Journal of critical care
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Journal of critical care · Apr 2023
The effect of duration of antimicrobial treatment for bacteremia in critically ill patients on in-hospital mortality - Retrospective double center analysis.
Excessive duration of antibiotic treatment is a major factor for inappropriate antibiotic consumption. Although in some instances shorter antibiotic courses are as efficient as longer ones, no specific recommendations as to the duration of antimicrobial treatment for bloodstream infections currently exist. In the present study, we investigated the effect of antibiotic treatment duration on in-hospital mortality using retrospective data from two cohorts that included patients with bacteremia at two Swiss tertiary Intensive Care Units (ICUs). ⋯ In this restrospective study, we found no evidence for a survival benefit of longer (>10 days) versus shorter treatment course in ICU patients with bacteremia.
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Journal of critical care · Apr 2023
Relationship Between Intra-Abdominal pressure and microaspiration of gastric contents in critically ill mechanically ventilated patients.
The relationship between increased intra-abdominal pressure (IAP) and microaspiration of oro-gastric content in mechanically-ventilated patients has not yet been established. Microaspiration is proposed as one of the causes of ventilator-associated pneumonia (VAP). We aimed to investigate whether mechanically-ventilated patients with increased IAP present evidence of lung microaspiration by assessing pepsin levels in bronchial secretions and evaluated the relationship between pepsin and VAP. 68 mechanically-ventilated patients and 10 control subjects were recruited from an academic ICU in Greece. ⋯ Pepsin values were higher in patients with VAP, while IAP was independently associated with VAP. There was an indication towards increased VAP in patients with increased pepsin. In conclusion, our results show that pepsin in bronchial secretions may be elevated when IAP is increased, indicating microaspiration and potentially VAP.
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Journal of critical care · Apr 2023
Randomized Controlled TrialProlonged sedation with sevoflurane in comparison to intravenous sedation in critically ill patients - A randomized controlled trial.
Volatile anesthetics are used more commonly for sedation in the intensive-care-unit (ICU). However, evidence for long-term use remains low. We therefore conducted a randomized-controlled trial comparing sevoflurane with intravenous sedation with particular focus on efficacy and safety. ⋯ ICU patients sedated with sevoflurane >48 h may return to spontaneous breathing faster, while the quality of sedation is comparable to a propofol-based sedation regime. Sevoflurane might be considered to be safe for long-term sedation in this patient population, while being non-inferior compared to propofol.
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Journal of critical care · Apr 2023
Regional citrate anticoagulation versus systemic heparin anticoagulation for continuous kidney replacement therapy in intensive care.
Many intensive care units (ICUs) have transitioned from systemic heparin anticoagulation (SHA) to regional citrate anticoagulation (RCA) for continuous kidney replacement therapy (CKRT). We evaluated the clinical and health economic impacts of ICU transition to RCA. ⋯ Transition to RCA was associated with significant increases in healthcare resource use, without corresponding clinical benefit, and is highly unlikely to be cost-effective over a one-year time horizon.