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  • Correspondence

    To: Critical COVID-19 and neurological dysfunction – a direct comparative analysis between SARS-CoV-2 and other infectious pathogens

    Crit Care Sci. 2024;36:e20240291en

    Abstract

    Correspondence

    To: Critical COVID-19 and neurological dysfunction – a direct comparative analysis between SARS-CoV-2 and other infectious pathogens

    Crit Care Sci. 2024;36:e20240291en

    DOI 10.62675/2965-2774.20240291-en

    Views13
    To the Editor We have read with great care the interesting article by Teixeira-Vaz et al. on a prospective, single-center cohort study of 27 coronavirus disease 2019 (COVID-19) patients requiring mechanical ventilation for >48 hours for acute respiratory distress syndrome (ARDS).() They noted that although neurological impairment caused by severe acute respiratory syndrome coronavirus 2 […]
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  • Correspondence

    To: Factors associated with mortality in mechanically ventilated patients with severe acute respiratory syndrome due to COVID-19 evolution

    Crit Care Sci. 2024;36:e20240192en

    Abstract

    Correspondence

    To: Factors associated with mortality in mechanically ventilated patients with severe acute respiratory syndrome due to COVID-19 evolution

    Crit Care Sci. 2024;36:e20240192en

    DOI 10.62675/2965-2774.20240192-en

    Views3
    To the Editor Oliveira et al. evaluated the factors associated with mortality in adult patients on mechanical ventilation (MV) with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19) in a retrospective multicenter cohort of 425 patients in Brazil.() One of the strengths of this study is the selected population, although I would […]
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  • Review

    Unmasking the hidden aftermath: postintensive care unit sequelae, discharge preparedness, and long-term follow-up

    Crit Care Sci. 2024;36:e20240265en

    Abstract

    Review

    Unmasking the hidden aftermath: postintensive care unit sequelae, discharge preparedness, and long-term follow-up

    Crit Care Sci. 2024;36:e20240265en

    DOI 10.62675/2965-2774.20240265-en

    Views3

    ABSTRACT

    A significant portion of individuals who have experienced critical illness encounter new or exacerbated impairments in their physical, cognitive, or mental health, commonly referred to as postintensive care syndrome. Moreover, those who survive critical illness often face an increased risk of adverse consequences, including infections, major cardiovascular events, readmissions, and elevated mortality rates, during the months following hospitalization. These findings emphasize the critical necessity for effective prevention and management of long-term health deterioration in the critical care environment. Although conclusive evidence from well-designed randomized clinical trials is somewhat limited, potential interventions include strategies such as limiting sedation, early mobilization, maintaining family presence during the intensive care unit stay, implementing multicomponent transition programs (from intensive care unit to ward and from hospital to home), and offering specialized posthospital discharge follow-up. This review seeks to provide a concise summary of recent medical literature concerning long-term outcomes following critical illness and highlight potential approaches for preventing and addressing health decline in critical care survivors.

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    Unmasking the hidden aftermath: postintensive care unit sequelae, discharge preparedness, and long-term follow-up
  • Original Article

    Evaluation of the classifications of severity in acute respiratory distress syndrome in childhood by the Berlin Consensus and the Pediatric Acute Lung Injury Consensus Conference

    Crit Care Sci. 2024;36:e20240229en

    Abstract

    Original Article

    Evaluation of the classifications of severity in acute respiratory distress syndrome in childhood by the Berlin Consensus and the Pediatric Acute Lung Injury Consensus Conference

    Crit Care Sci. 2024;36:e20240229en

    DOI 10.62675/2965-2774.20240229-en

    Views57

    ABSTRACT

    Objective

    To compare two methods for defining and classifying the severity of pediatric acute respiratory distress syndrome: the Berlin classification, which uses the relationship between the partial pressure of oxygen and the fraction of inspired oxygen, and the classification of the Pediatric Acute Lung Injury Consensus Conference, which uses the oxygenation index.

    Methods

    This was a prospective study of patients aged 0 – 18 years with a diagnosis of acute respiratory distress syndrome who were invasively mechanically ventilated and provided one to three arterial blood gas samples, totaling 140 valid measurements. These measures were evaluated for correlation using the Spearman test and agreement using the kappa coefficient between the two classifications, initially using the general population of the study and then subdividing it into patients with and without bronchospasm and those with and without the use of neuromuscular blockers. The effect of these two factors (bronchospasm and neuromuscular blocking agent) separately and together on both classifications was also assessed using two-way analysis of variance.

    Results

    In the general population, who were 54 patients aged 0 – 18 years a strong negative correlation was found by Spearman’s test (ρ -0.91; p < 0.001), and strong agreement was found by the kappa coefficient (0.62; p < 0.001) in the comparison between Berlin and Pediatric Acute Lung Injury Consensus Conference. In the populations with and without bronchospasm and who did and did not use neuromuscular blockers, the correlation coefficients were similar to those of the general population, though among patients not using neuromuscular blockers, there was greater agreement between the classifications than for patients using neuromuscular blockers (kappa 0.67 versus 0.56, p < 0.001 for both). Neuromuscular blockers had a significant effect on the relationship between the partial pressure of oxygen and the fraction of inspired oxygen (analysis of variance; F: 12.9; p < 0.001) and the oxygenation index (analysis of variance; F: 8.3; p = 0.004).

    Conclusion

    There was a strong correlation and agreement between the two classifications in the general population and in the subgroups studied. Use of neuromuscular blockers had a significant effect on the severity of acute respiratory distress syndrome.

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  • Viewpoint

    Revolutionizing care: unleashing the power of comprehensive geriatric assessment in tailoring treatment for frail postintensive care patients

    Crit Care Sci. 2024;36:e20240023en

    Abstract

    Viewpoint

    Revolutionizing care: unleashing the power of comprehensive geriatric assessment in tailoring treatment for frail postintensive care patients

    Crit Care Sci. 2024;36:e20240023en

    DOI 10.62675/2965-2774.20240023-en

    Views466
    Frailty represents a condition of vulnerability leading to inadequate recovery following a stressful event, such as an acute illness or injury. This inadequate recovery results from cumulative, multisystem physiological depletion over a lifetime.() The frailty state implies that the available functional reserve is insufficient for complete recovery, often leading to a maladaptive response disproportionate to […]
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    Revolutionizing care: unleashing the power of comprehensive geriatric assessment in tailoring treatment for frail postintensive care patients
  • Viewpoint

    “While the wolf is away”: the echo of globalization delaying family decisions in intensive care

    Crit Care Sci. 2024;36:e20240008en

    Abstract

    Viewpoint

    “While the wolf is away”: the echo of globalization delaying family decisions in intensive care

    Crit Care Sci. 2024;36:e20240008en

    DOI 10.62675/2965-2774.20240008-en

    Views59
    Globalization is a complex process that is defined as the “shrinking” of our world through advances in technology and industry; specifically, individuals, peoples, and nations that are very distant from each other are now in contact and may share at least some aspects of a “global” culture.() Globalization is multifaceted by nature, affecting society economically, […]
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  • Original Article

    Alternative approaches to analyzing ventilator-free days, mortality and duration of ventilation in critical care research

    Crit Care Sci. 2024;36:e20240246en

    Abstract

    Original Article

    Alternative approaches to analyzing ventilator-free days, mortality and duration of ventilation in critical care research

    Crit Care Sci. 2024;36:e20240246en

    DOI 10.62675/2965-2774.20240246-en

    Views114

    ABSTRACT

    Objective:

    To discuss the strengths and limitations of ventilator-free days and to provide a comprehensive discussion of the different analytic methods for analyzing and interpreting this outcome.

    Methods:

    Using simulations, the power of different analytical methods was assessed, namely: quantile (median) regression, cumulative logistic regression, generalized pairwise comparison, conditional approach and truncated approach. Overall, 3,000 simulations of a two-arm trial with n = 300 per arm were computed using a two-sided alternative hypothesis and a type I error rate of α = 0.05.

    Results:

    When considering power, median regression did not perform well in studies where the treatment effect was mainly driven by mortality. Median regression performed better in situations with a weak effect on mortality but a strong effect on duration, duration only, and moderate mortality and duration. Cumulative logistic regression was found to produce similar power to the Wilcoxon rank-sum test across all scenarios, being the best strategy for the scenarios of moderate mortality and duration, weak mortality and strong duration, and duration only.

    Conclusion:

    In this study, we describe the relative power of new methods for analyzing ventilator-free days in critical care research. Our data provide validation and guidance for the use of the cumulative logistic model, median regression, generalized pairwise comparisons, and the conditional and truncated approach in specific scenarios.

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  • Correspondence

    To: Association between rectus femoris cross-sectional area and diaphragmatic excursion with weaning of tracheostomized patients in the intensive care unit

    Crit Care Sci. 2024;36:e20240131en

    Abstract

    Correspondence

    To: Association between rectus femoris cross-sectional area and diaphragmatic excursion with weaning of tracheostomized patients in the intensive care unit

    Crit Care Sci. 2024;36:e20240131en

    DOI 10.62675/2965-2774.20240131-en

    Views24
    To the Editor We read an interesting prospective, single-center, observational cohort study on the relationship between the cross-sectional diameter of the rectus femoris muscle, the degree of diaphragmatic excursion, and the outcome of weaning 81 critically ill patients by Vieira et al.() Successfully weaning critically ill patients from mechanical ventilation has been found to be […]
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