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Original Article04-16-2025
Practice of pediatric palliative extubation in Brazil: a case series
Critical Care Science. 2025;37:e20250176
Abstract
Original ArticlePractice of pediatric palliative extubation in Brazil: a case series
Critical Care Science. 2025;37:e20250176
DOI 10.62675/2965-2774.20250176
Views122ABSTRACT
Objective:
To describe the clinical profile, procedures applied and outcomes of patients undergoing palliative extubation in the pediatric intensive care unit at a high-complexity teaching hospital in the northeastern region of Brazil.
Methods:
This is a descriptive analysis of a case series that included patients aged under 14 years who underwent palliative extubation in the pediatric intensive care unit between 2016 and 2023 (seven years). Data on admission diagnoses, palliative extubation indications, applied therapies, and outcomes following palliative extubation were retrieved from medical records.
Results:
In total, 35 patients were included in the service database. In eight patients, reports could not be found, and these patients were excluded. Twenty-seven patients aged between five days and ten years, mostly females (51.8%) and those with chronic diseases (77.8%), were included in the study. All patients were classified on the basis of World Health Organization pediatric palliative care indication categories. Palliative extubation was considered after the identification of severe neurological impairment, inadequate response or absence of curative therapies, and failure of mechanical ventilation weaning. Palliative care approaches were discussed with the family in 74% of the cases before palliative extubation. Following palliative extubation, 48.1% of patients presented symptoms, and dyspnea (84.6%) and agitation (53.8%) were the most common symptoms. Death occurred in 88.8% of the children from 20 minutes to 38 days after palliative extubation at the hospital. Three children (11.2%) were discharged from the hospital.
Conclusion:
Palliative extubation was mostly performed in infants diagnosed with complex chronic conditions and severe and irreversible diseases, all of whom were referred to other palliative care. Death in the hospital while controlling for some symptoms was the main outcome.
Keywords:Airway extubationchildChronic diseasesInfant, newbornPalliative CarePatient dischargePediatric intensive care unitsRespiration, artificialVentilator weaningSee moreViews122
Abstract
Original ArticlePractice of pediatric palliative extubation in Brazil: a case series
Critical Care Science. 2025;37:e20250176
DOI 10.62675/2965-2774.20250176
Views122ABSTRACT
Objective:
To describe the clinical profile, procedures applied and outcomes of patients undergoing palliative extubation in the pediatric intensive care unit at a high-complexity teaching hospital in the northeastern region of Brazil.
Methods:
This is a descriptive analysis of a case series that included patients aged under 14 years who underwent palliative extubation in the pediatric intensive care unit between 2016 and 2023 (seven years). Data on admission diagnoses, palliative extubation indications, applied therapies, and outcomes following palliative extubation were retrieved from medical records.
Results:
In total, 35 patients were included in the service database. In eight patients, reports could not be found, and these patients were excluded. Twenty-seven patients aged between five days and ten years, mostly females (51.8%) and those with chronic diseases (77.8%), were included in the study. All patients were classified on the basis of World Health Organization pediatric palliative care indication categories. Palliative extubation was considered after the identification of severe neurological impairment, inadequate response or absence of curative therapies, and failure of mechanical ventilation weaning. Palliative care approaches were discussed with the family in 74% of the cases before palliative extubation. Following palliative extubation, 48.1% of patients presented symptoms, and dyspnea (84.6%) and agitation (53.8%) were the most common symptoms. Death occurred in 88.8% of the children from 20 minutes to 38 days after palliative extubation at the hospital. Three children (11.2%) were discharged from the hospital.
Conclusion:
Palliative extubation was mostly performed in infants diagnosed with complex chronic conditions and severe and irreversible diseases, all of whom were referred to other palliative care. Death in the hospital while controlling for some symptoms was the main outcome.
Keywords:Airway extubationchildChronic diseasesInfant, newbornPalliative CarePatient dischargePediatric intensive care unitsRespiration, artificialVentilator weaningSee more -
Original Article01-30-2025
Ultrasonographic assessment of the muscle mass of the rectus femoris in mechanically ventilated patients at intensive care unit discharge is associated with deterioration of functional status at hospital discharge: a prospective cohort study
- Thiele Cabral Coelho Quadros
, - Thaline Lima Horn ,
- Marina Santos de Moraes,
- Luisa da Cunha Selmo,
- Alexandre Ribas , [ ... ],
- Márcio Manozzo Boniatti
Abstract
Original ArticleUltrasonographic assessment of the muscle mass of the rectus femoris in mechanically ventilated patients at intensive care unit discharge is associated with deterioration of functional status at hospital discharge: a prospective cohort study
Critical Care Science. 2025;37:e20250050
DOI 10.62675/2965-2774.20250050
- Thiele Cabral Coelho Quadros ,
- Thaline Lima Horn ,
- Marina Santos de Moraes,
- Luisa da Cunha Selmo,
- Alexandre Ribas ,
- Clarissa Netto Blattner,
- Márcio Manozzo Boniatti
Views174ABSTRACT
Objective:
To verify whether the rectus femoris muscle mass in mechanically ventilated patients assessed by ultrasonography at intensive care unit discharge is associated with functional status at hospital discharge.
Methods:
This cohort study was conducted at a tertiary hospital in Brazil between August 2019 and November 2020. We included patients over 18 years who were previously independent (Barthel index > 60) and underwent mechanical ventilation for at least 48 hours within 96 hours of admission. Ultrasonographic measurements of the rectus femoris cross-sectional area and right quadriceps thickness were performed upon enrollment, five days after enrollment, and at intensive care unit discharge. The primary outcome was assessing functional capacity via the Barthel index at hospital discharge.
Results:
Of the 78 patients included, 35 had assessable primary outcomes. Twenty (57.1%) patients were considered functionally dependent (Barthel index < 60). The Barthel index at hospital discharge was correlated with the cross-sectional area (r = 0.53; p = 0.001) and quadriceps thickness (r = 0.43; p = 0.01) at intensive care unit discharge. Multiple linear regression analysis revealed that the cross-sectional area at intensive care unit discharge was independently associated with the Barthel index.
Conclusion:
We found that muscle mass assessed by cross-sectional area ultrasonography at intensive care unit discharge was significantly correlated with functional capacity at hospital discharge.
Keywords:critical illnessFunctional statusintensive care unitsMuscle weaknessPatient dischargePhysical functional performanceQuadriceps muscleRespiration, artificialUltrasonographySee moreViews174Abstract
Original ArticleUltrasonographic assessment of the muscle mass of the rectus femoris in mechanically ventilated patients at intensive care unit discharge is associated with deterioration of functional status at hospital discharge: a prospective cohort study
Critical Care Science. 2025;37:e20250050
DOI 10.62675/2965-2774.20250050
- Thiele Cabral Coelho Quadros ,
- Thaline Lima Horn ,
- Marina Santos de Moraes,
- Luisa da Cunha Selmo,
- Alexandre Ribas ,
- Clarissa Netto Blattner,
- Márcio Manozzo Boniatti
Views174ABSTRACT
Objective:
To verify whether the rectus femoris muscle mass in mechanically ventilated patients assessed by ultrasonography at intensive care unit discharge is associated with functional status at hospital discharge.
Methods:
This cohort study was conducted at a tertiary hospital in Brazil between August 2019 and November 2020. We included patients over 18 years who were previously independent (Barthel index > 60) and underwent mechanical ventilation for at least 48 hours within 96 hours of admission. Ultrasonographic measurements of the rectus femoris cross-sectional area and right quadriceps thickness were performed upon enrollment, five days after enrollment, and at intensive care unit discharge. The primary outcome was assessing functional capacity via the Barthel index at hospital discharge.
Results:
Of the 78 patients included, 35 had assessable primary outcomes. Twenty (57.1%) patients were considered functionally dependent (Barthel index < 60). The Barthel index at hospital discharge was correlated with the cross-sectional area (r = 0.53; p = 0.001) and quadriceps thickness (r = 0.43; p = 0.01) at intensive care unit discharge. Multiple linear regression analysis revealed that the cross-sectional area at intensive care unit discharge was independently associated with the Barthel index.
Conclusion:
We found that muscle mass assessed by cross-sectional area ultrasonography at intensive care unit discharge was significantly correlated with functional capacity at hospital discharge.
Keywords:critical illnessFunctional statusintensive care unitsMuscle weaknessPatient dischargePhysical functional performanceQuadriceps muscleRespiration, artificialUltrasonographySee more
- Thiele Cabral Coelho Quadros
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Original Article10-31-2024
Analyzing how the components of the SOFA score change over time in their contribution to mortality
- Barbara D. Lam ,
- Tristan Struja ,
- Yanran Li ,
- João Matos ,
- Ziyue Chen , [ ... ],
- Jesse Raffa
Abstract
Original ArticleAnalyzing how the components of the SOFA score change over time in their contribution to mortality
Critical Care Science. 2024;36:e20240030en
DOI 10.62675/2965-2774.20240030-en
- Barbara D. Lam ,
- Tristan Struja ,
- Yanran Li ,
- João Matos ,
- Ziyue Chen ,
- Xiaoli Liu ,
- Leo Anthony Celi ,
- Yugang Jia ,
- Jesse Raffa
Views130ABSTRACT
Objective:
Determine how each organ component of the SOFA score differs in its contribution to mortality risk and how that contribution may change over time.
Methods:
We performed multivariate logistic regression analysis to assess the contribution of each organ component to mortality risk on Days 1 and 7 of an intensive care unit stay. We used data from two publicly available datasets, eICU Collaborative Research Database (eICU-CRD) (208 hospitals) and Medical Information Mart for Intensive Care IV (MIMIC-IV) (1 hospital). The odds ratio of each SOFA component that contributed to mortality was calculated. Mortality was defined as death either in the intensive care unit or within 72 hours of discharge from the intensive care unit.
Results:
A total of 7,871 intensive care unit stays from eICU-CRD and 4,926 intensive care unit stays from MIMIC-IV were included. Liver dysfunction was most predictive of mortality on Day 1 in both cohorts (OR 1.3; 95%CI 1.2 - 1.4; OR 1.3; 95%CI 1.2 - 1.4, respectively). In the eICU-CRD cohort, central nervous system dysfunction was most predictive of mortality on Day 7 (OR 1.4; 95%CI 1.4 - 1.5). In the MIMIC-IV cohort, respiratory dysfunction (OR 1.4; 95%CI 1.3 - 1.5) and cardiovascular dysfunction (OR 1.4; 95%CI 1.3 - 1.5) were most predictive of mortality on Day 7.
Conclusion:
The SOFA score may be an oversimplification of how dysfunction of different organ systems contributes to mortality over time. Further research at a more granular timescale is needed to explore how the SOFA score can evolve and be ameliorated.
Keywords:Central nervous systemsHospitalsintensive care unitsLiverLogistic modelsmortalityOrgan dysfunction scoresPatient dischargeSee moreViews130Abstract
Original ArticleAnalyzing how the components of the SOFA score change over time in their contribution to mortality
Critical Care Science. 2024;36:e20240030en
DOI 10.62675/2965-2774.20240030-en
- Barbara D. Lam ,
- Tristan Struja ,
- Yanran Li ,
- João Matos ,
- Ziyue Chen ,
- Xiaoli Liu ,
- Leo Anthony Celi ,
- Yugang Jia ,
- Jesse Raffa
Views130ABSTRACT
Objective:
Determine how each organ component of the SOFA score differs in its contribution to mortality risk and how that contribution may change over time.
Methods:
We performed multivariate logistic regression analysis to assess the contribution of each organ component to mortality risk on Days 1 and 7 of an intensive care unit stay. We used data from two publicly available datasets, eICU Collaborative Research Database (eICU-CRD) (208 hospitals) and Medical Information Mart for Intensive Care IV (MIMIC-IV) (1 hospital). The odds ratio of each SOFA component that contributed to mortality was calculated. Mortality was defined as death either in the intensive care unit or within 72 hours of discharge from the intensive care unit.
Results:
A total of 7,871 intensive care unit stays from eICU-CRD and 4,926 intensive care unit stays from MIMIC-IV were included. Liver dysfunction was most predictive of mortality on Day 1 in both cohorts (OR 1.3; 95%CI 1.2 - 1.4; OR 1.3; 95%CI 1.2 - 1.4, respectively). In the eICU-CRD cohort, central nervous system dysfunction was most predictive of mortality on Day 7 (OR 1.4; 95%CI 1.4 - 1.5). In the MIMIC-IV cohort, respiratory dysfunction (OR 1.4; 95%CI 1.3 - 1.5) and cardiovascular dysfunction (OR 1.4; 95%CI 1.3 - 1.5) were most predictive of mortality on Day 7.
Conclusion:
The SOFA score may be an oversimplification of how dysfunction of different organ systems contributes to mortality over time. Further research at a more granular timescale is needed to explore how the SOFA score can evolve and be ameliorated.
Keywords:Central nervous systemsHospitalsintensive care unitsLiverLogistic modelsmortalityOrgan dysfunction scoresPatient dischargeSee more
- Barbara D. Lam
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Original Article09-18-2024
Long-term mortality of Dutch COVID-19 patients admitted to the intensive care medicine: a retrospective analysis from a national quality registry
- Safira A. Wortel ,
- Ferishta Bakhshi-Raiez ,
- Ameen Abu-Hanna ,
- Dave A. Dongelmans ,
- Nicolette F. de Keizer , [ ... ],
Abstract
Original ArticleLong-term mortality of Dutch COVID-19 patients admitted to the intensive care medicine: a retrospective analysis from a national quality registry
Critical Care Science. 2024;36:e202400251en
DOI 10.62675/2965-2774.20240251-en
- Safira A. Wortel ,
- Ferishta Bakhshi-Raiez ,
- Ameen Abu-Hanna ,
- Dave A. Dongelmans ,
- Nicolette F. de Keizer ,
Views98ABSTRACT
Objective:
To describe the 12-month mortality of Dutch COVID-19 intensive care unit patients, the total COVID-19 population and various subgroups on the basis of the number of comorbidities, age, sex, mechanical ventilation, and vasoactive medication use.
Methods:
We included all patients admitted with COVID-19 between March 1, 2020, and March 29, 2022, from the Dutch National Intensive Care (NICE) database. The crude 12-month mortality rate is presented via Kaplan-Meier survival curves for each patient subgroup. We used Cox regression models to analyze the effects of patient characteristics on 12-month mortality after hospital discharge.
Results:
We included 16,605 COVID-19 patients. The in-hospital mortality rate was 28.1%, and the 12-month mortality rate after intensive care unit admission was 29.8%. Among hospital survivors, 12-month mortality after hospital discharge was 2.5% (300/11,931). The hazard of death at 12 months after hospital discharge was greater in patients between 60 and 79 years (HR 4.74; 95%CI 2.23 - 10.06) and ≥ 80 years (HR 22.77; 95%CI 9.91 - 52.28) than in patients < 40 years of age; in male patients than in female patients (HR 1.38; 95%CI 1.07 - 1.78); and in patients with one (adjusted HR 1.95; 95%CI 1.5 - 2.53), two (adjusted HR 4.49; 95%CI 3.27 - 6.16) or more than two comorbidities (adjusted HR 4.99; 95%CI 2.62 - 9.5) than in patients with no comorbidities. Neither vasoactive medication use nor mechanical ventilation resulted in statistically significant results.
Conclusion:
For Dutch COVID-19 intensive care unit patients, most deaths occurred during their hospital stay. For hospital survivors, the crude 12-month mortality rate was low. Patient age (older than 60), sex and the number of comorbidities were associated with a greater hazard of death at 12 months after hospital discharge, whereas mechanical ventilation and vasoactive medication were not.
Keywords:Coronavirus infectionsCOVID-19critical careDatabases, factualHospital mortalityintensive care unitsLength of stayOutcome assessment (Health Care)Patient dischargeRespiration, artificialSARS-CoV-2SurvivorsSee moreViews98Abstract
Original ArticleLong-term mortality of Dutch COVID-19 patients admitted to the intensive care medicine: a retrospective analysis from a national quality registry
Critical Care Science. 2024;36:e202400251en
DOI 10.62675/2965-2774.20240251-en
- Safira A. Wortel ,
- Ferishta Bakhshi-Raiez ,
- Ameen Abu-Hanna ,
- Dave A. Dongelmans ,
- Nicolette F. de Keizer ,
Views98ABSTRACT
Objective:
To describe the 12-month mortality of Dutch COVID-19 intensive care unit patients, the total COVID-19 population and various subgroups on the basis of the number of comorbidities, age, sex, mechanical ventilation, and vasoactive medication use.
Methods:
We included all patients admitted with COVID-19 between March 1, 2020, and March 29, 2022, from the Dutch National Intensive Care (NICE) database. The crude 12-month mortality rate is presented via Kaplan-Meier survival curves for each patient subgroup. We used Cox regression models to analyze the effects of patient characteristics on 12-month mortality after hospital discharge.
Results:
We included 16,605 COVID-19 patients. The in-hospital mortality rate was 28.1%, and the 12-month mortality rate after intensive care unit admission was 29.8%. Among hospital survivors, 12-month mortality after hospital discharge was 2.5% (300/11,931). The hazard of death at 12 months after hospital discharge was greater in patients between 60 and 79 years (HR 4.74; 95%CI 2.23 - 10.06) and ≥ 80 years (HR 22.77; 95%CI 9.91 - 52.28) than in patients < 40 years of age; in male patients than in female patients (HR 1.38; 95%CI 1.07 - 1.78); and in patients with one (adjusted HR 1.95; 95%CI 1.5 - 2.53), two (adjusted HR 4.49; 95%CI 3.27 - 6.16) or more than two comorbidities (adjusted HR 4.99; 95%CI 2.62 - 9.5) than in patients with no comorbidities. Neither vasoactive medication use nor mechanical ventilation resulted in statistically significant results.
Conclusion:
For Dutch COVID-19 intensive care unit patients, most deaths occurred during their hospital stay. For hospital survivors, the crude 12-month mortality rate was low. Patient age (older than 60), sex and the number of comorbidities were associated with a greater hazard of death at 12 months after hospital discharge, whereas mechanical ventilation and vasoactive medication were not.
Keywords:Coronavirus infectionsCOVID-19critical careDatabases, factualHospital mortalityintensive care unitsLength of stayOutcome assessment (Health Care)Patient dischargeRespiration, artificialSARS-CoV-2SurvivorsSee more
- Safira A. Wortel
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Original Article08-14-2024
Clinical trajectories of critically ill patients discharged directly from a critical unit to a postacute care facility: retrospective cohort
- João Gabriel Rosa Ramos ,
- Milton José de Souza Neto ,
- Alef Santiago Rezende,
- Flavia dos Santos Ferreira,
- Yanne Danielly Santos Amorim, [ ... ],
- Lucas Freire de Andrade
Abstract
Original ArticleClinical trajectories of critically ill patients discharged directly from a critical unit to a postacute care facility: retrospective cohort
Critical Care Science. 2024;36:e20240015en
DOI 10.62675/2965-2774.20240015-en
- João Gabriel Rosa Ramos ,
- Milton José de Souza Neto ,
- Alef Santiago Rezende,
- Flavia dos Santos Ferreira,
- Yanne Danielly Santos Amorim,
- Flaviane Ribeiro de Souza ,
- Lucas Freire de Andrade
Views96ABSTRACT
Objective:
To describe the clinical trajectories of patients discharged directly from a critical unit to a postacute care facility.
Methods:
This was a retrospective cohort study of patients who were transferred from an intensive care unit or intermediate care unit to a postacute care facility between July 2017 and April 2023. Functional status was measured by the Functional Independence Measure score.
Results:
A total of 847 patients were included in the study, and the mean age was 71 years. A total of 692 (82%) patients were admitted for rehabilitation, while 155 (18%) were admitted for palliative care. The mean length of stay in the postacute care facility was 36 days; 389 (45.9%) patients were discharged home, 173 (20.4%) were transferred to an acute hospital, and 285 (33.6%) died during hospitalization, of whom 263 (92%) had a do-not-resuscitate order. Of the patients admitted for rehabilitation purposes, 61 (9.4%) had a worsened functional status, 179 (27.6%) had no change in functional status, and 469 (63%) had an improved functional status during hospitalization. Moreover, 234 (33.8%) patients modified their care goals to palliative care, most of whom were in the group that did not improve functional status. Patients whose functional status improved during hospitalization were younger, had fewer comorbidities, had fewer previous hospitalizations, had lower rates of enteral feeding and tracheostomy, had higher Functional Independence Measure scores at admission to the postacute care facility and were more likely to be discharged home with less complex health care assistance.
Conclusion:
Postacute care facilities may play a role in the care of patients after discharge from intensive care units, both for those receiving rehabilitation and palliative care, especially for those with more severe illnesses who may not be discharged directly home.
Keywords:AgedDelivery of health careFunctional statusHospitalizationintensive care unitsLength of stayPalliative CarePatient dischargeSubacute careSee moreViews96Abstract
Original ArticleClinical trajectories of critically ill patients discharged directly from a critical unit to a postacute care facility: retrospective cohort
Critical Care Science. 2024;36:e20240015en
DOI 10.62675/2965-2774.20240015-en
- João Gabriel Rosa Ramos ,
- Milton José de Souza Neto ,
- Alef Santiago Rezende,
- Flavia dos Santos Ferreira,
- Yanne Danielly Santos Amorim,
- Flaviane Ribeiro de Souza ,
- Lucas Freire de Andrade
Views96ABSTRACT
Objective:
To describe the clinical trajectories of patients discharged directly from a critical unit to a postacute care facility.
Methods:
This was a retrospective cohort study of patients who were transferred from an intensive care unit or intermediate care unit to a postacute care facility between July 2017 and April 2023. Functional status was measured by the Functional Independence Measure score.
Results:
A total of 847 patients were included in the study, and the mean age was 71 years. A total of 692 (82%) patients were admitted for rehabilitation, while 155 (18%) were admitted for palliative care. The mean length of stay in the postacute care facility was 36 days; 389 (45.9%) patients were discharged home, 173 (20.4%) were transferred to an acute hospital, and 285 (33.6%) died during hospitalization, of whom 263 (92%) had a do-not-resuscitate order. Of the patients admitted for rehabilitation purposes, 61 (9.4%) had a worsened functional status, 179 (27.6%) had no change in functional status, and 469 (63%) had an improved functional status during hospitalization. Moreover, 234 (33.8%) patients modified their care goals to palliative care, most of whom were in the group that did not improve functional status. Patients whose functional status improved during hospitalization were younger, had fewer comorbidities, had fewer previous hospitalizations, had lower rates of enteral feeding and tracheostomy, had higher Functional Independence Measure scores at admission to the postacute care facility and were more likely to be discharged home with less complex health care assistance.
Conclusion:
Postacute care facilities may play a role in the care of patients after discharge from intensive care units, both for those receiving rehabilitation and palliative care, especially for those with more severe illnesses who may not be discharged directly home.
Keywords:AgedDelivery of health careFunctional statusHospitalizationintensive care unitsLength of stayPalliative CarePatient dischargeSubacute careSee more
- João Gabriel Rosa Ramos
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Review Article05-27-2024
Unmasking the hidden aftermath: postintensive care unit sequelae, discharge preparedness, and long-term follow-up
Critical Care Science. 2024;36:e20240265en
Abstract
Review ArticleUnmasking the hidden aftermath: postintensive care unit sequelae, discharge preparedness, and long-term follow-up
Critical Care Science. 2024;36:e20240265en
DOI 10.62675/2965-2774.20240265-en
Views139ABSTRACT
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.
Keywords:Cardiovascular diseasesCognitioncritical illnessHospital-to-home transitionintensive care unitsMental healthPatient dischargeSee moreViews139Abstract
Review ArticleUnmasking the hidden aftermath: postintensive care unit sequelae, discharge preparedness, and long-term follow-up
Critical Care Science. 2024;36:e20240265en
DOI 10.62675/2965-2774.20240265-en
Views139ABSTRACT
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.
Keywords:Cardiovascular diseasesCognitioncritical illnessHospital-to-home transitionintensive care unitsMental healthPatient dischargeSee more
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Special Article01-17-2023
Intensive glucose control in critically ill adults: a protocol for a systematic review and individual patient data meta-analysis
- Derick Adigbli ,
- Li Yang,
- Naomi Hammond ,
- Djillali Annane,
- Yaseen Arabi , [ ... ],
- Simon Finfer
Abstract
Special ArticleIntensive glucose control in critically ill adults: a protocol for a systematic review and individual patient data meta-analysis
Critical Care Science. 2023;35(4):345-354
DOI 10.5935/2965-2774.20230162-en
- Derick Adigbli ,
- Li Yang,
- Naomi Hammond ,
- Djillali Annane,
- Yaseen Arabi ,
- Federico Bilotta ,
- Julien Bohé ,
- Frank Martin Brunkhorst ,
- Alexandre Biasi Cavalcanti ,
- Deborah Cook,
- Christoph Engel,
- Deborah Green-LaRoche ,
- Wei He,
- William Henderson,
- Cornelia Hoedemaekers ,
- Gaetano Iapichino ,
- Pierre Kalfon ,
- Gisela de La Rosa ,
- Iain MacKenzie,
- Christian Mélot ,
- Imogen Mitchell ,
- Tuomas Oksanen,
- Federico Polli ,
- Jean-Charles Preiser ,
- Francisco Garcia Soriano ,
- Ling-Cong Wang,
- Jiaxiang Yuan,
- Anthony Delaney ,
- Gian Luca Di Tanna ,
- Simon Finfer
Views109ABSTRACT
Objective:
The optimal target for blood glucose concentration in critically ill patients is unclear. We will perform a systematic review and meta-analysis with aggregated and individual patient data from randomized controlled trials, comparing intensive glucose control with liberal glucose control in critically ill adults.
Data sources:
MEDLINE®, Embase, the Cochrane Central Register of Clinical Trials, and clinical trials registries (World Health Organization, clinical trials.gov). The authors of eligible trials will be invited to provide individual patient data. Published trial-level data from eligible trials that are not at high risk of bias will be included in an aggregated data meta-analysis if individual patient data are not available.
Methods:
Inclusion criteria: randomized controlled trials that recruited adult patients, targeting a blood glucose of ≤ 120mg/dL (≤ 6.6mmol/L) compared to a higher blood glucose concentration target using intravenous insulin in both groups. Excluded studies: those with an upper limit blood glucose target in the intervention group of > 120mg/dL (> 6.6mmol/L), or where intensive glucose control was only performed in the intraoperative period, and those where loss to follow-up exceeded 10% by hospital discharge.
Primary endpoint:
In-hospital mortality during index hospital admission. Secondary endpoints: mortality and survival at other timepoints, duration of invasive mechanical ventilation, vasoactive agents, and renal replacement therapy. A random effect Bayesian meta-analysis and hierarchical Bayesian models for individual patient data will be used.
Discussion:
This systematic review with aggregate and individual patient data will address the clinical question, ‘what is the best blood glucose target for critically ill patients overall?’
Keywords:Blood glucosecritical illnessGlycemic controlinsulinIntraoperative periodmortalityPatient dischargeRegistriesSee moreViews109Abstract
Special ArticleIntensive glucose control in critically ill adults: a protocol for a systematic review and individual patient data meta-analysis
Critical Care Science. 2023;35(4):345-354
DOI 10.5935/2965-2774.20230162-en
- Derick Adigbli ,
- Li Yang,
- Naomi Hammond ,
- Djillali Annane,
- Yaseen Arabi ,
- Federico Bilotta ,
- Julien Bohé ,
- Frank Martin Brunkhorst ,
- Alexandre Biasi Cavalcanti ,
- Deborah Cook,
- Christoph Engel,
- Deborah Green-LaRoche ,
- Wei He,
- William Henderson,
- Cornelia Hoedemaekers ,
- Gaetano Iapichino ,
- Pierre Kalfon ,
- Gisela de La Rosa ,
- Iain MacKenzie,
- Christian Mélot ,
- Imogen Mitchell ,
- Tuomas Oksanen,
- Federico Polli ,
- Jean-Charles Preiser ,
- Francisco Garcia Soriano ,
- Ling-Cong Wang,
- Jiaxiang Yuan,
- Anthony Delaney ,
- Gian Luca Di Tanna ,
- Simon Finfer
Views109ABSTRACT
Objective:
The optimal target for blood glucose concentration in critically ill patients is unclear. We will perform a systematic review and meta-analysis with aggregated and individual patient data from randomized controlled trials, comparing intensive glucose control with liberal glucose control in critically ill adults.
Data sources:
MEDLINE®, Embase, the Cochrane Central Register of Clinical Trials, and clinical trials registries (World Health Organization, clinical trials.gov). The authors of eligible trials will be invited to provide individual patient data. Published trial-level data from eligible trials that are not at high risk of bias will be included in an aggregated data meta-analysis if individual patient data are not available.
Methods:
Inclusion criteria: randomized controlled trials that recruited adult patients, targeting a blood glucose of ≤ 120mg/dL (≤ 6.6mmol/L) compared to a higher blood glucose concentration target using intravenous insulin in both groups. Excluded studies: those with an upper limit blood glucose target in the intervention group of > 120mg/dL (> 6.6mmol/L), or where intensive glucose control was only performed in the intraoperative period, and those where loss to follow-up exceeded 10% by hospital discharge.
Primary endpoint:
In-hospital mortality during index hospital admission. Secondary endpoints: mortality and survival at other timepoints, duration of invasive mechanical ventilation, vasoactive agents, and renal replacement therapy. A random effect Bayesian meta-analysis and hierarchical Bayesian models for individual patient data will be used.
Discussion:
This systematic review with aggregate and individual patient data will address the clinical question, ‘what is the best blood glucose target for critically ill patients overall?’
Keywords:Blood glucosecritical illnessGlycemic controlinsulinIntraoperative periodmortalityPatient dischargeRegistriesSee more - Derick Adigbli
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Original Article08-07-2023
Biomarkers of neuropsychiatric dysfunction in intensive care unit survivors: a prospective cohort study
- Franciani Rodrigues da Rocha ,
- Renata Casagrande Gonçalves ,
- Gabriele da Silveira Prestes ,
- Danusa Damásio ,
- Amanda Indalécio Goulart, [ ... ],
- Felipe Dal-Pizzol
Abstract
Original ArticleBiomarkers of neuropsychiatric dysfunction in intensive care unit survivors: a prospective cohort study
Critical Care Science. 2023;35(2):147-155
DOI 10.5935/2965-2774.20230422-en
- Franciani Rodrigues da Rocha ,
- Renata Casagrande Gonçalves ,
- Gabriele da Silveira Prestes ,
- Danusa Damásio ,
- Amanda Indalécio Goulart,
- Andriele Aparecida da Silva Vieira ,
- Monique Michels ,
- Maria Inês da Rosa ,
- Cristiane Ritter ,
- Felipe Dal-Pizzol
Views87ABSTRACT
Objective:
To assess factors associated with long-term neuropsychiatric outcomes, including biomarkers measured after discharge from the intensive care unit.
Methods:
A prospective cohort study was performed with 65 intensive care unit survivors. The cognitive evaluation was performed through the Mini-Mental State Examination, the symptoms of anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale, and posttraumatic stress disorder was evaluated using the Impact of Event Scale-6. Plasma levels of amyloid-beta (1-42) [Aβ (1-42)], Aβ (1-40), interleukin (IL)-10, IL-6, IL-33, IL-4, IL-5, tumor necrosis factor alpha, C-reactive protein, and brain-derived neurotrophic factor were measured at intensive care unit discharge.
Results:
Of the variables associated with intensive care, only delirium was independently related to the occurrence of long-term cognitive impairment. In addition, higher levels of IL-10 and IL-6 were associated with cognitive dysfunction. Only IL-6 was independently associated with depression. Mechanical ventilation, IL-33 levels, and C-reactive protein levels were independently associated with anxiety. No variables were independently associated with posttraumatic stress disorder.
Conclusion:
Cognitive dysfunction, as well as symptoms of depression, anxiety, and posttraumatic stress disorder, are present in patients who survive a critical illness, and some of these outcomes are associated with the levels of inflammatory biomarkers measured at discharge from the intensive care unit.
Keywords:AnxietyBiomarkersCognitive dysfunctionCritical care outcomescritical illnessdeliriumDepressionintensive care unitsPatient dischargeSee moreViews87Abstract
Original ArticleBiomarkers of neuropsychiatric dysfunction in intensive care unit survivors: a prospective cohort study
Critical Care Science. 2023;35(2):147-155
DOI 10.5935/2965-2774.20230422-en
- Franciani Rodrigues da Rocha ,
- Renata Casagrande Gonçalves ,
- Gabriele da Silveira Prestes ,
- Danusa Damásio ,
- Amanda Indalécio Goulart,
- Andriele Aparecida da Silva Vieira ,
- Monique Michels ,
- Maria Inês da Rosa ,
- Cristiane Ritter ,
- Felipe Dal-Pizzol
Views87ABSTRACT
Objective:
To assess factors associated with long-term neuropsychiatric outcomes, including biomarkers measured after discharge from the intensive care unit.
Methods:
A prospective cohort study was performed with 65 intensive care unit survivors. The cognitive evaluation was performed through the Mini-Mental State Examination, the symptoms of anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale, and posttraumatic stress disorder was evaluated using the Impact of Event Scale-6. Plasma levels of amyloid-beta (1-42) [Aβ (1-42)], Aβ (1-40), interleukin (IL)-10, IL-6, IL-33, IL-4, IL-5, tumor necrosis factor alpha, C-reactive protein, and brain-derived neurotrophic factor were measured at intensive care unit discharge.
Results:
Of the variables associated with intensive care, only delirium was independently related to the occurrence of long-term cognitive impairment. In addition, higher levels of IL-10 and IL-6 were associated with cognitive dysfunction. Only IL-6 was independently associated with depression. Mechanical ventilation, IL-33 levels, and C-reactive protein levels were independently associated with anxiety. No variables were independently associated with posttraumatic stress disorder.
Conclusion:
Cognitive dysfunction, as well as symptoms of depression, anxiety, and posttraumatic stress disorder, are present in patients who survive a critical illness, and some of these outcomes are associated with the levels of inflammatory biomarkers measured at discharge from the intensive care unit.
Keywords:AnxietyBiomarkersCognitive dysfunctionCritical care outcomescritical illnessdeliriumDepressionintensive care unitsPatient dischargeSee more
- Franciani Rodrigues da Rocha
Patient discharge Archives - Critical Care Science (CCS)
