardo Hospital, ASST-Monza, Monza, Italy
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Serafim RB, Salluh J. Re: 'Clinical course and outcomes of critically ill patients with COVID-19 infection: a systematic review - authors' reply'. Clin Microbiol Infect 2021; 27:940. [PMID: 33631333 PMCID: PMC8153817 DOI: 10.1016/j.cmi.2021.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 12/03/2022]
Affiliation(s)
- Rodrigo B Serafim
- Department of Internal Medicine, Federal University of Rio de Janeiro, and Instituto D'Or de Pesquisa e Ensino, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jorge Salluh
- Department of Intensive Care, Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro, Brazil
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15
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Gaudet A, Martin-Loeches I, Povoa P, Rodriguez A, Salluh J, Duhamel A, Nseir S. Accuracy of the clinical pulmonary infection score to differentiate ventilator-associated tracheobronchitis from ventilator-associated pneumonia. Ann Intensive Care 2020; 10:101. [PMID: 32748025 PMCID: PMC7396887 DOI: 10.1186/s13613-020-00721-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Differentiating Ventilator-Associated Tracheobronchitis (VAT) from Ventilator-Associated Pneumonia (VAP) may be challenging for clinicians, yet their management currently differs. In this study, we evaluated the accuracy of the Clinical Pulmonary Infection Score (CPIS) to differentiate VAT and VAP. METHODS We performed a retrospective analysis based on the data from 2 independent prospective cohorts. Patients of the TAVeM database with a diagnosis of VAT (n = 320) or VAP (n = 369) were included in the derivation cohort. Patients admitted to the Intensive Care Centre of Lille University Hospital between January 1, 2016 and December 31, 2017 who had a diagnosis of VAT (n = 70) or VAP (n = 139) were included in the validation cohort. The accuracy of the CPIS to differentiate VAT from VAP was assessed within the 2 cohorts by calculating sensitivity and specificity values, establishing the ROC curves and choosing the best threshold according to the Youden index. RESULTS The areas under ROC curves of CPIS to differentiate VAT from VAP were calculated at 0.76 (95% CI [0.72-0.79]) in the derivation cohort and 0.67 (95% CI [0.6-0.75]) in the validation cohort. A CPIS value ≥ 7 was associated with the highest Youden index in both cohorts. With this cut-off, sensitivity and specificity were respectively found at 0.51 and 0.88 in the derivation cohort, and at 0.45 and 0.89 in the validation cohort. CONCLUSIONS A CPIS value ≥ 7 reproducibly allowed to differentiate VAT from VAP with high specificity and PPV and moderate sensitivity and NPV in our derivation and validation cohorts.
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Affiliation(s)
- Alexandre Gaudet
- Department of Intensive Care Medicine, Critical Care Centre, CHU Lille, Lille, 59000, France.,Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR9017-CIIL-Centre d'Infection et d'Immunité de Lille, Lille, France
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, St James Street, Dublin 8, Dublin, Ireland.,Hospital Clinic, IDIBAPS, Universidad de Barcelona, Ciberes, Barcelona, Spain
| | - Pedro Povoa
- Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.,NOVA Medical School, New University of Lisbon, Lisbon, Portugal
| | - Alejandro Rodriguez
- Hospital Universitari Joan XXIII, Critical Care Medicine, Rovira & Virgili University, Rovira, Tarragona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Bunyola, Mallorca, Spain
| | - Jorge Salluh
- Department of Critical Care and Graduate Program in Translational Medicine, Programa de Pós-Graduação em Clínica Médica, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Alain Duhamel
- Univ. Lille, CHU Lille, ULR 2694 METRICS- Evaluation des technologies de santé et des pratiques médicales, 59000, Lille, France.,CHU Lille, Unité de Méthodologie, Biostatistiques et Data Management, Lille, 59000, France
| | - Saad Nseir
- Department of Intensive Care Medicine, Critical Care Centre, CHU Lille, Lille, 59000, France. .,Université de Lille, INSERM U995, Lille Inflammation Research International Center E2, Lille, 59000, France.
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16
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Aziz S, Arabi YM, Alhazzani W, Evans L, Citerio G, Fischkoff K, Salluh J, Meyfroidt G, Alshamsi F, Oczkowski S, Azoulay E, Price A, Burry L, Dzierba A, Benintende A, Morgan J, Grasselli G, Rhodes A, Møller MH, Chu L, Schwedhelm S, Lowe JJ, Bin D, Christian MD. Managing ICU surge during the COVID-19 crisis: rapid guidelines. Intensive Care Med 2020; 46:1303-1325. [PMID: 32514598 PMCID: PMC7276667 DOI: 10.1007/s00134-020-06092-5] [Citation(s) in RCA: 231] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/07/2020] [Indexed: 02/06/2023]
Abstract
Given the rapidly changing nature of COVID-19, clinicians and policy makers require urgent review and summary of the literature, and synthesis of evidence-based guidelines to inform practice. The WHO advocates for rapid reviews in these circumstances. The purpose of this rapid guideline is to provide recommendations on the organizational management of intensive care units caring for patients with COVID-19 including: planning a crisis surge response; crisis surge response strategies; triage, supporting families, and staff.
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Affiliation(s)
- Shadman Aziz
- London's Air Ambulance, Royal London Hospital, Barts NHS Health Trust, Whitechapel Rd, Whitechapel, London, E1 1FR, England, UK
| | - Yaseen M Arabi
- Intensive Care Department, Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Waleed Alhazzani
- Department of Medicine and Department of Health Research Methods, Evidence and Impact, Master University, Ontario, Canada
| | - Laura Evans
- Department of Pulmonary and Critical Care Medicine, University of Washington, Seattle, USA
| | | | | | - Jorge Salluh
- Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro, Brazil
| | | | - Fayez Alshamsi
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Abu Dhabi, UAE
| | - Simon Oczkowski
- Department of Medicine and Department of Health Research Methods, Evidence and Impact, Master University, Ontario, Canada
| | - Elie Azoulay
- Assistance publique - Hôpitaux de Paris, Paris, France
| | - Amy Price
- Anaesthesia and Informatics Lab, Stanford University, Stanford, USA
| | - Lisa Burry
- Sinai Health System, University of Toronto, Toronto, Canada
| | - Amy Dzierba
- New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, USA
| | | | | | - Giacomo Grasselli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Andrew Rhodes
- St Georges Hospitals NHS Foundation Trust, London, UK
| | - Morten H Møller
- Department of Intensive Care, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Larry Chu
- Anaesthesia and Informatics Lab, Stanford University, Stanford, USA
| | | | - John J Lowe
- Department of Environmental and Occupational Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Du Bin
- Peking Union Medical College Hospital, Beijing, China
| | - Michael D Christian
- London's Air Ambulance, Royal London Hospital, Barts NHS Health Trust, Whitechapel Rd, Whitechapel, London, E1 1FR, England, UK.
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Abstract
Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality despite adequate antibiotic therapy. It is the single most common cause of infection-related mortality in the United States. An exaggerated host inflammatory response can potentially be harmful to both the lung and host, and has been associated with treatment failure and mortality. Modulation of inflammatory response may, therefore, be theoretically beneficial. The anti-inflammatory and immunosuppressive effects of steroids seem an attractive therapeutic option in severe CAP patients. Available datapoint to overall shorter time to clinical stability and decreased length-of-stay in CAP patients, with a potential mortality benefit in severe CAP. The level of evidence is, however, low to moderate regarding mortality due to high heterogeneity and insufficient power of data. Furthermore, steroids were deleterious in influenza pneumonia and in patients with pneumococcal pneumonia data suggest a lack of efficacy and potential harm. Both European and American guidelines recommend not using corticosteroids in CAP. Patients who might benefit and those that can be harmed from steroids remain to be clearly identified, as does the ideal steroid for CAP patients, based on pharmacokinetic and pharmacodynamic properties. It is essential for future studies to avoid the same methodological bias present in the available data so that high-quality evidence on the true role of steroids in CAP can be provided.
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Affiliation(s)
- David Nora
- Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, Centro Hospitalar De Lisboa Ocidental, Lisbon, Portugal.,NOVA Medical School, CHRC, New University of Lisbon, Lisbon, Portugal
| | - Wagner Nedel
- Intensive Care Unit, Hospital Nossa Senhora Da Conceição, Porto Alegre, Brazil
| | - Thiago Lisboa
- Critical Care Department, Hospital De Clínicas De Porto Alegre, Post-Graduation Program (PPG) Pneumology,Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Jorge Salluh
- D'or Institute for Research and Education, Rio De Janeiro, Brazil
| | - Pedro Póvoa
- Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, Centro Hospitalar De Lisboa Ocidental, Lisbon, Portugal.,NOVA Medical School, CHRC, New University of Lisbon, Lisbon, Portugal.,Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Denmark
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18
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Martin-Loeches I, Torres A, Povoa P, Zampieri FG, Salluh J, Nseir S, Ferrer M, Rodriguez A. The association of cardiovascular failure with treatment for ventilator-associated lower respiratory tract infection. Intensive Care Med 2019; 45:1753-1762. [PMID: 31620836 DOI: 10.1007/s00134-019-05797-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/22/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Ventilator associated-lower respiratory tract infections (VA-LRTIs), either ventilator-associated pneumonia (VAP) or tracheobronchitis (VAT), accounts for most nosocomial infections in intensive care units (ICU) including. Our aim was to determine if appropriate antibiotic treatment in patients with VA-LRTI will effectively reduce mortality in patients who had cardiovascular failure. METHODS This was a pre-planned subanalysis of a large prospective cohort of mechanically ventilated patients for at least 48 h in eight countries in two continents. Patients with a modified Sequential Organ Failure Assessment (mSOFA) cardiovascular score of 4 (at the time of VA-LRTI diagnosis and needed be present for at least 12 h) were defined as having cardiovascular failure. RESULTS VA-LRTI occurred in 689 (23.2%) out of 2960 patients and 174 (25.3%) developed cardiovascular failure. Patients with cardiovascular failure had significantly higher ICU mortality than those without (58% vs. 26.8%; p < 0.001; OR 3.7; 95% CI 2.6-5.4). A propensity score analysis found that the presence of inappropriate antibiotic treatment was an independent risk factor for ICU mortality in patients without cardiovascular failure, but not in those with cardiovascular failure. When the propensity score analysis was conducted in patients with VA-LRTI, the use of appropriate antibiotic treatment conferred a survival benefit for patients without cardiovascular failure who had only VAP. CONCLUSIONS Patients with VA-LRTI and cardiovascular failure did not show an association to a higher ICU survival with appropriate antibiotic treatment. Additionally, we found that in patients without cardiovascular failure, appropriate antibiotic treatment conferred a survival benefit for patients only with VAP. TRIAL REGISTRY ClinicalTrials.gov, number NCT01791530.
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Affiliation(s)
- Ignacio Martin-Loeches
- Department of Anaesthesia and Critical Care Medicine, St. James's Hospital, Dublin, Ireland. .,Multidisciplinary Intensive Care Research Organization (MICRO), St James's Hospital, P.O. Box 580, James's Street, Dublin 8, Ireland. .,Pulmonary Intensive Care Unit, Respiratory Institute, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, CIBERes, Barcelona, Spain.
| | - Antoni Torres
- Pulmonary Intensive Care Unit, Respiratory Institute, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, CIBERes, Barcelona, Spain
| | - Pedro Povoa
- Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.,NOVA Medical School, New University of Lisbon, Lisbon, Portugal.,Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark
| | | | - Jorge Salluh
- Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education, Rio De Janeiro, Brazil
| | - Saad Nseir
- Critical Care Center, University Hospital of Lille, Lille University, Lille, France
| | - Miquel Ferrer
- Pulmonary Intensive Care Unit, Respiratory Institute, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, CIBERes, Barcelona, Spain
| | - Alejandro Rodriguez
- Critical Care Department, Hospital Universitario Joan XXIII, URV/IISPV/CIBERES, Tarragona, Spain
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19
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Martin-Loeches I, Lemiale V, Geoghegan P, McMahon MA, Pickkers P, Soares M, Perner A, Meyhoff TS, Bukan RB, Rello J, Bauer PR, van de Louw A, Taccone FS, Salluh J, Hemelaar P, Schellongowski P, Rusinova K, Terzi N, Mehta S, Antonelli M, Kouatchet A, Klepstad P, Valkonen M, Landburg PP, Barratt-Due A, Bruneel F, Pène F, Metaxa V, Moreau AS, Souppart V, Burghi G, Girault C, Silva UVA, Montini L, Barbier F, Nielsen LB, Gaborit B, Mokart D, Chevret S, Azoulay E. Influenza and associated co-infections in critically ill immunosuppressed patients. Crit Care 2019; 23:152. [PMID: 31046842 PMCID: PMC6498695 DOI: 10.1186/s13054-019-2425-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/09/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND It is unclear whether influenza infection and associated co-infection are associated with patient-important outcomes in critically ill immunocompromised patients with acute respiratory failure. METHODS Preplanned secondary analysis of EFRAIM, a prospective cohort study of 68 hospitals in 16 countries. We included 1611 patients aged 18 years or older with non-AIDS-related immunocompromise, who were admitted to the ICU with acute hypoxemic respiratory failure. The main exposure of interest was influenza infection status. The primary outcome of interest was all-cause hospital mortality, and secondary outcomes ICU length of stay (LOS) and 90-day mortality. RESULTS Influenza infection status was categorized into four groups: patients with influenza alone (n = 95, 5.8%), patients with influenza plus pulmonary co-infection (n = 58, 3.6%), patients with non-influenza pulmonary infection (n = 820, 50.9%), and patients without pulmonary infection (n = 638, 39.6%). Influenza infection status was associated with a requirement for intubation and with LOS in ICU (P < 0.001). Patients with influenza plus co-infection had the highest rates of intubation and longest ICU LOS. On crude analysis, influenza infection status was associated with ICU mortality (P < 0.001) but not hospital mortality (P = 0.09). Patients with influenza plus co-infection and patients with non-influenza infection alone had similar ICU mortality (41% and 37% respectively) that was higher than patients with influenza alone or those without infection (33% and 26% respectively). A propensity score-matched analysis did not show a difference in hospital mortality attributable to influenza infection (OR = 1.01, 95%CI 0.90-1.13, P = 0.85). Age, severity scores, ARDS, and performance status were all associated with ICU, hospital, and 90-day mortality. CONCLUSIONS Category of infectious etiology of respiratory failure (influenza, non-influenza, influenza plus co-infection, and non-infectious) was associated with ICU but not hospital mortality. In a propensity score-matched analysis, influenza infection was not associated with the primary outcome of hospital mortality. Overall, influenza infection alone may not be an independent risk factor for hospital mortality in immunosuppressed patients.
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Affiliation(s)
- Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland. .,Department of Clinical Medicine, Wellcome Trust-HRB Clinical Research Facility, St. James Hospital, Trinity College, Dublin, Ireland. .,Department of Intensive Care Medicine, St. James's Hospital, St. James's St, Dublin, Dublin 8, Ireland.
| | - Virginie Lemiale
- Medical Intensive Care Unit, Hôpital Saint-Louis and Paris Diderot Sorbonne University, Paris, France
| | - Pierce Geoghegan
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland.,Department of Clinical Medicine, Wellcome Trust-HRB Clinical Research Facility, St. James Hospital, Trinity College, Dublin, Ireland
| | - Mary Aisling McMahon
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland.,Department of Clinical Medicine, Wellcome Trust-HRB Clinical Research Facility, St. James Hospital, Trinity College, Dublin, Ireland
| | - Peter Pickkers
- Department of Intensive Care Medicine (710), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Marcio Soares
- Department of Critical Care and Graduate Program in Translational Medicine, Programa de Pós-Graduação em Clínica Médica, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Anders Perner
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Tine Sylvest Meyhoff
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ramin Brandt Bukan
- Department of Anesthesiology I, Herlev University Hospital, Herlev, Denmark
| | - Jordi Rello
- CIBERES, Universitat Autonòma de Barcelona, European Study Group of Infections in Critically Ill Patients (ESGCIP), Barcelona, Spain
| | - Philippe R Bauer
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Andry van de Louw
- Division of Pulmonary and Critical Care, Penn State University College of Medicine, Hershey, PA, USA
| | - Fabio Silvio Taccone
- Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Jorge Salluh
- Department of Critical Care and Graduate Program in Translational Medicine, Programa de Pós-Graduação em Clínica Médica, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Pleun Hemelaar
- Department of Intensive Care Medicine (710), Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Katerina Rusinova
- Department of Anesthesiology and Intensive Care Medicine and Institute for Medical Humanities, 1st Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Nicolas Terzi
- CHU Grenoble Alpes, Service de Réanimation Médicale, Faculté de Médecine de Grenoble, INSERM U1042, Université Grenoble-Alpes, Grenoble, France
| | - Sangeeta Mehta
- Department of Medicine and Interdepartmental Division of Critical Care Medicine, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Massimo Antonelli
- Agostino Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Achille Kouatchet
- Department of Medical Intensive Care Medicine, University Hospital of Angers, Angers, France
| | - Pål Klepstad
- Norwegian University of Science and Technology, Trondheim, Norway
| | - Miia Valkonen
- Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Precious Pearl Landburg
- Department of Critical Care, University Medical Center Groningen, Groningen, The Netherlands
| | - Andreas Barratt-Due
- Department of Immunology-Department of Emergencies and Critical Care, University of Oslo, Oslo, Norway
| | - Fabrice Bruneel
- Medical-Surgical Intensive Care Unit, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Frédéric Pène
- Medical ICU, Cochin Hospital, Assistance Publique-Hôpitaux de Paris and University Paris Descartes, Paris, France
| | - Victoria Metaxa
- Critical Care Department, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Anne Sophie Moreau
- Critical Care Center, CHU Lille, School of Medicine, University of Lille, Lille, France
| | - Virginie Souppart
- Medical Intensive Care Unit, Hôpital Saint-Louis and Paris Diderot Sorbonne University, Paris, France
| | - Gaston Burghi
- Terapia Intensiva, Hospital Maciel, Montevideo, Uruguay
| | - Christophe Girault
- Department of Medical Intensive Care, Normandie Univ, UNIROUEN, EA-3830, Rouen University Hospital, F-76000, Rouen, France
| | | | - Luca Montini
- Agostino Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francois Barbier
- Medical Intensive Care Unit, La Source Hospital - CHR Orléans, Orléans, France
| | - Lene B Nielsen
- Intensive Care Department, University of Southern Denmark, Sønderborg, Denmark.,Department of Anaesthesia and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Benjamin Gaborit
- Medical Intensive Care Unit, Hôtel Dieu-HME-University Hospital of Nantes, Nantes, France
| | - Djamel Mokart
- Réanimation Polyvalente et Département d'Anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Sylvie Chevret
- 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, Saint-Louis, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Hôpital Saint-Louis and Paris Diderot Sorbonne University, Paris, France
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20
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Timsit JF, Bassetti M, Cremer O, Daikos G, de Waele J, Kallil A, Kipnis E, Kollef M, Laupland K, Paiva JA, Rodríguez-Baño J, Ruppé É, Salluh J, Taccone FS, Weiss E, Barbier F. Rationalizing antimicrobial therapy in the ICU: a narrative review. Intensive Care Med 2019; 45:172-189. [PMID: 30659311 DOI: 10.1007/s00134-019-05520-5] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/04/2019] [Indexed: 12/13/2022]
Abstract
The massive consumption of antibiotics in the ICU is responsible for substantial ecological side effects that promote the dissemination of multidrug-resistant bacteria (MDRB) in this environment. Strikingly, up to half of ICU patients receiving empirical antibiotic therapy have no definitively confirmed infection, while de-escalation and shortened treatment duration are insufficiently considered in those with documented sepsis, highlighting the potential benefit of implementing antibiotic stewardship programs (ASP) and other quality improvement initiatives. The objective of this narrative review is to summarize the available evidence, emerging options, and unsolved controversies for the optimization of antibiotic therapy in the ICU. Published data notably support the need for better identification of patients at risk of MDRB infection, more accurate diagnostic tools enabling a rule-in/rule-out approach for bacterial sepsis, an individualized reasoning for the selection of single-drug or combination empirical regimen, the use of adequate dosing and administration schemes to ensure the attainment of pharmacokinetics/pharmacodynamics targets, concomitant source control when appropriate, and a systematic reappraisal of initial therapy in an attempt to minimize collateral damage on commensal ecosystems through de-escalation and treatment-shortening whenever conceivable. This narrative review also aims at compiling arguments for the elaboration of actionable ASP in the ICU, including improved patient outcomes and a reduction in antibiotic-related selection pressure that may help to control the dissemination of MDRB in this healthcare setting.
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Affiliation(s)
- Jean-François Timsit
- Medical and Infectious Diseases ICU, APHP, Bichat-Claude Bernard Hospital, 46 Rue Henri-Huchard, 75877, Paris Cedex 18, France.
- INSERM, IAME, UMR 1137, Paris-Diderot Sorbonne-Paris Cité University, Paris, France.
| | - Matteo Bassetti
- Infectious Diseases Division, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Olaf Cremer
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - George Daikos
- Scool of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Jan de Waele
- Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Andre Kallil
- Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | - Eric Kipnis
- Surgical Critical Care Unit, Department of Anesthesiology, Critical Care and Perioperative Medicine, CHU Lille, Lille, France
| | - Marin Kollef
- Critical Care Research, Washington University School of Medicine and Respiratory Care Services, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Kevin Laupland
- Department of Medicine, Royal Inland Hospital, Kamloops, Canada
| | - Jose-Artur Paiva
- Intensive Care Medicine Department, Centro Hospitalar São João and Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jesús Rodríguez-Baño
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Universitario Virgen Macarena, Departament of Medicine, University of Sevilla, Biomedicine Institute of Seville (IBiS), Seville, Spain
| | - Étienne Ruppé
- INSERM, IAME, UMR 1137, Paris-Diderot Sorbonne-Paris Cité University, Paris, France
- Bacteriology Laboratory, Bichat-Claude Bernard Hospital, APHP, Paris, France
| | - Jorge Salluh
- Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education, IDOR, Rio De Janeiro, Brazil
| | | | - Emmanuel Weiss
- Department of Anesthesiology and Critical Care, Beaujon Hospital, AP-HP, Clichy, France
- INSERM, CRI, UMR 1149, Paris-Diderot Sorbonne-Paris Cité University, Paris, France
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21
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Serafim R, Gomes JA, Salluh J, Póvoa P. Response. Chest 2019; 155:244-245. [DOI: 10.1016/j.chest.2018.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 10/10/2018] [Indexed: 11/28/2022] Open
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22
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Coelho L, Rabello L, Salluh J, Martin-Loeches I, Rodriguez A, Nseir S, Gomes JA, Povoa P. C-reactive protein and procalcitonin profile in ventilator-associated lower respiratory infections. J Crit Care 2018; 48:385-389. [PMID: 30308469 DOI: 10.1016/j.jcrc.2018.09.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 09/29/2018] [Accepted: 09/30/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE Ventilator-associated tracheobronchitis (VAT) has been suggested as an intermediate process between tracheobronchial colonization and ventilator-associated pneumonia (VAP) in patients receiving mechanical ventilation. The aim of this study was to evaluate the ability of C-reactive protein (CRP) and procalcitonin (PCT) to differentiate between VAT and VAP. METHODS Pre-planned analysis of the prospective multinational TAVeM database, performed on 2960 patients receiving mechanical ventilation for >48 h, including 689 patients with VA-LRTI. Patients with the diagnosis of VAT or VAP microbiologically documented and with one measurement of CRP and/or PCT on the day of diagnosis were included. RESULTS Four hundred and four patients (mean age 63 years, 298 men, ICU mortality 40%) were studied, 207 with VAT and 197 with VAP. On the day of infection diagnosis, the median CRP was elevated in both groups but significantly higher in VAP (18 mg/dL vs. 14 mg/dL, p = .001). Median PCT was also significantly higher in VAP (2.1 ng/dL vs. 0.64 ng/d L, p < .001). Both biomarkers could not help distinguish between VAT and VAP. CONCLUSION Although PCT and CRP presented lower values in VAT as compared to VAP, there was a marked overlap of both biomarkers values in both VA-LRTI not allowing adequate discrimination.
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Affiliation(s)
- Luis Coelho
- Unidade de Cuidados Intensivos Polivalente, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; NOVA Medical School, CEDOC, Universidade Nova de Lisboa, Lisboa, Portugal.
| | - Ligia Rabello
- Department of Critical Care, D'Or Institute for Research and Education, Rio De Janeiro, Brazil
| | - Jorge Salluh
- Department of Critical Care, D'Or Institute for Research and Education, Rio De Janeiro, Brazil
| | - Ignacio Martin-Loeches
- Department of Clinical Medicine, Trinity College, Welcome Trust-HRB Clinical Research Facility, St James Hospital, Dublin, Ireland
| | - Alejandro Rodriguez
- Critical Care Department, Hospital Universitari de Tarragona Joan XXIII/IISPV/URV/CIBERes, Mallafre Guasch 4, 43007 Tarragona, Spain
| | - Saad Nseir
- Centre de Réanimation, CHU Lille, F-59000 Lille, France; Lille University, Medicine School, 59000-F Lille, France
| | | | - Pedro Povoa
- Unidade de Cuidados Intensivos Polivalente, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; NOVA Medical School, CEDOC, Universidade Nova de Lisboa, Lisboa, Portugal
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23
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Barth C, Soares M, Toffart AC, Timsit JF, Burghi G, Irrazabal C, Pattison N, Tobar E, Almeida BF, Silva UV, Azevedo LC, Rabbat A, Lamer C, Parrot A, Souza-Dantas VC, Wallet F, Blot F, Bourdin G, Piras C, Delemazure J, Durand M, Salluh J, Azoulay E, Lemiale V. Characteristics and outcome of patients with newly diagnosed advanced or metastatic lung cancer admitted to intensive care units (ICUs). Ann Intensive Care 2018; 8:80. [PMID: 30076547 PMCID: PMC6076209 DOI: 10.1186/s13613-018-0426-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 07/25/2018] [Indexed: 02/07/2023] Open
Abstract
Background Although patients with advanced or metastatic lung cancer have poor prognosis, admission to the ICU for management of life-threatening complications has increased over the years. Patients with newly diagnosed lung cancer appear as good candidates for ICU admission, but more robust information to assist decisions is lacking. The aim of our study was to evaluate the prognosis of newly diagnosed unresectable lung cancer patients. Methods A retrospective multicentric study analyzed the outcome of patients admitted to the ICU with a newly diagnosed lung cancer (diagnosis within the month) between 2010 and 2013. Results Out of the 100 patients, 30 had small cell lung cancer (SCLC) and 70 had non-small cell lung cancer. (Thirty patients had already been treated with oncologic treatments.) Mechanical ventilation (MV) was performed for 81 patients. Seventeen patients received emergency chemotherapy during their ICU stay. ICU, hospital, 3- and 6-month mortality were, respectively, 47, 60, 67 and 71%. Hospital mortality was 60% when invasive MV was used alone, 71% when MV and vasopressors were needed and 83% when MV, vasopressors and hemodialysis were required. In multivariate analysis, hospital mortality was associated with metastatic disease (OR 4.22 [1.4–12.4]; p = 0.008), need for invasive MV (OR 4.20 [1.11–16.2]; p = 0.030), while chemotherapy in ICU was associated with survival (OR 0.23, [0.07–0.81]; p = 0.020). Conclusion This study shows that ICU management can be appropriate for selected newly diagnosed patients with advanced lung cancer, and chemotherapy might improve outcome for patients with SCLC admitted for cancer-related complications. Nevertheless, tumors’ characteristics, numbers and types of organ dysfunction should be taken into account in the decisional process before admitting these patients in ICU.
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Affiliation(s)
- C Barth
- Medical ICU, AP-HP, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - M Soares
- Post-Graduation Program, Instituto Nacional de Câncer, Rio de Janeiro Department of Clinical Research, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - A C Toffart
- Inserm, u 823, Institut A Bonniot, Grenoble, France
| | - J F Timsit
- Medical ICU, Hôpital Bichat-Claude Bernard, Paris, France
| | - G Burghi
- ICU, Hospital Maciel, Montevideo, Uruguay
| | - C Irrazabal
- ICU, Instituto Medico Especializado Alexander Fleming, Buenos Aires, Argentina
| | - N Pattison
- ICU, Royal Brompton NHS Foundation Trust, London ICU, Royal Marsden Hospital, London, UK
| | - E Tobar
- ICU, Hospital Clinico Universidad de Chile, Santiago, Chile
| | - B F Almeida
- ICU, Hospital A. C. Camargo, São Paulo, Brazil
| | - U V Silva
- ICU, Fundação Pio XII-Hospital do Câncer de Barretos, Barretos, Brazil
| | - L C Azevedo
- ICU, Hospital Sírio Libanês, São Paulo, Brazil
| | - A Rabbat
- Thoracic ICU, Hôpital Cochin, Paris, France
| | - C Lamer
- ICU, Institut Mutualiste Montsouris, Paris, France
| | - A Parrot
- Medical ICU, Hôpital Tenon, Paris, France
| | - V C Souza-Dantas
- ICU, Instituto Nacional de Câncer-Hospital do Câncer I, Rio de Janeiro, Brazil
| | - F Wallet
- Medical-Surgical ICU, Hospices Civils de Lyon Centre Hospitalier Lyon Sud, Lyon, France
| | - F Blot
- ICU, Institut Gustave Roussy, Villejuif, France
| | - G Bourdin
- Medical ICU, Hôpital de la Croix-Rousse, Lyon, France
| | - C Piras
- ICU, Vitória Apart Hospital, Vitória, Brazil
| | - J Delemazure
- Medical ICU, Groupe Hospitalier Pitié Salpêtrière, Paris, France
| | - M Durand
- Surgical ICU, Hôpital A. Michallon Chu de Grenoble, Grenoble, France
| | - J Salluh
- Post-Graduation Program, Instituto Nacional de Câncer, Rio de Janeiro Department of Clinical Research, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - E Azoulay
- Medical ICU, AP-HP, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Virginie Lemiale
- Medical ICU, AP-HP, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France.
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24
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Moreau AS, Martin-Loeches I, Povoa P, Salluh J, Rodriguez A, Thille AW, Diaz Santos E, Vedes E, Lobo SM, Mégarbane B, Molero Silvero E, Coelho L, Argaud L, Sanchez Iniesta R, Labreuche J, Rouzé A, Nseir S. Impact of immunosuppression on incidence, aetiology and outcome of ventilator-associated lower respiratory tract infections. Eur Respir J 2018; 51:13993003.01656-2017. [PMID: 29439020 DOI: 10.1183/13993003.01656-2017] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 01/24/2018] [Indexed: 12/15/2022]
Abstract
The aim of this planned analysis of the prospective multinational TAVeM database was to determine the incidence, aetiology and impact on outcome of ventilator-associated lower respiratory tract infections (VA-LRTI) in immunocompromised patients.All patients receiving mechanical ventilation for >48 h were included. Immunocompromised patients (n=663) were compared with non-immunocompromised patients (n=2297).The incidence of VA-LRTI was significantly lower among immunocompromised than among non-immunocompromised patients (16.6% versus 24.2%; sub-hazard ratio 0.65, 95% CI 0.53-0.80; p<0.0001). Similar results were found regarding ventilator-associated tracheobronchitis (7.3% versus 11.6%; sub-hazard ratio 0.61, 95% CI 0.45-0.84; p=0.002) and ventilator-associated pneumonia (9.3% versus 12.7%; sub-hazard ratio 0.72, 95% CI 0.54-0.95; p=0.019). Among patients with VA-LRTI, the rates of multidrug-resistant bacteria (72% versus 59%; p=0.011) and intensive care unit mortality were significantly higher among immunocompromised than among non-immunocompromised patients (54% versus 30%; OR 2.68, 95% CI 1.78-4.02; p<0.0001). In patients with ventilator-associated pneumonia, mortality rates were higher among immunocompromised than among non-immunocompromised patients (64% versus 34%; p<0.001).Incidence of VA-LRTI was significantly lower among immunocompromised patients, but it was associated with a significantly higher mortality rate. Multidrug-resistant pathogens were more frequently found in immunocompromised patients with VA-LRTI.
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Affiliation(s)
| | - Ignacio Martin-Loeches
- Dept of Clinical Medicine, Trinity College, Welcome Trust-HRB Clinical Research Facility, St James Hospital, Dublin, Ireland
| | - Pedro Povoa
- Unidade de Cuidados Intensivos Polivalente, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.,NOVA Medical School, CEDOC, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Jorge Salluh
- Dept of Critical Care, D'Or Institute for Research and Education, Rio De Janeiro, Brazil
| | | | - Arnaud W Thille
- CHU de Poitiers, Réanimation Médicale, Faculté de Médecine et de Pharmacie de Poitiers, Université de Poitiers, INSERM, CIC-1402, équipe 5 ALIVE, Poitiers, France
| | - Emilio Diaz Santos
- Critical Care Center, Sabadell Hospital, Corporación Sanitaria Universitaria Parc Taulí, Universitat Autonoma de Barcelona, CIBER de Enfermedades Respiratorias (CIBERES), Sabadell, Spain
| | - Elisa Vedes
- Unidade de Cuidados Intensivos do Hospital da Luz, Lisbon, Portugal
| | | | - Bruno Mégarbane
- Dept of Medical and Toxicological Critical Care, Lariboisière Hospital, Paris-Diderot University, INSERM UMRS-1144, Paris, France
| | | | - Luis Coelho
- Unidade de Cuidados Intensivos Polivalente, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.,NOVA Medical School, CEDOC, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Laurent Argaud
- Service de Réanimation Médicale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | | | - Julien Labreuche
- CHU Lille, Clinique de Santé Publique, Plateforme d'Aide Méthodologique, Lille, France
| | | | - Saad Nseir
- Centre de Réanimation, CHU Lille, Lille, France.,Medical School, Lille University, Lille, France
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25
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Azoulay E, Schellongowski P, Darmon M, Bauer PR, Benoit D, Depuydt P, Divatia JV, Lemiale V, van Vliet M, Meert AP, Mokart D, Pastores SM, Perner A, Pène F, Pickkers P, Puxty KA, Vincent F, Salluh J, Soubani AO, Antonelli M, Staudinger T, von Bergwelt-Baildon M, Soares M. The Intensive Care Medicine research agenda on critically ill oncology and hematology patients. Intensive Care Med 2017; 43:1366-1382. [PMID: 28725926 DOI: 10.1007/s00134-017-4884-z] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 07/08/2017] [Indexed: 12/13/2022]
Abstract
Over the coming years, accelerating progress against cancer will be associated with an increased number of patients who require life-sustaining therapies for infectious or toxic chemotherapy-related events. Major changes include increased number of cancer patients admitted to the ICU with full-code status or for time-limited trials, increased survival and quality of life in ICU survivors, changing prognostic factors, early ICU admission for optimal monitoring, and use of noninvasive diagnostic and therapeutic strategies. In this review, experts in the management of critically ill cancer patients highlight recent changes in the use and the results of intensive care in patients with malignancies. They seek to put forward a standard of care for the management of these patients and highlight important updates that are required to care for them. The research agenda they suggest includes important studies to be conducted in the next few years to increase our understanding of organ dysfunction in this population and to improve our ability to appropriately use life-saving therapies or select new therapeutic approaches that are likely to improve outcomes. This review aims to provide more guidance for the daily management of patients with cancer, in whom outcomes are constantly improving, as is our global ability to fight against what is becoming the leading cause of mortality in industrialized and non-industrialized countries.
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Affiliation(s)
- Elie Azoulay
- ECSTRA Team, and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France. .,Medical Intensive Care Unit, Hôpital Saint-Louis, Paris, France.
| | | | - Michael Darmon
- Saint-Etienne University Hospital, Saint-Etienne, France
| | | | | | | | | | | | | | | | | | | | | | | | - Peter Pickkers
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Jorge Salluh
- Instituto de Ensino e Perquisa da Santa Casa de Belo Horizonte, Rio de Janeiro, Brazil
| | | | | | | | | | - Marcio Soares
- Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
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26
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Abstract
Biomarkers as C-reactive protein (CRP) and procalcitonin (PCT) emerged as tools to help clinicians to diagnose infection and to properly initiate and define the duration of antibiotic therapy. Several randomized controlled trials, including adult critically ill patients, showed that PCT-guided antibiotic stewardship was repeatedly associated with a decrease in the duration of antibiotic therapy with no apparent harm. There are however some relevant limitations in these trials namely the low rate of compliance of PCT-guided algorithms, the high rate of exclusion (without including common clinical situations and pathogens) and the long duration of antibiotic therapy in control groups. Such limitations weakened the real impact of such algorithms in the clinical decision-making process and strengthened the concept that the initiation and the duration of antibiotic therapy cannot depend solely on a biomarker. Future efforts should address these limitations in order to better clarify the role of biomarkers on the complex and multifactorial issue of antibiotic management and to deeply understand its potential effect on mortality.
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Affiliation(s)
- David Nora
- Intensive Care Unit, Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal.,NOVA Medical School, New University of Lisbon, Lisbon, Portugal
| | - Jorge Salluh
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Ignacio Martin-Loeches
- St. James's University Hospital, Trinity Centre for Health Sciences, Dublin, Ireland.,Irish Center for Vascular Biology, Dublin, Ireland
| | - Pedro Póvoa
- NOVA Medical School, New University of Lisbon, Lisbon, Portugal.,Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, Lisbon, Portugal
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27
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Rob D, Špunda R, Lindner J, Šmalcová J, Šmíd O, Kovárník T, Linhart A, Bìlohlávek J, Marinoni MM, Cianchi G, Trapani S, Migliaccio ML, Gucci L, Bonizzoli M, Cramaro A, Cozzolino M, Valente S, Peris A, Grins E, Kort E, Weiland M, Shresta NM, Davidson P, Algotsson L, Fitch S, Marco G, Sturgill J, Lee S, Dickinson M, Boeve T, Khaghani A, Wilton P, Jovinge S, Ahmad AN, Loveridge R, Vlachos S, Patel S, Gelandt E, Morgan L, Butt S, Whitehorne M, Kakar V, Park C, Hayes M, Willars C, Hurst T, Best T, Vercueil A, Auzinger G, Adibelli B, Akovali N, Torgay A, Zeyneloglu P, Pirat A, Kayhan Z, Schmidbauer SS, Herlitz J, Karlsson T, Friberg H, Knafelj R, Radsel P, Duprez F, Bonus T, Cuvelier G, Mashayekhi S, Maka M, Ollieuz S, Reychler G, Mosaddegh R, Abbasi S, Talaee S, Zotzmann VZ, Staudacher DS, Wengenmayer TW, Dürschmied DD, Bode CB, Nelskylä A, Nurmi J, Jousi M, Schramko A, Mervaala E, Ristagno G, Skrifvars M, Ozsoy G, Kendirli T, Azapagasi E, Perk O, Gadirova U, Ozcinar E, Cakici M, Baran C, Durdu S, Uysalel A, Dogan M, Ramoglu M, Ucar T, Tutar E, Atalay S, Akar R, Kamps M, Leeuwerink G, Hofmeijer J, Hoiting O, Van der Hoeven J, Hoedemaekers C, Konkayev A, Kuklin V, Kondratyev T, Konkayeva M, Akhatov N, Sovershaev M, Tveita T, Dahl V, Wihersaari L, Skrifvars MB, Bendel S, Kaukonen KM, Vaahersalo J, Romppanen J, Pettilä V, Reinikainen M, Lybeck A, Cronberg T, Nielsen N, Friberg H, Rauber M, Steblovnik K, Jazbec A, Noc M, Kalasbail P, Garrett F, Kulstad E, Bergström DJ, Olsson HR, Schmidbauer S, Friberg H, Mandel I, Mikheev S, Podoxenov Y, Suhodolo I, Podoxenov A, Svirko J, Sementsov A, Maslov L, Shipulin V, Vammen LV, Rahbek SR, Secher NS, Povlsen JP, Jessen NJ, Løfgren BL, Granfeldt AG, Grossestreuer A, Perman S, Patel P, Ganley S, Portmann J, Cocchi M, Donnino M, Nassar Y, Fathy S, Gaber A, Mokhtar S, Chia YC, Lewis-Cuthbertson R, Mustafa K, Sabra A, Evans A, Bennett P, Eertmans W, Genbrugge C, Boer W, Dens J, De Deyne C, Jans F, Skorko A, Thomas M, Casadio M, Coppo A, Vargiolu A, Villa J, Rota M, Avalli L, Citerio G, Moon JB, Cho JH, Park CW, Ohk TG, Shin MC, Won MH, Papamichalis P, Zisopoulou V, Dardiotis E, Karagiannis S, Papadopoulos D, Zafeiridis T, Babalis D, Skoura A, Staikos I, Komnos A, Passos SS, Maeda F, Souza LS, Filho AA, Granjeia TAG, Schweller M, Franci D, De Carvalho Filho M, Santos TM, De Azevedo P, Wall R, Welters I, Tansuwannarat P, Sanguanwit P, Langer T, Carbonara M, Caccioppola A, Fusarini CF, Carlesso E, Paradiso E, Battistini M, Cattaneo E, Zadek F, Maiavacca R, Stocchetti N, Pesenti A, Ramos A, Acharta F, Toledo J, Perezlindo M, Lovesio L, Dogliotti A, Lovesio C, Schroten N, Van der Veen B, De Vries MC, Veenstra J, Abulhasan YB, Rachel S, Châtillon-Angle M, Alabdulraheem N, Schiller I, Dendukuri N, Angle M, Frenette C, Lahiri S, Schlick K, Mayer SA, Lyden P, Akatsuka M, Arakawa J, Yamakage M, Rubio J, Mateo-Sidron JAR, Sierra R, Celaya M, Benitez L, Alvarez-Ossorio S, Rubio J, Mateo-Sidron JAR, Sierra R, Fernandez A, Gonzalez O, Engquist H, Rostami E, Enblad P, Toledo J, Ramos A, Acharta F, Canullo L, Nallino J, Dogliotti A, Lovesio C, Perreault M, Talic J, Frenette AJ, Burry L, Bernard F, Williamson DR, Adukauskiene D, Cyziute J, Adukauskaite A, Malciene L, Luca L, Rogobete A, Bedreag O, Papurica M, Sarandan M, Cradigati C, Popovici S, Vernic C, Sandesc D, Avakov V, Shakhova I, Trimmel H, Majdan M, Herzer GH, Sokoloff CS, Albert M, Williamson D, Odier C, Giguère J, Charbonney E, Bernard F, Husti Z, Kaptás T, Fülep Z, Gaál Z, Tusa M, Donnelly J, Aries M, Czosnyka M, Robba C, Liu M, Ercole A, Menon D, Hutchinson P, Smielewski P, López R, Graf J, Montes JM, Kenawi M, Kandil A, Husein K, Samir A, Heijneman J, Huijben J, Abid-Ali F, Stolk M, Van Bommel J, Lingsma H, Van der Jagt M, Cihlar RC, Mancino G, Bertini P, Forfori F, Guarracino F, Pavelescu D, Grintescu I, Mirea L, Alamri S, Tharwat M, Kono N, Okamoto H, Uchino H, Ikegami T, Fukuoka T, Simoes M, Trigo E, Coutinho P, Pimentel J, Franci A, Basagni D, Boddi M, Cozzolino M, Anichini V, Cecchi A, Peris A, Markopoulou D, Venetsanou K, Papanikolaou I, Barkouri T, Chroni D, Alamanos I, Cingolani E, Bocci MG, Pisapia L, Tersali A, Cutuli SL, Fiore V, Palma A, Nardi G, Antonelli M, Coke R, Kwong A, Dwivedi DJ, Xu M, McDonald E, Marshall JC, Fox-Robichaud AE, Charbonney E, Liaw PC, Kuchynska I, Malysh IR, Zgrzheblovska LV, Mestdagh L, Verhoeven EF, Hubloue I, Ruel-laliberte J, Zarychanski R, Lauzier F, Bonaventure PL, Green R, Griesdale D, Fowler R, Kramer A, Zygun D, Walsh T, Stanworth S, Léger C, Turgeon AF, Baron DM, Baron-Stefaniak J, Leitner GC, Ullrich R, Tarabrin O, Mazurenko A, Potapchuk Y, Sazhyn D, Tarabrin P, Tarabrin O, Mazurenko A, Potapchuk Y, Sazhyn D, Tarabrin P, Pérez AG, Silva J, Artemenko V, Bugaev A, Tokar I, Konashevskaya S, Kolesnikova IM, Roitman EV, Kiss TR, Máthé Z, Piros L, Dinya E, Tihanyi E, Smudla A, Fazakas J, Ubbink R, Boekhorst te P, Mik E, Caneva L, Ticozzelli G, Pirrelli S, Passador D, Riccardi F, Ferrari F, Roldi EM, Di Matteo M, Bianchi I, Iotti GA, Zurauskaite G, Voegeli A, Meier M, Koch D, Haubitz S, Kutz A, Bargetzi M, Mueller B, Schuetz P, Von Meijenfeldt G, Van der Laan M, Zeebregts C, Christopher KB, Vernikos P, Melissopoulou T, Kanellopoulou G, Panoutsopoulou M, Xanthis D, Kolovou K, Kypraiou T, Floros J, Broady H, Pritchett C, Marshman M, Jannaway N, Ralph C, Lehane CL, Keyl CK, Zimmer EZ, Trenk DT, Ducloy-Bouthors AS, Jonard MJ, Fourrier F, Piza F, Correa T, Marra A, Guerra J, Rodrigues R, Vilarinho A, Aranda V, Shiramizo S, Lima MR, Kallas E, Cavalcanti AB, Donoso M, Vargas P, Graf J, McCartney J, Ramsay S, McDowall K, Novitzky-Basso I, Wright C, Medic MG, Bielen L, Radonic V, Zlopasa O, Vrdoljak NG, Gasparovic V, Radonic R, Narváez G, Cabestrero D, Rey L, Aroca M, Gallego S, Higuera J, De Pablo R, González LR, Chávez GN, Lucas JH, Alonso DC, Ruiz MA, Valarezo LJ, De Pablo Sánchez R, Real AQ, Wigmore TW, Bendavid I, Cohen J, Avisar I, Serov I, Kagan I, Singer P, Hanison J, Mirza U, Conway D, Takasu A, Tanaka H, Otani N, Ohde S, Ishimatsu S, Coffey F, Dissmann P, Mirza K, Lomax M, Dissmann P, Coffey F, Mirza K, Lomax M, Miner JR, Leto R, Markota AM, Gradišek PG, Aleksejev VA, Sinkovič AS, Romagnoli S, Chelazzi C, Zagli G, Benvenuti F, Mancinelli P, Boninsegni P, Paparella L, Bos AT, Thomas O, Goslar T, Knafelj R, Perreault M, Martone A, Sandu PR, Rosu VA, Capilnean A, Murgoi P, Frenette AJ, Lecavalier A, Jayaraman D, Rico P, Bellemare P, Gelinas C, Williamson D, Nishida T, Kinoshita T, Iwata N, Yamakawa K, Fujimi S, Maggi L, Sposato F, Citterio G, Bonarrigo C, Rocco M, Zani V, De Blasi RA, Alcorn D, Barry L, Riedijk MA, Milstein DM, Caldas J, Panerai R, Camara L, Ferreira G, Bor-Seng-Shu E, Lima M, Galas F, Mian N, Nogueira R, de Oliveira GQ, Almeida J, Jardim J, Robinson TG, Gaioto F, Hajjar LA, Zabolotskikh I, Musaeva T, Saasouh W, Freeman J, Turan A, Saseedharan S, Pathrose E, Poojary S, Messika J, Martin Y, Maquigneau N, Henry-Lagarrigue M, Puechberty C, Stoclin A, Martin-Lefevre L, Blot F, Dreyfuss D, Dechanet A, Hajage D, Ricard J, Almeida E, Almeida J, Landoni G, Galas F, Fukushima J, Fominskiy E, De Brito C, Cavichio L, Almeida L, Ribeiro U, Osawa E, Boltes R, Battistella L, Hajjar L, Fontela P, Lisboa T, Junior LF, Friedman GF, Abruzzi F, Primo JAP, Filho PM, de Andrade JS, Brenner KM, boeira MS, Leães C, Rodrigues C, Vessozi A, Machado AS, Weiler M, Bryce H, Hudson A, Law T, Reece-Anthony R, Molokhia A, Abtahinezhadmoghaddam F, Cumber E, Channon L, Wong A, Groome R, Gearon D, Varley J, Wilson A, Reading J, Wong A, Zampieri FG, Bozza FA, Ferez M, Fernandes H, Japiassú A, Verdeal J, Carvalho AC, Knibel M, Salluh JI, Soares M, Gao J, Ahmadnia E, Patel B, McCartney J, MacKay A, Binning S, Wright C, Pugh RJ, Battle C, Hancock C, Harrison W, Szakmany T, Mulders F, Vandenbrande J, Dubois J, Stessel B, Siborgs K, Ramaekers D, Soares M, Silva UV, Homena WS, Fernandes GC, Moraes AP, Brauer L, Lima MF, De Marco F, Bozza FA, Salluh JI, Maric N, Mackovic M, Udiljak N, Bosso CE, Caetano RD, Cardoso AP, Souza OA, Pena R, Mescolotte MM, Souza IA, Mescolotte GM, Bangalore H, Borrows E, Barnes D, Ferreira V, Azevedo L, Alencar G, Andrade A, Bierrenbach A, Buoninsegni LT, Bonizzoli M, Cecci L, Cozzolino M, Peris A, Lindskog J, Rowland K, Sturgess P, Ankuli A, Molokhia A, Rosa R, Tonietto T, Ascoli A, Madeira L, Rutzen W, Falavigna M, Robinson C, Salluh J, Cavalcanti A, Azevedo L, Cremonese R, Da Silva D, Dornelles A, Skrobik Y, Teles J, Ribeiro T, Eugênio C, Teixeira C, Zarei M, Hashemizadeh H, Eriksson M, Strandberg G, Lipcsey M, Larsson A, Lignos M, Crissanthopoulou E, Flevari K, Dimopoulos P, Armaganidis A, Golub JG, Markota AM, Stožer AS, Sinkovič AS, Rüddel H, Ehrlich C, Burghold CM, Hohenstein C, Winning J, Sellami W, Hajjej Z, Bousselmi M, Gharsallah H, Labbene I, Ferjani M, Sattler J, Steinbrunner D, Poppert H, Schneider G, Blobner M, Kanz KG, Schaller SJ, Apap K, Xuereb G, Xuereb G, Apap K, Massa L, Xuereb G, Apap K, Massa L, Delvau N, Penaloza A, Liistro G, Thys F, Delattre IK, Hantson P, Roy PM, Gianello P, Hadîrcă L, Ghidirimschi A, Catanoi N, Scurtov N, Bagrinovschi M, Sohn YS, Cho YC, Golovin B, Creciun O, Ghidirimschi A, Bagrinovschi M, Tabbara R, Whitgift JZ, Ishimaru A, Yaguchi A, Akiduki N, Namiki M, Takeda M, Tamminen JN, Reinikainen M, Uusaro A, Taylor CG, Mills ED, Mackay AD, Ponzoni C, Rabello R, Serpa A, Assunção M, Pardini A, Shettino G, Corrêa T, Vidal-Cortés PV, Álvarez-Rocha L, Fernández-Ugidos P, Virgós-Pedreira A, Pérez-Veloso MA, Suárez-Paul IM, Del Río-Carbajo L, Fernández SP, Castro-Iglesias A, Butt A, Alghabban AA, Khurshid SK, Ali ZA, Nizami IN, Salahuddin NS, Alshahrani M, Alsubaie AW, Alshamsy AS, Alkhiliwi BA, Alshammari HK, Alshammari MB, Telmesani NK, Alshammari RB, Asonto LP, Zampieri FG, Damiani LP, Bozza F, Salluh JI, Cavalcanti AB, El Khattate A, Bizrane M, Madani N, Belayachi J, Abouqal R, Ramnarain D, Gouw-Donders B, Benstoem C, Moza A, Meybohm P, Stoppe C, Autschbach R, Devane D, Goetzenich A, Taniguchi LU, Araujo L, Salgado G, Vieira JM, Viana J, Ziviani N, Pessach I, Lipsky A, Nimrod A, O´Connor M, Matot I, Segal E, Kluzik A, Gradys A, Smuszkiewicz P, Trojanowska I, Cybulski M, De Jong A, Sebbane M, Chanques G, Jaber S, Rosa R, Robinson C, Bessel M, Cavalheiro L, Madeira L, Rutzen W, Oliveira R, Maccari J, Falavigna M, Sanchez E, Dutra F, Dietrich C, Balzano P, Rezende J, Teixeira C, Sinha S, Majhi K, Gorlicki JG, Pousset FP, Kelly J, Aron J, Gilbert AC, Urankar NP, Knafelj R, Irazabal M, Bosque M, Manciño J, Kotsopoulos A, Jansen N, Abdo W, Casey ÚM, O’Brien B, Plant R, Doyle B. 37th International Symposium on Intensive Care and Emergency Medicine (part 2 of 3). Crit Care 2017. [PMCID: PMC5374552 DOI: 10.1186/s13054-017-1630-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Von Seth M, Hillered L, Otterbeck A, Hanslin K, Larsson A, Sjölin J, Lipcsey M, Cove ME, Chew NS, Vu LH, Lim RZ, Puthucheary Z, Hanslin K, Wilske F, Skorup P, Tano E, Sjölin J, Lipcsey M, Derese I, Thiessen S, Derde S, Dufour T, Pauwels L, Bekhuis Y, Van den Berghe G, Vanhorebeek I, Khan M, Dwivedi D, Zhou J, Prat A, Seidah NG, Liaw PC, Fox-Robichaud AE, Von Seth M, Skorup P, Hillered L, Larsson A, Sjölin J, Lipcsey M, Otterbeck A, Hanslin K, Lipcsey M, Larsson A, Von Seth M, Correa T, Pereira J, Takala J, Jakob S, Skorup P, Maudsdotter L, Tano E, Lipcsey M, Castegren M, Larsson A, Sjölin J, Xue M, Xu JY, Liu L, Huang YZ, Guo FM, Yang Y, Qiu HB, Kuzovlev A, Moroz V, Goloubev A, Myazin A, Chumachenko A, Pisarev V, Takeyama N, Tsuda M, Kanou H, Aoki R, Kajita Y, Hashiba M, Terashima T, Tomino A, Davies R, O’Dea KP, Soni S, Ward JK, O’Callaghan DJ, Takata M, Gordon AC, Wilson J, Zhao Y, Singer M, Spencer J, Shankar-Hari M, Genga KR, Lo C, Cirstea MS, Walley KR, Russell JA, Linder A, Boyd 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Mudersbach E, Schwedhelm E, Daum G, Kluge S, Zoellner C, Greiwe G, Sawari H, Schwedhelm E, Nierhaus A, Kluge S, Kubitz J, Jung R, Daum G, Reichenspurner H, Zoellner C, Winkler MS, Groznik M, Ihan A, Andersen LW, Chase M, Holmberg MJ, Wulff A, Cocchi MN, Donnino MW, Balci C, Haliloglu M, Bilgili B, Bilgin H, Kasapoglu U, Sayan I, Süzer M, Mulazımoglu L, Cinel I, Patel V, Shah S, Parulekar P, Minton C, Patel J, Ejimofo C, Choi H, Costa R, Caruso P, Nassar P, Fu J, Jin J, Xu Y, Kong J, Wu D, Yaguchi A, Klonis A, Ganguly S, Kollef M, Burnham C, Fuller B, Mavrommati A, Chatzilia D, Salla E, Papadaki E, Kamariotis S, Christodoulatos S, Stylianakis A, Alamanos G, Simoes M, Trigo E, Silva N, Martins P, Pimentel J, Baily D, Curran LA, Ahmadnia E, Patel BV, Adukauskiene D, Cyziute J, Adukauskaite A, Pentiokiniene D, Righetti F, Colombaroli E, Castellano G, Wilske F, Skorup P, Lipcsey M, Hanslin K, Larsson A, Sjölin J, Man M, Shum HP, Chan YH, Chan KC, Yan WW, Lee RA, Lau SK, Dilokpattanamongkol P, Thirapakpoomanunt P, Anakkamaetee R, Montakantikul P, Tangsujaritvijit V, Sinha S, Pati J, Sahu S, Adukauskiene D, Valanciene D, Dambrauskiene A, Adukauskiene D, Valanciene D, Dambrauskiene A, Hernandez K, Lopez T, Saca D, Bello M, Mahmood W, Hamed K, Al Badi N, AlThawadi S, Al Hosaini S, Salahuddin N, Cilloniz CC, Ceccato AC, Bassi GLL, Ferrer MF, Gabarrus AG, Ranzani OR, Jose ASS, Vidal CGG, de la Bella Casa JPP, Blasi FB, Torres AT, Adukauskiene D, Ciginskiene A, Dambrauskiene A, Simoliuniene R, Giuliano G, Triunfio D, Sozio E, Taddei E, Brogi E, Sbrana F, Ripoli A, Bertolino G, Tascini C, Forfori F, Fleischmann C, Goldfarb D, Schlattmann P, Schlapbach L, Kissoon N, Baykara N, Akalin H, Arslantas MK, Gavrilovic SG, Vukoja MV, Hache MH, Kashyap RK, Dong YD, Gajic OG, Ranzani O, Shankar-Hari M, Harrison D, Rabello L, Rowan K, Salluh J, Soares M, Markota AM, Fluher JF, Kogler DK, Borovšak ZB, Sinkovic AS, László I, Öveges N, Forgács M, Kiss T, Hankovszky P, Palágyi P, Bebes A, Gubán B, Földesi I, Araczki Á, Telkes M, Ondrik Z, Helyes Z, Kemény Á, Molnár Z, Fareed J, Siddiqui Z, Aggarwal P, Iqbal O, Hoppensteadt D, Lewis M, Wasmund R, Abro S, Raghuvir S, Tsuruta K, Barie PS, Fineberg D, Radford A, Tsuruta K, Casazza A, Vilardo A, Bellazzi E, Boschi R, Ciprandi D, Gigliuto C, Preda R, Vanzino R, Vetere M, Carnevale L, Kyriazopoulou E, Pistiki A, Routsi C, Tsangaris I, Giamarellos-Bourboulis E, Kyriazopoulou E, Tsangaris I, Routsi C, Pnevmatikos I, Vlachogiannis G, Antoniadou E, Mandragos K, Armaganidis A, Giamarellos-Bourboulis E, Allan P, Oehmen R, Luo J, Ellis C, Latham P, Newman J, Pritchett C, Pandya D, Cripps A, Harris S, Jadav M, Langford R, Ko B, Park H, Beumer CM, Koch R, Beuningen DV, Oudelashof AM, Vd Veerdonk FL, Kolwijck E, VanderHoeven JG, Bergmans DC, Hoedemaekers C, Brandt JB, Golej J, Burda G, Mostafa G, Schneider A, Vargha R, Hermon M, Levin P, Broyer C, Assous M, Wiener-Well Y, Dahan M, Benenson S, Ben-Chetrit E, Faux A, Sherazi R, Sethi A, Saha S, Kiselevskiy M, Gromova E, Loginov S, Tchikileva I, Dolzhikova Y, Krotenko N, Vlasenko R, Anisimova N, Spadaro S, Fogagnolo A, Remelli F, Alvisi V, Romanello A, Marangoni E, Volta C, Degrassi A, Mearelli F, Casarsa C, Fiotti N, Biolo G, Cariqueo M, Luengo C, Galvez R, Romero C, Cornejo R, Llanos O, Estuardo N, Alarcon P, Magazi B, Khan S, Pasipanodya J, Eriksson M, Strandberg G, Lipsey M, Larsson A, Rajput Z, Hiscock F, Karadag T, Uwagwu J, Jain S, Molokhia A, Barrasa H, Soraluce A, Uson E, Rodriguez A, Isla A, Martin A, Fernández B, Fonseca F, Sánchez-Izquierdo JA, Maynar FJ, Kaffarnik M, Alraish R, Frey O, Roehr A, Stockmann M, Wicha S, Shortridge D, Castanheira M, Sader HS, Streit JM, Flamm RK, Falsetta K, Lam T, Reidt S, Jancik J, Kinoshita T, Yoshimura J, Yamakawa K, Fujimi S, Armaganidis A, Torres A, Zakynthinos S, Mandragos C, Giamarellos-Bourboulis E, Ramirez P, De la Torre-Prados M, Rodriguez A, Dale G, Wach A, Beni L, Hooftman L, Zwingelstein C, François B, Colin G, Dequin PF, Laterre PF, Perez A, Welte R, Lorenz I, Eller P, Joannidis M, Bellmann R, Lim S, Chana S, Patel S, Higuera J, Cabestrero D, Rey L, Narváez G, Blandino A, Aroca M, Saéz S, De Pablo R, Thiessen S, Vanhorebeek I, Derde S, Derese I, Dufour T, Albert CN, Langouche L, Goossens C, Peersman N, Vermeersch P, Vander Perre S, Holst J, Wouters P, Van den Berghe G, Liu X, Uber AU, Holmberg M, Konanki V, McNaughton M, Zhang J, Donnino MW, Demirkiran O, Byelyalov A, Luengo C, Guerrero J, Cariqueo M, Scorcella C, Domizi R, Damiani E, Tondi S, Pierantozzi S, Rossini N, Falanga U, Monaldi V, Adrario E, Pelaia P, Donati A, Cole O, Scawn N, Balciunas M, Blascovics I, Vuylsteke A, Salaunkey K, Omar A, Salama A, Allam M, Alkhulaifi A, Verstraete S, Vanhorebeek I, Van Puffelen E, Derese I, Ingels C, Verbruggen S, Wouters P, Joosten K, Hanot J, Guerra G, Vlasselaers D, Lin J, Van den Berghe G, Haines R, Zolfaghari P, Hewson R, Offiah C, Prowle J, Park H, Ko B, Buter H, Veenstra JA, Koopmans M, Boerma EC, Veenstra JA, Buter H, Koopmans M, Boerma EC, Taha A, Shafie A, Hallaj S, Gharaibeh D, Hon H, Bizrane M, El Khattate AA, Madani N, Abouqal R, Belayachi J, Kongpolprom N, Sanguanwong N, Sanaie S, Mahmoodpoor A, Hamishehkar H, Biderman P, Van Heerden P, Avitzur Y, Solomon S, Iakobishvili Z, Carmi U, Gorfil D, Singer P, Paisley C, Patrick-Heselton J, Mogk M, Humphreys J, Welters I, Pierantozzi S, Scorcella C, Domizi R, Damiani E, Tondi S, Casarotta E, Bolognini S, Adrario E, Pelaia P, Donati A, Holmberg MJ, Moskowitz A, Patel P, Grossestreuer A, Uber A, Andersen LW, Donnino MW, Malinverni S, Goedeme D, Mols P, Langlois PL, Szwec C, D’Aragon F, Heyland DK, Manzanares W, Manzanares W, Szwec C, Langlois P, Aramendi I, Heyland D, Stankovic N, Nadler J, Uber A, Holmberg M, Sanchez L, Wolfe R, Chase M, Donnino M, Cocchi M, Atalan HK, Gucyetmez B, Kavlak ME, Aslan S, Kargi A, Yazici S, Donmez R, Polat KY, Piechota M, Piechota A, Misztal M, Bernas S, Pietraszek-Grzywaczewska I, Saleh M, Hamdy A, Hamdy A, Elhallag M, Atar F, Kundakci A, Gedik E, Sahinturk H, Zeyneloglu P, Pirat A, Popescu M, Tomescu D, Van Gassel R, Baggerman M, Schaap F, Bol M, Nicolaes G, Beurskens D, Damink SO, Van de Poll M, Horibe M, Sasaki M, Sanui M, Iwasaki E, Sawano H, Goto T, Ikeura T, Hamada T, Oda T, Mayumi T, Kanai T, Kjøsen G, Horneland R, Rydenfelt K, Aandahl E, Tønnessen T, Haugaa H, Lockett P, Evans L, Somerset L, Ker-Reid F, Laver S, Courtney E, Dalton S, Georgiou A, Robinson K, Lam T, Haas B, Reidt S, Bartlett K, Jancik J, Bigwood M, Hanley R, Morgan P, Marouli D, Chatzimichali A, Kolyvaki S, Panteli A, Diamantaki E, Pediaditis E, Sirogianni P, Ginos P, Kondili E, Georgopoulos D, Askitopoulou H, Zampieri FG, Liborio AB, Besen BA, Cavalcanti AB, Dominedò C, Dell’Anna AM, Monayer A, Grieco DL, Barelli R, Cutuli SL, Maddalena AI, Picconi E, Sonnino C, Sandroni C, Antonelli M, Gucyetmez B, Atalan HK, Tuzuner F, Cakar N, Jacob M, Sahu S, Singh YP, Mehta Y, Yang KY, Kuo S, Rai V, Cheng T, Ertmer C, Czempik P, Hutchings S, Watts S, Wilson C, Burton C, Kirkman E, Drennan D, O’Prey A, MacKay A, Forrest R, Oglinda A, Ciobanu G, Casian M, Oglinda C, Lun CT, Yuen HJ, Ng G, Leung A, So SO, Chan HS, Lai KY, Sanguanwit P, Charoensuk W, Phakdeekitcharoen B, Batres-Baires G, Kammerzell I, Lahmer T, Mayr U, Schmid R, Huber W, Spanuth E, Bomberg H, Klingele M, Thomae R, Groesdonk H, Bernas S, Piechota M, Mirkiewicz K, Pérez AG, Silva J, Ramos A, Acharta F, Perezlindo M, Lovesio L, Antonelli PG, Dogliotti A, Lovesio C, Baron J, Schiefer J, Baron DM, Faybik P, Shum HP, Yan WW, Chan TM, Marouli D, Chatzimichali A, Kolyvaki S, Panteli A, Diamantaki E, Pediaditis E, Sirogianni P, Ginos P, Kondili E, Georgopoulos D, Askitopoulou H, Vicka V, Gineityte D, Ringaitiene D, Sipylaite J, Pekarskiene J, Beurskens DM, Van Smaalen TC, Hoogland P, Winkens B, Christiaans MH, Reutelingsperger CP, Van Heurn E, Nicolaes GA, Schmitt FS, Salgado ES, Friebe JF, Fleming TF, Zemva JZ, Schmoch TS, Uhle FU, Kihm LK, Morath CM, Nusshag CN, Zeier MZ, Bruckner TB, Mehrabi AM, Nawroth PN, Weigand MW, Hofer SH, Brenner TB, Fotopoulou G, Poularas I, Kokkoris S, Brountzos E, Zakynthinos S, Routsi C, Saleh M, Elghonemi M, Nilsson KF, Sandin J, Gustafsson L, Frithiof R, Skorniakov I, Varaksin A, Vikulova D, Shaikh O, Whiteley C, Ostermann M, Di Lascio G, Anicetti L, Bonizzoli M, Fulceri G, Migliaccio ML, Sentina P, Cozzolino M, Peris A, Khadzhynov D, Halleck F, Staeck O, Lehner L, Budde K, Slowinski T, Slowinski T, Kindgen-Milles D, Khadzhynov D, Huysmans N, Laenen MV, Helmschrodt A, Boer W. 37th International Symposium on Intensive Care and Emergency Medicine (part 3 of 3). Crit Care 2017. [PMCID: PMC5374592 DOI: 10.1186/s13054-017-1629-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Tomasi CD, Salluh J, Soares M, Vuolo F, Zanatta F, Constantino LDS, Zugno AI, Ritter C, Dal-Pizzol F. Baseline acetylcholinesterase activity and serotonin plasma levels are not associated with delirium in critically ill patients. Rev Bras Ter Intensiva 2016; 27:170-7. [PMID: 26340158 PMCID: PMC4489786 DOI: 10.5935/0103-507x.20150029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 05/03/2015] [Indexed: 12/25/2022] Open
Abstract
Objective The aim of this study was to investigate whether plasma serotonin levels or
acetylcholinesterase activities determined upon intensive care unit admission
could predict the occurrence of acute brain dysfunction in intensive care unit
patients. Methods A prospective cohort study was conducted with a sample of 77 non-consecutive
patients observed between May 2009 and September 2010. Delirium was determined
using the Confusion Assessment Method for the Intensive Care Unit tool, and the
acetylcholinesterase and serotonin measurements were determined from blood samples
collected up to a maximum of 24 h after the admission of the patient to the
intensive care unit. Results In the present study, 38 (49.6%) patients developed delirium during their
intensive care unit stays. Neither serum acetylcholinesterase activity nor
serotonin level was independently associated with delirium. No significant
correlations of acetylcholinesterase activity or serotonin level with
delirium/coma-free days were observed, but in the patients who developed delirium,
there was a strong negative correlation between the acetylcholinesterase level and
the number of delirium/coma-free days, indicating that higher acetylcholinesterase
levels are associated with fewer days alive without delirium or coma. No
associations were found between the biomarkers and mortality. Conclusions Neither serum acetylcholinesterase activity nor serotonin level was associated
with delirium or acute brain dysfunction in critically ill patients. Sepsis did
not modify these relationships.
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Affiliation(s)
- Cristiane Damiani Tomasi
- Laboratório de Fisiopatologia Experimental, Instituto Nacional de Ciência e Tecnologia, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brasil
| | - Jorge Salluh
- Programa de Pós-Graduação em Oncologia, Instituto Nacional do Câncer, Rio de Janeiro, RJ, Brasil
| | - Márcio Soares
- Programa de Pós-Graduação em Oncologia, Instituto Nacional do Câncer, Rio de Janeiro, RJ, Brasil
| | - Francieli Vuolo
- Laboratório de Fisiopatologia Experimental, Instituto Nacional de Ciência e Tecnologia, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brasil
| | - Francieli Zanatta
- Laboratório de Fisiopatologia Experimental, Instituto Nacional de Ciência e Tecnologia, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brasil
| | - Larissa de Souza Constantino
- Laboratório de Fisiopatologia Experimental, Instituto Nacional de Ciência e Tecnologia, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brasil
| | - Alexandra Ioppi Zugno
- Laboratório de Neurociências, Instituto Nacional de Ciência e Tecnologia Translacional em Medicina, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brasil
| | - Cristiane Ritter
- Laboratório de Fisiopatologia Experimental, Instituto Nacional de Ciência e Tecnologia, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brasil
| | - Felipe Dal-Pizzol
- Laboratório de Fisiopatologia Experimental, Instituto Nacional de Ciência e Tecnologia, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brasil
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Souza-Dantas VC, Póvoa P, Bozza F, Soares M, Salluh J. Preventive strategies and potential therapeutic interventions for delirium in sepsis. Hosp Pract (1995) 2016; 44:190-202. [PMID: 27223862 DOI: 10.1080/21548331.2016.1192453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 05/18/2016] [Indexed: 06/05/2023]
Abstract
Delirium is the most frequent and severe clinical presentation of brain dysfunction in critically ill septic patients with an incidence ranging from 9% to 71%. Delirium represents a significant burden for patients and relatives, as well as to the health care system, resulting in higher costs, long-term cognitive impairment and significant risk of death after 6 months. Current interventions for the prevention of delirium typically involve early recognition and amelioration of modifiable risk factors and treatment of underlying conditions that predisposes the individual to delirium. Several pharmacological interventions to prevent and treat delirium have been tested, although their effectiveness remains uncertain, especially in larger and more homogeneous subgroups of ICU patients, like in patients with sepsis. To date, there is inconsistent and conflicting data regarding the efficacy of any particular pharmacological agent, thus substantial attention has been paid to non-pharmacological interventions and preventive strategies should be applied to every patient admitted in the ICU. Future trials should be designed to evaluate the impact of these pharmacologic interventions on the prevention and treatment of delirium on clinically relevant outcomes such as length of stay, hospital mortality and long-term cognitive function. The role of specific medications like statins in delirium prevention is also yet to be evaluated.
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Affiliation(s)
| | - Pedro Póvoa
- b Polyvalent Intensive Care Unit, Hospital S. Francisco Xavier , Centro Hospitalar de Lisboa Ocidental (CHLO) , Lisbon , Portugal
- c Nova Medical School , CEDOC, New University of Lisbon , Portugal
| | - Fernando Bozza
- d Oswaldo Cruz Foundation , Rio de Janeiro , Brazil
- e D'Or Institute for Research and Education , Rio de Janeiro , Brazil
| | - Marcio Soares
- e D'Or Institute for Research and Education , Rio de Janeiro , Brazil
| | - Jorge Salluh
- e D'Or Institute for Research and Education , Rio de Janeiro , Brazil
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ESICM LIVES 2016: part two. Intensive Care Med Exp 2016. [PMCID: PMC5042923 DOI: 10.1186/s40635-016-0099-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Colino L, Perez JL, Pérez H, Calpe P, Alcala MA, Robaglia D, Perez C, Lan SK, Cunha MM, Moreira T, Santos F, Lafuente E, Fernandes MJ, Silva JG, Rosario LEDLC, Lesmes SPG, Herrera ANG, Romero JCG, Pertuz EDD, Sánchez MJG, Sanz ER, Echeverría JGA, Hernández AA, Hualde JB, Podlepich V, Sokolova E, Alexandrova E, Lapteva K, Kurtz P, Shuinotsuka C, Rabello L, Vianna G, Reis A, Cairus C, Salluh J, Bozza F, Torres JCB, Araujo NJF, García-Olivares P, Keough E, Dalorzo M, Tang LK, De Sousa I, Díaz M, Marcos-Zambrano LJ, Guerrero JE, Gomez SEZ, Lopez GDH, Cuellar AIV, Nieto ORP, Gonzalez JAC, Bhasin D, Rai S, Singh H, Gupta O, Bhattal MK, Sampley S, Sekhri K, Nandha R, Aliaga FA, Olivares F, Appiani F, Farias P, Alberto F, Hernández A, Pons S, Sonneville R, Bouadma L, Neuville M, Mariotte E, Radjou A, Lebut J, Chemam S, Voiriot G, Dilly MP, Mourvillier B, Dorent R, Nataf P, Wolff M, Timsit JF, Ediboglu O, Ataman S, Ozkarakas H, Kirakli C, Vakalos A, Avramidis V, Obukhova O, Kurmukov IA, Kashiya S, Golovnya E, Baikova VN, Ageeva T, Haritydi T, Kulaga EV, Rios-Toro JJ, Perez-Borrero L, Aguilar-Alonso E, Arias-Verdu MD, Garcia-Alvarez JM, Lopez-Caler C, De La Fuente-Martos C, Rodriguez-Fernandez S, Sanchez-Orézzoli MG, Martin-Gallardo F, Nikhilesh J, Joshi V, Villarreal E, Ruiz J, Gordon M, Quinza A, Gimenez J, Piñol M, Castellanos A, Ramirez P, Jeon YD, Jeong WY, Kim MH, Jeong IY, Ahn MY, Ahn JY, Han SH, Choi JY, Song YG, Kim JM, Ku NS, Shah H, Kellner F, Rezai F, Mistry N, Yodice P, Ovnanian V, Fless K, Handler E, Alejos RM, Romeu JDM, Antón DG, Quinart A, Martí AT, Llaurado-Serra M, Lobo-Civico A, Ventura-Rosado A, Piñol-Tena A, Pi-Guerrero M, Paños-Espinosa C, Peralvo-Bernat M, Marine-Vidal J, Gonzalez-Engroba R, Montesinos-Cerro N, Treso-Geira M, Valeiras-Valero A, Martinez-Reyes L, Sandiumenge A, Jimenez-Herrera MF, Helyar S, Riozzi P, Noon A, Hallows G, Cotton H, Keep J, Hopkins PA, Taggu A, Renuka S, Sampath S, Rood PJT, Frenzel T, Verhage R, Bonn M, Pickkers P, van der Hoeven JG, van den Boogaard M, Corradi F, Melnyk L, Moggia F, Pienovi R, Adriano G, Brusasco C, Mariotti L, Lattuada M, Bloomer MJ, Coombs M, Ranse K, Endacott R, Maertens B, Blot K, Blot S, Amerongen MPVN, van der Heiden ES, Twisk JWR, Girbes ARJ, Spijkstra JJ, Riozzi P, Helyar S, Cotton H, Hallows G, Noon A, Bell C, Peters K, Feehan A, Keep J, Hopkins PA, Churchill K, Hawkins K, Brook R, Paver N, Endacott R, Maistry N, van Wijk A, Rouw N, van Galen T, Evelein-Brugman S, Taggu A, Krishna B, Sampath S, Putzu A, Fang M, Berto MB, Belletti A, Cassina T, Cabrini L, Mistry M, Alhamdi Y, Welters I, Abrams ST, Toh CH, Han HS, Gil EM, Lee DS, Park CM, Winder-Rhodes S, Lotay R, Doyle J, Ke MW, Huang WC, Chiang CH, Hung WT, Cheng CC, Lin KC, Lin SC, Chiou KR, Wann SR, Shu CW, Kang PL, Mar GY, Liu CP, Dubó S, Aquevedo A, Jibaja M, Berrutti D, Labra C, Lagos R, García MF, Ramirez V, Tobar M, Picoita F, Peláez C, Carpio D, Alegría L, Hidalgo C, Godoy K, Bakker J, Hernández G, Sadamoto Y, Katabami K, Wada T, Ono Y, Maekawa K, Hayakawa M, Sawamura A, Gando S, Marin-Mateos H, Perez-Vela JL, Garcia-Gigorro R, Peiretti MAC, Lopez-Gude MJ, Chacon-Alves S, Renes-Carreño E, Montejo-González JC, Parlevliet KL, Touw HRW, Beerepoot M, Boer C, Elbers PWG, Tuinman PR, Abdelmonem SA, Helmy TA, El Sayed I, Ghazal S, Akhlagh SH, Masjedi M, Hozhabri K, Kamali E, Zýková I, Paldusová B, Sedlák P, Morman D, Youn AM, Ohta Y, Sakuma M, Bates D, Morimoto T, Su PL, Chang WY, Lin WC, Chen CW, Facchin F, Zarantonello F, Panciera G, De Cassai A, Venrdramin A, Ballin A, Tonetti T, Persona P, Ori C, Del Sorbo L, Rossi S, Vergani G, Cressoni M, Chiumello D, Chiurazzi C, Brioni M, Algieri I, Tonetti T, Guanziroli M, Colombo A, Tomic I, Colombo A, Crimella F, Carlesso E, Gasparovic V, Gattinoni L, Neto AS, Schmidt M, Pham T, Combes A, de Abreu MG, Pelosi P, Schultz MJ, Katira BH, Engelberts D, Giesinger RE, Ackerley C, Yoshida T, Zabini D, Otulakowski G, Post M, Kuebler WM, McNamara PJ, Kavanagh BP, Pirracchio R, Rigon MR, Carone M, Chevret S, Annane D, Eladawy S, El-Hamamsy M, Bazan N, Elgendy M, De Pascale G, Vallecoccia MS, Cutuli SL, Di Gravio V, Pennisi MA, Conti G, Antonelli M, Andreis DT, Khaliq W, Singer M, Hartmann J, Harm S, Carmona SA, Almudevar PM, Abellán AN, Ramos JV, Pérez LP, Valbuena BL, Sanz NM, Simón IF, Arrigo M, Feliot E, Deye N, Cariou A, Guidet B, Jaber S, Leone M, Resche-Rigon M, Baron AV, Legrand M, Gayat E, Mebazaa A, Balik M, Kolnikova I, Maly M, Waldauf P, Tavazzi G, Kristof J, Herpain A, Su F, Post E, Taccone F, Vincent JL, Creteur J, Lee C, Hatib F, Jian Z, Buddi S, Cannesson M, Fileković S, Turel M, Knafelj R, Gorjup V, Stanić R, Gradišek P, Cerović O, Mirković T, Noč M, Tirkkonen J, Hellevuo H, Olkkola KT, Hoppu S, Lin KC, Hung WT, Chiang CC, Huang WC, Juan WC, Lin SC, Cheng CC, Lin PH, Fong KY, Hou DS, Kang PL, Wann SR, Chen YS, Mar GY, Liu CP, Paul M, Bougouin W, Geri G, Dumas F, Champigneulle B, Legriel S, Charpentier J, Mira JP, Sandroni C, Cariou A, Zimmerman J, Sullivan E, Noursadeghi M, Fox B, Sampson D, McHugh L, Yager T, Cermelli S, Seldon T, Bhide S, Brandon RA, Brandon RB, Zwaag J, Beunders R, Pickkers P, Kox M, Gul F, Arslantas MK, Genc D, Zibandah N, Topcu L, Akkoc T, Cinel I, Greco E, Lauretta MP, Andreis DT, Singer M, Garcia IP, Cordero M, Martin AD, Pallás TA, Montero JG, Rey JR, Malo LR, Montoya AAT, Martinez ADCA, Ayala LYD, Zepeda EM, Granillo JF, Sanchez JA, Alejo GC, Cabrera AR, Montenegro AP, Pham T, Beduneau G, Schortgen F, Piquilloud L, Zogheib E, Jonas M, Grelon F, Runge I, Terzi N, Grangé S, Barberet G, Guitard PG, Frat JP, Constan A, Chrétien JM, Mancebo J, Mercat A, Richard JCM, Brochard L, Soilemezi E, Koco E, Savvidou S, Nouris C, Matamis D, Di Mussi R, Spadaro S, Volta CA, Mariani M, Colaprico A, Antonio C, Bruno F, Grasso S, Rodriguez A, Martín-Loeches I, Díaz E, Masclans JR, Gordo F, Solé-Violán J, Bodí M, Avilés-Jurado FX, Trefler S, Magret M, Reyes LF, Marín-Corral J, Yebenes JC, Esteban A, Anzueto A, Aliberti S, Restrepo MI, Larsson JS, Redfors B, Ricksten SE, Haines R, Powell-Tuck J, Leonard H, Ostermann M, Berthelsen RE, Itenov TS, Perner A, Jensen JU, Ibsen M, Jensen AEK, Bestle MH, Bucknall T, Dixon J, Boa F, MacPhee I, Philips BJ, Doyle J, Saadat F, Samuels T, Huddart S, McCormick B, DeBrunnar R, Preece J, Swart M, Peden C, Richardson S, Forni L, Kalfon P, Baumstarck K, Estagnasie P, Geantot MA, Berric A, Simon G, Floccard B, Signouret T, Boucekine M, Fromentin M, Nyunga M, Sossou A, Venot M, Robert R, Follin A, Renault A, Garrouste M, Collange O, Levrat Q, Villard I, Thévenin D, Pottecher J, Patrigeon RG, Revel N, Vigne C, Mimoz O, Auquier P, Pawar S, Jacques T, Deshpande K, Pusapati R, Wood B, Pulham RA, Wray J, Brown K, Pierce C, Nadel S, Ramnarayan P, Azevedo JR, Montenegro WS, Rodrigues DP, Sousa SC, Araujo VF, Leitao AL, Prazeres PH, Mendonca AV, Paula MP, Das Neves A, Loudet CI, Busico M, Vazquez D, Villalba D, Lischinsky A, Veronesi M, Emmerich M, Descotte E, Juliarena A, Bisso MC, Grando M, Tapia A, Camargo M, Ulla DV, Corzo L, dos Santos HP, Ramos A, Doglia JA, Estenssoro E, Carbonara M, Magnoni S, Donald CLM, Shimony JS, Conte V, Triulzi F, Stretti F, Macrì M, Snyder AZ, Stocchetti N, Brody DL, Podlepich V, Shimanskiy V, Savin I, Lapteva K, Chumaev A, Tjepkema-Cloostermans MC, Hofmeijer J, Beishuizen A, Hom H, Blans MJ, van Putten MJAM, Longhi L, Frigeni B, Curinga M, Mingone D, Beretta S, Patruno A, Gandini L, Vargiolu A, Ferri F, Ceriani R, Rottoli MR, Lorini L, Citerio G, Pifferi S, Battistini M, Cordolcini V, Agarossi A, Di Rosso R, Ortolano F, Stocchetti N, Lourido CM, Cabrera JLS, Santana JDM, Alzola LM, del Rosario CG, Pérez HR, Torrent RL, Eslami S, Dalhuisen A, Fiks T, Schultz MJ, Hanna AA, Spronk PE, Wood M, Maslove D. ESICM LIVES 2016: part three. Intensive Care Med Exp 2016. [PMCID: PMC5042925 DOI: 10.1186/s40635-016-0100-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Sarmet Cunha Farah Rabello L, Bozza F, Kahn J, Brasil P, Angus D, Salluh J, Soares M. The impact of organizational characteristics on the outcomes of septic patients admitted to the ICU. Intensive Care Med Exp 2015. [PMCID: PMC4796207 DOI: 10.1186/2197-425x-3-s1-a473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Sarmet Cunha Farah Rabello L, Lisbo T, Azevedo L, Lapa e Silva JR, Soares M, Póvoa P, Salluh J. C-reactive protein as an early marker of healthcare-associated pneumonia outcome in cancer patients. Intensive Care Med Exp 2015. [PMCID: PMC4796097 DOI: 10.1186/2197-425x-3-s1-a299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Angus DC, Bozza F, Kahn J, Salluh J, Soares M, Investigators ORCHESTRAS, Brasil P. Organizational characteristics, outcomes and resource use in ICUs: the ORCHESTRA Study. Crit Care 2015. [PMCID: PMC4601645 DOI: 10.1186/cc14684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Sarmet Cunha Farah Rabello L, Lisboo T, Azevedo L, Lapa e Silva JR, Soares M, Póvoa P, Salluh J. Patterns of c-reactive protein predicts response to therapy in healthcare-associated pneumonia in critically ill patients with cancer. Intensive Care Med Exp 2015. [PMCID: PMC4798069 DOI: 10.1186/2197-425x-3-s1-a254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Martin-Loeches I, Povoa P, Rodríguez A, Curcio D, Suarez D, Mira JP, Cordero ML, Lepecq R, Girault C, Candeias C, Seguin P, Paulino C, Messika J, Castro AG, Valles J, Coelho L, Rabello L, Lisboa T, Collins D, Torres A, Salluh J, Nseir S. Incidence and prognosis of ventilator-associated tracheobronchitis (TAVeM): a multicentre, prospective, observational study. Lancet Respir Med 2015; 3:859-68. [PMID: 26472037 DOI: 10.1016/s2213-2600(15)00326-4] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 08/11/2015] [Accepted: 08/12/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Ventilator-associated tracheobronchitis has been suggested as an intermediate process between tracheobronchial colonisation and ventilator-associated pneumonia in patients receiving mechanical ventilation. We aimed to establish the incidence and effect of ventilator-associated tracheobronchitis in a large, international patient cohort. METHODS We did a multicentre, prospective, observational study in 114 intensive care units (ICU) in Spain, France, Portugal, Brazil, Argentina, Ecuador, Bolivia, and Colombia over a preplanned time of 10 months. All patients older than 18 years admitted to an ICU who received invasive mechanical ventilation for more than 48 h were eligible. We prospectively obtained data for incidence of ventilator-associated lower respiratory tract infections, defined as ventilator-associated tracheobronchitis or ventilator-associated pneumonia. We grouped patients according to the presence or absence of such infections, and obtained data for the effect of appropriate antibiotics on progression of tracheobronchitis to pneumonia. Patients were followed up until death or discharge from hospital. To account for centre effects with a binary outcome, we fitted a generalised estimating equation model with a logit link, exchangeable correlation structure, and non-robust standard errors. This trial is registered with ClinicalTrials.gov, number NCT01791530. FINDINGS Between Sept 1, 2013, and July 31, 2014, we obtained data for 2960 eligible patients, of whom 689 (23%) developed ventilator-associated lower respiratory tract infections. The incidence of ventilator-associated tracheobronchitis and that of ventilator-associated pneumonia at baseline were similar (320 [11%; 10·2 of 1000 mechanically ventilated days] vs 369 [12%; 8·8 of 1000 mechanically ventilated days], p=0·48). Of the 320 patients with tracheobronchitis, 250 received appropriate antibiotic treatment and 70 received inappropriate antibiotics. 39 patients with tracheobronchitis progressed to pneumonia; however, the use of appropriate antibiotic therapy for tracheobronchitis was associated with significantly lower progression to pneumonia than was inappropriate treatment (19 [8%] of 250 vs 20 [29%] of 70, p<0·0001; crude odds ratio 0·21 [95% CI 0·11-0·41]). Significantly more patients with ventilator-associated pneumonia died (146 [40%] of 369) than those with tracheobronchitis (93 [29%] of 320) or absence of ventilator-associated lower respiratory tract infections (673 [30%] of 2271, p<0·0001). Median time to discharge from the ICU for survivors was significantly longer in the tracheobronchitis (21 days [IQR 15-34]) and pneumonia (22 [13-36]) groups than in the group with no ventilator-associated lower respiratory tract infections (12 [8-20]; hazard ratio 1·65 [95% CI 1·38-1·97], p<0·0001). INTERPRETATION This large database study emphasises that ventilator-associated tracheobronchitis is a major health problem worldwide, associated with high resources consumption in all countries. Our findings also show improved outcomes with use of appropriate antibiotic treatment for both ventilator-associated tracheobronchitis and ventilator-associated pneumonia, underlining the importance of treating both infections, since inappropriate treatment of tracheobronchitis was associated with a higher risk of progression to pneumonia. FUNDING None.
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Affiliation(s)
- Ignacio Martin-Loeches
- Department of Clinical Medicine, St James's Hospital, Multidisciplinary Intensive Care Research Organization (MICRO), Trinity Centre for Health Sciences, Dublin, Ireland.
| | - Pedro Povoa
- Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Alejandro Rodríguez
- Hospital Joan XXIII, Tarragona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Bunyola, Mallorca, Spain
| | - Daniel Curcio
- Hospital Municipal de Chivilcoy, Chivilcoy Nueva, Buenos Aires, Argentina
| | - David Suarez
- Epidemiology and Assessment Unit, Fundació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Jean-Paul Mira
- Cochin University Hospital, APHP, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Medical Faculty, Paris, France
| | | | | | | | | | | | - Carolina Paulino
- Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | | | - Alejandro G Castro
- Hospital Universitario Marques de Valdecilla, Santander, Cantabria, Spain
| | - Jordi Valles
- Corporacion Sanitaria Parc Tauli CIBER Enfermedades respiratorias, Parc Tauli, University Institute, Sabadell, Spain
| | | | - Ligia Rabello
- Intensive Care Unit, Instituto Nacional de Câncer, Rio de Janeiro, Brazil; D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Thiago Lisboa
- Critical Care Department and Infection Control Committee, Hospital de Clinicas de Porto Alegre, Rede Institucional de Pesquisa e Inovação em Medicina Intensiva, Complexo Hospitalar Santa Casa, Porto Alegre, Brazil
| | - Daniel Collins
- Department of Clinical Medicine, St James's Hospital, Multidisciplinary Intensive Care Research Organization (MICRO), Trinity Centre for Health Sciences, Dublin, Ireland
| | | | - Jorge Salluh
- Intensive Care Unit, Instituto Nacional de Câncer, Rio de Janeiro, Brazil; D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Saad Nseir
- Centre Hospitalier Régional Universitaire de Lille, Lille, France
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Salluh J, Viana W, Machado F, Cavalvanti A, Bozza F, Soares M. Barriers to the implementation of checklists in the ICU: a survey on the perceptions of 314 Brazilian critical care nurses and physicians. Crit Care 2015. [PMCID: PMC4470651 DOI: 10.1186/cc14596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Toffart AC, Timsit JF, Salluh J, Burghi G, Irrazabal C, Pattison N, Tobar E, Almeida B, Azoulay E, Soares M. Characteristics and outcomes of lung cancer patients requiring ventilatory support: results from a multinational study. Crit Care 2015. [PMCID: PMC4472967 DOI: 10.1186/cc14621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Rodríguez A, Póvoa P, Nseir S, Salluh J, Curcio D, Martín-Loeches I. Incidence and diagnosis of ventilator-associated tracheobronchitis in the intensive care unit: an international online survey. Crit Care 2014; 18:R32. [PMID: 24521533 PMCID: PMC4057509 DOI: 10.1186/cc13725] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 01/24/2014] [Indexed: 11/30/2022] Open
Abstract
Introduction Several aspects of ventilator-associated tracheobronchitis (VAT)—including diagnostic criteria, overlap with ventilator-associated pneumonia (VAP), and appropriate treatment regimens—remain poorly defined. The objectives of this study were to survey reported practices in the clinical and microbiological diagnosis of VAT and to evaluate perceptions of the impact of VAT on patient outcomes. Methods We developed a questionnaire consisting of (a) characteristics of the respondent, the ICU, and hospital; (b) current clinical and microbiological diagnostic approach; (c) empirical antibiotic therapy; and (d) the perception of physicians regarding the clinical impact of VAT and its implications. Results A total of 288 ICUs from 16 different countries answered the survey: 147 (51%) from the Latin American (LA) group and 141 (49%) from Spain, Portugal, and France (SPF group). The majority of respondents (n = 228; 79.2%) reported making the diagnosis of VAT based on clinical and microbiological criteria, and 40 (13.9%) by clinical criteria alone. Approximately half (50.3%) of the respondents agreed that patients should receive antibiotics for the treatment of VAT. Out of all respondents, 269 (93.4%) assume that a VAT episode increases ICU length of stay, and this perception is greater in the LA group (97.3%) than in the SPF group (89.4%, P <0.05). Half of the physicians considered that VAT increases the risk of mortality, and this perception is again greater in the LA group (58.5% versus 41.1%, P <0.05). Conclusions Given the possible high incidence of VAT and the perception of its importance as a risk factor for VAP and mortality, a large multicenter international prospective study would be helpful to validate a consensual definition of VAT, determine its incidence, and delineate its impact on subsequent VAP occurrence.
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Rabello L, Salluh J, Soares M, Rosolem M, Bogado V, Souza I, Lapa e Silva J, Azevedo L. Microbiology and outcomes of severe pneumonia in critically ill cancer patients. Crit Care 2014. [PMCID: PMC4069523 DOI: 10.1186/cc13492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Fagundes JADO, Tomasi CD, Giombelli VR, Alves SC, de Macedo RC, Topanotti MFL, de Lourdes Ugioni Bristot M, do Brasil PEAA, Soares M, Salluh J, Dal-Pizzol F, Ritter C. CAM-ICU and ICDSC agreement in medical and surgical ICU patients is influenced by disease severity. PLoS One 2012; 7:e51010. [PMID: 23226448 PMCID: PMC3511417 DOI: 10.1371/journal.pone.0051010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 10/29/2012] [Indexed: 11/30/2022] Open
Abstract
Introduction Delirium is a prevalent condition in patients admitted to intensive care units (ICU) associated with worse outcomes. The principal aim of the present study was compare the agreement between two tools for delirium assessment in medical and surgical patients admitted to the ICU. Methods Consecutive adult surgical and medical patients admitted to the ICU for more than 24 hours between March 2009 and September 2010 were included. Delirium was evaluated twice a day using the Intensive Care Delirium Screening Checklist (ICDSC) and Confusion Assessment Method adapted to the Intensive Care Unit (CAM-ICU). The kappa (k) and AC1 coefficients were calculated as a measure of agreement between the CAM-ICU and ICDSC. Results A total of 595 patients were enrolled in the study. There were 69 (12%) emergency surgical, 207 (35%) elective surgical and 319 (54%) medical patients. Delirium incidence evaluated by the ICDSC, but not by the CAM-ICU, was similar among the three groups. Overall agreement between CAM-ICU and ICDSC was moderate (k = 0.5) to substantial (AC1 = 0.71). In medical patients the agreement between the two instruments was moderate (k = 0.53) to substantial (AC1 = 0.76). The agreement between the two tools in emergency surgical patients was also moderate (k = 0.53) to substantial (AC1 = 0.68). In elective surgical patients the agreement between the two instruments was low (k = 0.42) to substantial (AC1 = 0.74).Agreement rates seemed to be influenced by disease severity. The agreement rate in the general ICU population with APACHE II = <14 was k = 0.57 and AC1 = 0.81, compared to k = 0.44 and AC1 = 0.59, in patients with more severe disease. This was even more different when the need for mechanical ventilation was used as a surrogate of disease severity. Conclusions The agreement rates between CAM-ICU and ICDSC may vary between different groups of ICU patients and seems to be affected by disease severity.
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Affiliation(s)
- Jorge Alberto de Oliveira Fagundes
- Laboratório de Fisiopatologia Experimental and Instituto Nacional de Ciência e Tecnologia Translacional em Medicina, Programa de Pós-Graduação em Ciências da Saúde, Unidade Acadêmica de Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, Santa Catarina, Brazil
| | - Cristiane Damiani Tomasi
- Laboratório de Fisiopatologia Experimental and Instituto Nacional de Ciência e Tecnologia Translacional em Medicina, Programa de Pós-Graduação em Ciências da Saúde, Unidade Acadêmica de Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, Santa Catarina, Brazil
- Intensive Care Unit, Hospital São José, Criciúma, Santa Catarina, Brazil
| | - Vinicius Rene Giombelli
- Laboratório de Fisiopatologia Experimental and Instituto Nacional de Ciência e Tecnologia Translacional em Medicina, Programa de Pós-Graduação em Ciências da Saúde, Unidade Acadêmica de Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, Santa Catarina, Brazil
- Intensive Care Unit, Hospital São José, Criciúma, Santa Catarina, Brazil
| | - Sarah Cascaes Alves
- Laboratório de Fisiopatologia Experimental and Instituto Nacional de Ciência e Tecnologia Translacional em Medicina, Programa de Pós-Graduação em Ciências da Saúde, Unidade Acadêmica de Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, Santa Catarina, Brazil
- Intensive Care Unit, Hospital São José, Criciúma, Santa Catarina, Brazil
| | - Roberta Candal de Macedo
- Laboratório de Fisiopatologia Experimental and Instituto Nacional de Ciência e Tecnologia Translacional em Medicina, Programa de Pós-Graduação em Ciências da Saúde, Unidade Acadêmica de Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, Santa Catarina, Brazil
- Intensive Care Unit, Hospital São José, Criciúma, Santa Catarina, Brazil
| | - Maria Fernanda Locks Topanotti
- Laboratório de Fisiopatologia Experimental and Instituto Nacional de Ciência e Tecnologia Translacional em Medicina, Programa de Pós-Graduação em Ciências da Saúde, Unidade Acadêmica de Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, Santa Catarina, Brazil
- Intensive Care Unit, Hospital São José, Criciúma, Santa Catarina, Brazil
| | - Maria de Lourdes Ugioni Bristot
- Laboratório de Fisiopatologia Experimental and Instituto Nacional de Ciência e Tecnologia Translacional em Medicina, Programa de Pós-Graduação em Ciências da Saúde, Unidade Acadêmica de Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, Santa Catarina, Brazil
- Intensive Care Unit, Hospital São José, Criciúma, Santa Catarina, Brazil
| | - Pedro Emmanuel Alvarenga Americano do Brasil
- D’or Institute of Research and Education, Rio de Janeiro, Rio de Janeiro, Brazil
- Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Márcio Soares
- D’or Institute of Research and Education, Rio de Janeiro, Rio de Janeiro, Brazil
- Programa de Pós-Graduação em Oncologia, Instituto Nacional do Câncer, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jorge Salluh
- D’or Institute of Research and Education, Rio de Janeiro, Rio de Janeiro, Brazil
- Programa de Pós-Graduação em Oncologia, Instituto Nacional do Câncer, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Felipe Dal-Pizzol
- Laboratório de Fisiopatologia Experimental and Instituto Nacional de Ciência e Tecnologia Translacional em Medicina, Programa de Pós-Graduação em Ciências da Saúde, Unidade Acadêmica de Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, Santa Catarina, Brazil
- Intensive Care Unit, Hospital São José, Criciúma, Santa Catarina, Brazil
- * E-mail:
| | - Cristiane Ritter
- Laboratório de Fisiopatologia Experimental and Instituto Nacional de Ciência e Tecnologia Translacional em Medicina, Programa de Pós-Graduação em Ciências da Saúde, Unidade Acadêmica de Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, Santa Catarina, Brazil
- Intensive Care Unit, Hospital São José, Criciúma, Santa Catarina, Brazil
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Tomasi CD, Grandi C, Salluh J, Soares M, Giombelli VR, Cascaes S, Macedo RC, de Souza Constantino L, Biff D, Ritter C, Dal Pizzol F. Comparison of CAM-ICU and ICDSC for the detection of delirium in critically ill patients focusing on relevant clinical outcomes. J Crit Care 2012; 27:212-7. [DOI: 10.1016/j.jcrc.2011.05.015] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 04/14/2011] [Accepted: 05/09/2011] [Indexed: 01/25/2023]
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Rabello LSCF, Rosalem M, Lisboa T, Caruso P, Costa R, Leal J, Salluh J, Soares M. Critically ill patients with cancer and sepsis: clinical course and prognostic factors. Crit Care 2011. [PMCID: PMC3124160 DOI: 10.1186/cc10158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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Lobo S, Soares M, Torelly A, Mello P, Silva U, Teles J, Silva E, Caruso P, Friedman G, Souza P, Rea-Neto A, Vianna A, Maia M, Salluh J. Outcomes of cancer patients admitted to intensive care units with severe acute kidney injury. Crit Care 2010. [PMCID: PMC2934069 DOI: 10.1186/cc8654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Carvalho ARS, Jandre FC, Pino AV, Bozza FA, Salluh J, Rodrigues R, Ascoli FO, Giannella-Neto A. Positive end-expiratory pressure at minimal respiratory elastance represents the best compromise between mechanical stress and lung aeration in oleic acid induced lung injury. Crit Care 2008; 11:R86. [PMID: 17688701 PMCID: PMC2206498 DOI: 10.1186/cc6093] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2007] [Revised: 04/03/2007] [Accepted: 08/09/2007] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Protective ventilatory strategies have been applied to prevent ventilator-induced lung injury in patients with acute lung injury (ALI). However, adjustment of positive end-expiratory pressure (PEEP) to avoid alveolar de-recruitment and hyperinflation remains difficult. An alternative is to set the PEEP based on minimizing respiratory system elastance (Ers) by titrating PEEP. In the present study we evaluate the distribution of lung aeration (assessed using computed tomography scanning) and the behaviour of Ers in a porcine model of ALI, during a descending PEEP titration manoeuvre with a protective low tidal volume. METHODS PEEP titration (from 26 to 0 cmH2O, with a tidal volume of 6 to 7 ml/kg) was performed, following a recruitment manoeuvre. At each PEEP, helical computed tomography scans of juxta-diaphragmatic parts of the lower lobes were obtained during end-expiratory and end-inspiratory pauses in six piglets with ALI induced by oleic acid. The distribution of the lung compartments (hyperinflated, normally aerated, poorly aerated and non-aerated areas) was determined and the Ers was estimated on a breath-by-breath basis from the equation of motion of the respiratory system using the least-squares method. RESULTS Progressive reduction in PEEP from 26 cmH2O to the PEEP at which the minimum Ers was observed improved poorly aerated areas, with a proportional reduction in hyperinflated areas. Also, the distribution of normally aerated areas remained steady over this interval, with no changes in non-aerated areas. The PEEP at which minimal Ers occurred corresponded to the greatest amount of normally aerated areas, with lesser hyperinflated, and poorly and non-aerated areas. Levels of PEEP below that at which minimal Ers was observed increased poorly and non-aerated areas, with concomitant reductions in normally inflated and hyperinflated areas. CONCLUSION The PEEP at which minimal Ers occurred, obtained by descending PEEP titration with a protective low tidal volume, corresponded to the greatest amount of normally aerated areas, with lesser collapsed and hyperinflated areas. The institution of high levels of PEEP reduced poorly aerated areas but enlarged hyperinflated ones. Reduction in PEEP consistently enhanced poorly or non-aerated areas as well as tidal re-aeration. Hence, monitoring respiratory mechanics during a PEEP titration procedure may be a useful adjunct to optimize lung aeration.
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Affiliation(s)
- Alysson Roncally S Carvalho
- Biomedical Engineering Program, COPPE, Federal University of Rio de Janeiro, Av. Horácio Macedo, CT Bloco H-327, 2030, 21941-914, Rio de Janeiro, Brazil
| | - Frederico C Jandre
- Biomedical Engineering Program, COPPE, Federal University of Rio de Janeiro, Av. Horácio Macedo, CT Bloco H-327, 2030, 21941-914, Rio de Janeiro, Brazil
| | - Alexandre V Pino
- Biomedical Engineering Program, COPPE, Federal University of Rio de Janeiro, Av. Horácio Macedo, CT Bloco H-327, 2030, 21941-914, Rio de Janeiro, Brazil
| | - Fernando A Bozza
- Fundação Oswaldo Cruz, Instituto de Pesquisa Clinica Evandro Chagas e Laboratório de Imunofarmacologia, IOC, Av Brasil, 4365, Manguinhos, 21045-900 Rio de Janeiro, Brazil
| | - Jorge Salluh
- National Institute of Cancer-1, ICU, Praça Cruz Vermelha, 20230-130 Rio de Janeiro, Brazil
| | - Rosana Rodrigues
- Radiodiagnostic Service, Clementino Fraga Filho Hospital, Federal University of Rio de Janeiro, R Professor Rodolpho Paulo Rocco, 255, 21-941-913 Rio de Janeiro, Brazil
| | - Fabio O Ascoli
- Fundação Oswaldo Cruz, Instituto de Pesquisa Clinica Evandro Chagas e Laboratório de Imunofarmacologia, IOC, Av Brasil, 4365, Manguinhos, 21045-900 Rio de Janeiro, Brazil
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Soares M, Darmon M, Ferreira CG, Salluh J, De Miranda S, Adda M, Spector N, Azoulay E. Outcomes of critically ill patients with lung cancer. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.16001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
16001 Background: Recent advances in oncology and critical care have resulted in improved survival in critically ill cancer patients. An appraisal of the prognosis of critically ill patients with lung cancer is timely. Methods: The aim of this study was to evaluate the outcomes and prognostic factors of critically ill cancer patients with lung cancer. From 2000 to 2005, patients with either small-cell (SCLC) or non-small-cell lung cancer (NSCLC) admitted at two intensive care units (ICU) in Brazil and France were included. Patients with postoperative care, ICU stay <24 h and readmissions were excluded. Demographics, clinical, cancer related and outcome variables were collected. Hospital mortality was the outcome variable of interest. Variables selected in the univariate analysis (p < 0.25) and those considered clinically relevant were entered in a multivariable logistic regression analysis [results were expressed as odds-ratios (OR), 95% confidence interval (CI)]. Results: A total of 132 patients were studied (INCA = 87, St Louis Hospital = 45). Their mean age was 61 ± 10 years and 73% were males. Twenty-five (19%) had SCLC and 107 (81%), NSCLC. The SAPS II score was 48 ± 21 points. The main reasons for ICU admission were severe sepsis (45%) and acute respiratory failure (33%). During ICU stay, 96 (73%) patients received mechanical ventilation, 76 (58%) vasopressors and 11 (8%) dialysis; 15 (11%) patients were treated with chemotherapy and 6 (5%), radiation therapy. Thirty-eight (29%) patients had end-of-life decisions. ICU and hospital mortality were 43% and 60%, respectively. Multivariable analysis identified three independent determinants of hospital mortality: airway obstruction/infiltration by cancer [OR = 2.87 (1.34–8.13), p < 0.001], number of organ failures [OR = 1.91 (1.01–2.74), p = 0.047] and performance status 3–4 before admission [OR = 2.90 (0.94–8.95), p = 0.065]. Conclusions: Improved survival in overall ICU cancer patients extends to patients with lung cancer, including those needing mechanical ventilation. Interestingly, the characteristics of the cancer are not associated with the outcome and should not be the grounds for the ICU decision making. Mortality is increased with the number of organ dysfunctions, in particular when respiratory failure is due to cancer progression. No significant financial relationships to disclose.
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Affiliation(s)
- M. Soares
- Instituto Nacional de Cancer-INCA, Rio de Janeiro, Brazil; Saint Louis Hospital and Paris 7 University, Paris, France; Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - M. Darmon
- Instituto Nacional de Cancer-INCA, Rio de Janeiro, Brazil; Saint Louis Hospital and Paris 7 University, Paris, France; Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - C. G. Ferreira
- Instituto Nacional de Cancer-INCA, Rio de Janeiro, Brazil; Saint Louis Hospital and Paris 7 University, Paris, France; Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - J. Salluh
- Instituto Nacional de Cancer-INCA, Rio de Janeiro, Brazil; Saint Louis Hospital and Paris 7 University, Paris, France; Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - S. De Miranda
- Instituto Nacional de Cancer-INCA, Rio de Janeiro, Brazil; Saint Louis Hospital and Paris 7 University, Paris, France; Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - M. Adda
- Instituto Nacional de Cancer-INCA, Rio de Janeiro, Brazil; Saint Louis Hospital and Paris 7 University, Paris, France; Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - N. Spector
- Instituto Nacional de Cancer-INCA, Rio de Janeiro, Brazil; Saint Louis Hospital and Paris 7 University, Paris, France; Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - E. Azoulay
- Instituto Nacional de Cancer-INCA, Rio de Janeiro, Brazil; Saint Louis Hospital and Paris 7 University, Paris, France; Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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de Abreu MG, Quelhas AD, Spieth P, Bräuer G, Knels L, Kasper M, Pino AV, Bleyl JU, Hübler M, Bozza F, Salluh J, Kuhlisch E, Giannella-Neto A, Koch T. Comparative effects of vaporized perfluorohexane and partial liquid ventilation in oleic acid-induced lung injury. Anesthesiology 2006; 104:278-89. [PMID: 16436847 DOI: 10.1097/00000542-200602000-00013] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND It is currently not known whether vaporized perfluorohexane is superior to partial liquid ventilation (PLV) for therapy of acute lung injury. In this study, the authors compared the effects of both therapies in oleic acid-induced lung injury. METHODS Lung injury was induced in 30 anesthetized and mechanically ventilated pigs by means of central venous infusion of oleic acid. Animals were assigned to one of the following groups: (1) control or gas ventilation (GV), (2) 2.5% perfluorohexane vapor, (3) 5% perfluorohexane vapor, (4) 10% perfluorohexane vapor, or (5) PLV with perfluorooctane (30 ml/kg). Two hours after randomization, lungs were recruited and positive end-expiratory pressure was adjusted to obtain minimal elastance. Ventilation was continued during 4 additional hours, when animals were killed for lung histologic examination. RESULTS Gas exchange and elastance were comparable among vaporized perfluorohexane, PLV, and GV before the open lung approach was used and improved in a similar fashion in all groups after positive end-expiratory pressure was adjusted to optimal elastance (P < 0.05). A similar behavior was observed in functional residual capacity (FRC) in animals treated with vaporized perfluorohexane and GV. Lung resistance improved after recruitment (P < 0.05), but values were higher in the 10% perfluorohexane and PLV groups as compared with GV (P < 0.05). Interestingly, positive end-expiratory pressure values required to obtain minimal elastance were lower with 5% perfluorohexane than with PLV and GV (P < 0.05). In addition, diffuse alveolar damage was significantly lower in the 5% and 10% perfluorohexane vapor groups as compared with PLV and GV (P < 0.05). CONCLUSIONS Although the use of 5% vaporized perfluorohexane permitted the authors to reduce pressures needed to stabilize the lungs and was associated with better histologic findings than were PLV and GV, none of these perfluorocarbon therapies improved gas exchange or lung mechanics as compared with GV.
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Affiliation(s)
- Marcelo Gama de Abreu
- Clinic of Anesthesiology and Intensive Care Medicine, University Clinic Carl Gustav Carus, Technical University Dresden, Fetscherstrasse 74, 01307 Dresden, Germany.
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