Review Archives - Critical Care Science (CCS)

  • 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

    Views93

    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
  • Review

    Cytokine hemoadsorption with CytoSorb® in patients with sepsis: a systematic review and meta-analysis

    Crit Care Sci. 2023;35(2):217-225

    Abstract

    Review

    Cytokine hemoadsorption with CytoSorb® in patients with sepsis: a systematic review and meta-analysis

    Crit Care Sci. 2023;35(2):217-225

    DOI 10.5935/2965-2774.20230289-pt

    Views8

    ABSTRACT

    Objective:

    To analyze the effect of CytoSorb® on mortality, interleukin levels, vasopressor use and adverse events in patients with sepsis.

    Methods:

    We searched MEDLINE®, Embase and the Cochrane Library for randomized controlled trials and cohort studies that reported the use of CytoSorb® among septic patients. The primary outcome was mortality, and secondary outcomes included the use of vasopressors, levels of inflammatory markers, predicted versus observed mortality, length of stay in the intensive care unit, and adverse events.

    Results:

    We included 6 studies enrolling 413 patients, and assessment for risk of bias indicated variations in study quality from high to moderate. The overall mortality rate was 45%, and no significant effect on mortality was found at 28 - 30 days (RR 0.98 [0.12 - 8.25] for the randomized clinical trial and RR 0.74 [0.49 - 1.13] for cohort studies). We did not perform a metanalysis for other outcomes due to the small number of studies found or the lack of data.

    Conclusion:

    Our study found very low certainty evidence, due to imprecision, risk of bias, and heterogeneity, thereby showing no benefit of CytoSorb® use in terms of mortality at 28 - 30 days. We cannot recommend the use of CytoSorb® in septic or septic shock patients outside clinical trials. Further high-quality randomized trials with a common intervention arm are needed to evaluate the influence of CytoSorb® in this population.

    PROSPERO register:

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    Cytokine hemoadsorption with CytoSorb® in patients with sepsis: a systematic review and meta-analysis
  • Review

    High-value care for critically ill oncohematological patients: what do we know thus far?

    Crit Care Sci. 2023;35(1):84-96

    Abstract

    Review

    High-value care for critically ill oncohematological patients: what do we know thus far?

    Crit Care Sci. 2023;35(1):84-96

    DOI 10.5935/2965-2774.20230405-pt

    Views17

    ABSTRACT

    The number of patients with cancer requiring intensive care unit admission is increasing around the world. The improvement in the pathophysiological understanding of this group of patients, as well as the increasingly better and more targeted treatment options for their underlying disease, has led to a significant increase in their survival over the past three decades. Within the organizational concepts, it is necessary to know what adds value in the care of critical oncohematological patients. Practices in medicine that do not benefit patients and possibly cause harm are called low-value practices, while high-value practices are defined as high-quality care at relatively low cost. In this article, we discuss ten domains with high-value evidence in the care of cancer patients: (1) intensive care unit admission policies; (2) intensive care unit organization; (3) etiological investigation of hypoxemia; (4) management of acute respiratory failure; (5) management of febrile neutropenia; (6) urgent chemotherapy treatment in critically ill patients; (7) patient and family experience; (8) palliative care; (9) care of intensive care unit staff; and (10) long-term impact of critical disease on the cancer population. The disclosure of such policies is expected to have the potential to change health care standards. We understand that it is a lengthy process, and initiatives such as this paper are one of the first steps in raising awareness and beginning a discussion about high-value care in various health scenarios.

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    High-value care for critically ill oncohematological patients: what do we know thus far?

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