Home - Critical Care Science (CCS)

  • Original Article

    Association of biomarkers with successful ventilatory weaning in COVID-19 patients: an observational study

    Crit Care Sci. 2024;36:e20240158en

    Abstract

    Original Article

    Association of biomarkers with successful ventilatory weaning in COVID-19 patients: an observational study

    Crit Care Sci. 2024;36:e20240158en

    DOI 10.62675/2965-2774.20240158-pt

    Views3

    ABSTRACT

    Objective:

    To evaluate the association of biomarkers with successful ventilatory weaning in COVID-19 patients.

    Methods:

    An observational, retrospective, and single-center study was conducted between March 2020 and April 2021. C-reactive protein, total lymphocytes, and the neutrophil/lymphocyte ratio were evaluated during attrition and extubation, and the variation in these biomarker values was measured. The primary outcome was successful extubation. ROC curves were drawn to find the best cutoff points for the biomarkers based on sensitivity and specificity. Statistical analysis was performed using logistic regression.

    Results:

    Of the 2,377 patients admitted to the intensive care unit, 458 were included in the analysis, 356 in the Successful Weaning Group and 102 in the Failure Group. The cutoff points found from the ROC curves were −62.4% for C-reactive protein, +45.7% for total lymphocytes, and −32.9% for neutrophil/lymphocyte ratio. These points were significantly associated with greater extubation success. In the multivariate analysis, only C-reactive protein variation remained statistically significant (OR 2.6; 95%CI 1.51 – 4.5; p < 0.001).

    Conclusion:

    In this study, a decrease in C-reactive protein levels was associated with successful extubation in COVID-19 patients. Total lymphocytes and the neutrophil/lymphocyte ratio did not maintain the association after multivariate analysis. However, a decrease in C-reactive protein levels should not be used as a sole variable to identify COVID-19 patients suitable for weaning; as in our study, the area under the ROC curve demonstrated poor accuracy in discriminating extubation outcomes, with low sensitivity and specificity.

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    Association of biomarkers with successful ventilatory weaning in COVID-19 patients: an observational study
  • Research Letter

    COVID-19 underpinning the inverse equity hypothesis between public and private health care in Brazil

    Crit Care Sci. 2024;36:e20240294en

    Abstract

    Research Letter

    COVID-19 underpinning the inverse equity hypothesis between public and private health care in Brazil

    Crit Care Sci. 2024;36:e20240294en

    DOI 10.62675/2965-2774.20240294-pt

    Views6
    Since 1990, the Brazilian public health care system, known as the Unified Health System (SUS – Sistema Único de Saúde), has provided free health care services to all individuals throughout the country. However, approximately 24.9% of the Brazilian population has the financial means to afford private health care alternatives.() Equity, a fundamental principle of SUS, […]
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    COVID-19 underpinning the inverse equity hypothesis between public and private health care in Brazil
  • Clinical Report

    Topical glyceryl trinitrate to increase radial artery diameter in neonates: study protocol for a randomized controlled trial

    Crit Care Sci. 2024;36:e20240235en

    Abstract

    Clinical Report

    Topical glyceryl trinitrate to increase radial artery diameter in neonates: study protocol for a randomized controlled trial

    Crit Care Sci. 2024;36:e20240235en

    DOI 10.62675/2965-2774.20240235-pt

    Views2

    ABSTRACT

    Background:

    Newborn infants admitted to the neonatal intensive care unit require arterial cannulation for hemodynamic monitoring and blood sampling. Arterial access is achieved through catheterization of umbilical or peripheral arteries. Peripheral artery cannulation is performed in critically ill newborns, but artery localization and cannulation is often challenging and unsuccessful. Therefore, increasing the internal diameter and preventing vasospasm are important for successful peripheral artery cannulation in neonates. Topical glyceryl trinitrate has the potential to increase cannulation success by relaxing arterial smooth muscles and thus increasing the internal diameter. We aim to conduct a pilot randomized controlled trial to evaluate the efficacy and safety of topycal glyceryl trinitrate in increasing the diameter of the radial artery in neonates.

    Methods/Design:

    This study will be a single-center, observer-blind, randomized, placebo-controlled trial conducted in the neonatal intensive care unit of Perth Children’s Hospital, Western Australia. A total of 60 infants born at >34 weeks of gestation who are admitted for elective surgery or medical reasons and for whom a peripheral arterial line is needed for sampling or blood pressure monitoring will be recruited after informed parental consent is obtained. The primary outcome will be the change in radial arterial diameter from baseline to postintervention. Secondary outcomes will be the absolute and percentage change from baseline in the radial arterial diameter in both limbs and safety (hypotension and methemoglobinemia).

    Discussion:

    This will be the first randomized controlled trial evaluating the use of topical glyceryl trinitrate to facilitate peripheral artery cannulation in neonates. If our pilot randomized controlled trial confirms the benefits of glyceryl trinitrate patches, it will pave the way for large multicenter randomized controlled trials in this field.

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  • Research Letter

    Generalizing the application of machine learning predictive models across different populations: does a model to predict the use of renal replacement therapy in critically ill COVID-19 patients apply to general intensive care unit patients?

    Crit Care Sci. 2024;36:e20240285en

    Abstract

    Research Letter

    Generalizing the application of machine learning predictive models across different populations: does a model to predict the use of renal replacement therapy in critically ill COVID-19 patients apply to general intensive care unit patients?

    Crit Care Sci. 2024;36:e20240285en

    DOI 10.62675/2965-2774.20240285-pt

    Views9
    TO THE EDITOR The widespread use of machine learning has created the possibility of generating robust prediction models for individual patients; however, caution is needed in their use for heterogeneous critically ill populations.() Recent literature has demonstrated major advances in the field of acute kidney injury prediction and the need for renal replacement therapy (RRT).() […]
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    Generalizing the application of machine learning predictive models across different populations: does a model to predict the use of renal replacement therapy in critically ill COVID-19 patients apply to general intensive care unit patients?
  • Original Article

    Conscious prone positioning in nonintubated COVID-19 patients with acute respiratory distress syndrome: systematic review and meta-analysis

    Crit Care Sci. 2024;36:e20240176en

    Abstract

    Original Article

    Conscious prone positioning in nonintubated COVID-19 patients with acute respiratory distress syndrome: systematic review and meta-analysis

    Crit Care Sci. 2024;36:e20240176en

    DOI 10.62675/2965-2774.20240176-en

    Views94

    ABSTRACT

    Objective:

    To systematically review the effect of the prone position on endotracheal intubation and mortality in nonintubated COVID-19 patients with acute respiratory distress syndrome.

    Methods:

    We registered the protocol (CRD42021286711) and searched for four databases and gray literature from inception to December 31, 2022. We included observational studies and clinical trials. There was no limit by date or the language of publication. We excluded case reports, case series, studies not available in full text, and those studies that included children < 18-years-old.

    Results:

    We included ten observational studies, eight clinical trials, 3,969 patients, 1,120 endotracheal intubation events, and 843 deaths. All of the studies had a low risk of bias (Newcastle-Ottawa Scale and Risk of Bias 2 tools). We found that the conscious prone position decreased the odds of endotracheal intubation by 44% (OR 0.56; 95%CI 0.40 – 0.78) and mortality by 43% (OR 0.57; 95%CI 0.39 – 0.84) in nonintubated COVID-19 patients with acute respiratory distress syndrome. This protective effect on endotracheal intubation and mortality was more robust in those who spent > 8 hours/day in the conscious prone position (OR 0.43; 95%CI 0.26 – 0.72 and OR 0.38; 95%CI 0.24 – 0.60, respectively). The certainty of the evidence according to the GRADE criteria was moderate.

    Conclusion:

    The conscious prone position decreased the odds of endotracheal intubation and mortality, especially when patients spent over 8 hours/day in the conscious prone position and treatment in the intensive care unit. However, our results should be cautiously interpreted due to limitations in evaluating randomized clinical trials, nonrandomized clinical trials and observational studies. However, despite systematic reviews with meta-analyses of randomized clinical trials, we must keep in mind that these studies remain heterogeneous from a clinical and methodological point of view.

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    Conscious prone positioning in nonintubated COVID-19 patients with acute respiratory distress syndrome: systematic review and meta-analysis
  • Original Article

    Efficacy of melatonin in decreasing the incidence of delirium in critically ill adults: a randomized controlled trial

    Crit Care Sci. 2024;36:e20240144en

    Abstract

    Original Article

    Efficacy of melatonin in decreasing the incidence of delirium in critically ill adults: a randomized controlled trial

    Crit Care Sci. 2024;36:e20240144en

    DOI 10.62675/2965-2774.20240144-pt

    Views6

    ABSTRACT

    Objective:

    To determine whether enteral melatonin decreases the incidence of delirium in critically ill adults.

    Methods:

    In this randomized controlled trial, adults were admitted to the intensive care unit and received either usual standard care alone (Control Group) or in combination with 3mg of enteral melatonin once a day at 9 PM (Melatonin Group). Concealment of allocation was done by serially numbered opaque sealed envelopes. The intensivist assessing delirium and the investigator performing the data analysis were blinded to the group allocation. The primary outcome was the incidence of delirium within 24 hours of the intensive care unit stay. The secondary outcomes were the incidence of delirium on Days 3 and 7, intensive care unit mortality, length of intensive care unit stay, duration of mechanical ventilation and Glasgow outcome score (at discharge).

    Results:

    We included 108 patients in the final analysis, with 54 patients in each group. At 24 hours of intensive care unit stay, there was no difference in the incidence of delirium between Melatonin and Control Groups (29.6 versus 46.2%; RR = 0.6; 95%CI 0.38 – 1.05; p = 0.11). No secondary outcome showed a statistically significant difference.

    Conclusion:

    Enteral melatonin 3mg is not more effective at decreasing the incidence of delirium than standard care is in critically ill adults.

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    Efficacy of melatonin in decreasing the incidence of delirium in critically ill adults: a randomized controlled trial
  • Viewpoint

    Why the Sequential Organ Failure Assessment score needs updating?

    Crit Care Sci. 2024;36:e20240296en

    Abstract

    Viewpoint

    Why the Sequential Organ Failure Assessment score needs updating?

    Crit Care Sci. 2024;36:e20240296en

    DOI 10.62675/2965-2774.20240296-pt

    Views9
    The Sequential Organ Failure Assessment (SOFA) score was developed almost 30 years ago. It rapidly became one of the most widely used scoring systems in intensive care, both for clinical practice and research,(,) and remains one of the most cited scores in our speciality. Since its original description, there have been substantial changes in clinical […]
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  • Letter to the Editor

    To: Posterior reversible encephalopathy syndrome in a child with severe multisystem inflammatory syndrome due to COVID-19

    Crit Care Sci. 2023;35(4):429-430

    Abstract

    Letter to the Editor

    To: Posterior reversible encephalopathy syndrome in a child with severe multisystem inflammatory syndrome due to COVID-19

    Crit Care Sci. 2023;35(4):429-430

    DOI 10.5935/2965-2774.20230322-pt

    Views52
    To the editorWe eagerly read the article by Dominguez-Rojas et al. about a 9-year-old male with a 3-day history of a gastrointestinal infection who underwent explorative abdominal surgery for acute abdomen, which was noninformative.() Postoperatively, the patient developed pneumonia requiring mechanical ventilation.() After extubation, the patient was diagnosed with multisystem inflammatory syndrome in children (MIS-C) […]
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