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Objectives To describe the clinical characteristics and in-hospital mortality of chronic dialysis-dependent end-stage kidney disease patients with septic shock in comparison to septic shock patients not receiving chronic dialysis. Methods Using an international, multicenter database, we conducted a retrospective analysis of data collected from 10,414 patients admitted to the intensive care unit (ICU) with septic shock from 1989 to 2013, of which 800 (7.7 %) were chronic dialysis patients. Data on demographic characteristics, sites of infection, microbial pathogens, antimicrobial usage patterns, and in-hospital mortality were aggregated and compared for chronic dialysis and non-dialysis patients. Multivariate time-varying Cox models with and without propensity score matching were constructed to determine the association between dialysis and in-hospital death. Results Septic shock secondary to central venous catheter infection, peritonitis, ischemic bowel, and cellulitis was more frequent in chronic dialysis patients. The isolation of resistant organisms (10.7 vs. 7.1 %; p = 0.005) and delays in receiving antimicrobials (6.0 vs. 5.0 h) were more common in chronic dialysis patients than in non-dialysis patients. Delayed appropriate antimicrobial therapy was associated with an increased risk of death in chronic dialysis patients (p < 0.0001). In-hospital death occurred in 54.8 and 49.0 % of chronic dialysis and non-dialysis patients, respectively. After propensity score matching, there was no difference in overall survival between chronic dialysis and non-dialysis patients, but survival in chronic dialysis patients decreased over time compared to non-dialysis patients. Conclusions The demographic and clinical characteristics of chronic dialysis patients with septic shock differ from those of similar non-dialysis patients. However, there was no significant difference in mortality between the chronic dialysis and non-dialysis patients with septic shock enrolled in this analysis., Author(s): Edward Clark [sup.1], Anand Kumar [sup.2], Amit Langote [sup.1], Stephen Lapinsky [sup.3], Peter Dodek [sup.4], Andreas Kramer [sup.5], Gordon Wood [sup.6], Sean M. Bagshaw [sup.7], Ken Wood [sup.8], Dave [...]

A study was conducted to investigate the characteristics, treatment methodologies and outcomes of critically ill patients with 2009 influenza A (H1N1) in Mexico. Results indicated that the critically ill cases were those of young adults who had severe respiratory distress syndrome and a high mortality rate.

The study aims to investigate the characteristics, treatment methodologies and outcomes of critically ill patients with 2009 Influenza A (H1N1) infection in Canada. The results indicate that critical illness in such cases occurred after admission to hospital and was found among young adults and needed prolonged mechanical ventilation and other rescue therapies.

Byline: Sean M. Bagshaw (1), Stephen Lapinsky (2), Sandra Dial (3), Yaseen Arabi (4), Peter Dodek (5), Gordon Wood (6), Paul Ellis (7), Jorge Guzman (8), John Marshall (9), Joseph E. Parrillo (10), Yoanna Skrobik (11), Anand Kumar (12) Keywords: Acute kidney injury; Acute renal failure; Critically ill; Sepsis; Septic shock; Mortality; Incidence; Multi-center Abstract: Objective To describe the incidence and outcomes associated with early acute kidney injury (AKI) in septic shock and explore the association between duration from hypotension onset to effective antimicrobial therapy and AKI. Design Retrospective cohort study. Subjects A total of 4,532 adult patients with septic shock from 1989 to 2005. Setting Intensive care units of 22 academic and community hospitals in Canada, the United States and Saudi Arabia. Measurements and main results In total, 64.4% of patients with septic shock developed early AKI (i.e., within 24 h after onset of hypotension). By RIFLE criteria, 16.3% had risk, 29.4% had injury and 18.7% had failure. AKI patients were older, more likely female, with more co-morbid disease and greater severity of illness. Of 3,373 patients (74.4%) with hypotension prior to receiving effective antimicrobial therapy, the median (IQR) time from hypotension onset to antimicrobial therapy was 5.5 h (2.0--13.3). Patients with AKI were more likely to have longer delays to receiving antimicrobial therapy compared to those with no AKI [6.0 (2.3--15.3) h for AKI vs. 4.3 (1.5--10.8) h for no AKI, P < 0.0001). A longer duration to antimicrobial therapy was also associated an increase in odds of AKI [odds ratio (OR) 1.14, 95% CI 1.10--1.20, P < 0.001, per hour (log-transformed) delay]. AKI was associated with significantly higher odds of death in both ICU (OR 1.73, 95% CI 1.60--1.9, P < 0.0001) and hospital (OR 1.62, 95% CI, 1.5--1.7, P < 0.0001). By Cox proportional hazards analysis, including propensity score-adjustment, each RIFLE category was independently associated with a greater hazard ratio for death (risk 1.31 injury 1.45 failure 1.56). Conclusion Early AKI is common in septic shock. Delays to appropriate antimicrobial therapy may contribute to significant increases in the incidence of AKI. Survival was considerably lower for septic shock associated with early AKI, with increasing severity of AKI, and with increasing delays to appropriate antimicrobial therapy. Author Affiliation: (1) Division of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada (2) Section of Critical Care Medicine, Mount Sinai Hospital, Toronto, ON, Canada (3) Section of Critical Care Medicine, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC, Canada (4) Department of Critical Care, National Guard Hospital, Riyadh, Saudi Arabia (5) Section of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada (6) Critical Care Medicine, Royal Jubilee and Victoria General Hospitals, Vancouver Island Health Authority, Victoria, BC, Canada (7) Department of Emergency Medicine, United Health Network, University of Toronto, Toronto, ON, Canada (8) Section of Critical Care Medicine, Harper Hospital, Wayne State University, Detroit, MI, USA (9) Section of Critical Care Medicine, St. Michael's Hospital, Toronto, ON, Canada (10) Department of Medicine, Robert Wood Johnson Medical School, UMDNJ, Cooper Hospital, University Medical Center, Camden, NJ, USA (11) Section of Critical Care Medicine, Hopital Maisonneuve Rosemont, Montreal, QC, Canada (12) Section of Critical Care Medicine, Section of Infectious Diseases, Health Sciences Centre JJ 399, University of Manitoba, 700 William Ave, Winnipeg, MB, R3E-0Z3, Canada Article History: Registration Date: 28/11/2008 Received Date: 03/02/2008 Accepted Date: 05/07/2008 Online Date: 09/12/2008

The effect of a "lung open ventilation" (LOV) strategy on mortality in patients with acute lung injury and acute respiratory distress syndrome is described. A combination of low tidal volumes, recruitment maneuvers, and high levels of positive end-expiratory pressure shows no significant difference in all-cause hospital mortality compared with low-tidal-volume protocolized ventilation strategy.

Severe acute respiratory syndrome (SARS) is a threat to healthcare workers. After a brief, unexpected exposure to a patient with SARS, 69 intensive-care staff at risk for SARS were interviewed [...]

Severe acute respiratory syndrome (SARS) can cause critical illness in some people. Of 196 people in Toronto, Canada, who developed SARS, 38 became so sick they had to be admitted to an intensive care unit. Twenty-nine had to be put on a mechanical ventilator. One-third died and half of the patients on mechanical ventilation died. Some of the patients were healthcare workers who had contracted SARS from a patient.

Byline: Stephen E. Lapinsky (1), Laura Hawryluck (2) Keywords: Severe acute respiratory syndrome Acute respiratory distress syndrome Mechanical ventilation Infection control Abstract: Background. Severe acute respiratory syndrome (SARS) is a contagious viral illness first recognized in late 2002. It has now been documented in 26 countries worldwide, with significant outbreaks in China, Hong Kong, Singapore, and Toronto. Research into identifying the etiological agent, evaluating modes of disease transmission, and treatment options is currently ongoing. Discussion. The disease can produce a severe bilateral pneumonia, with progressive hypoxemia. Up to 20% of patients require mechanical ventilatory support, with a fatal outcome occurring in about 5% of cases. Conclusions. We review the current knowledge about this disease, with particular emphasis on ICU management and infection control precautions to prevent disease transmission. Author Affiliation: (1) Mount Sinai Hospital, Interdepartmental Division of Critical Care, University of Toronto, 600 University Ave, M5G 1X5, Toronto, Canada (2) University Health Network, Interdepartmental Division of Critical Care, University of Toronto, 500 University Ave, M5G 1X7, Toronto, Canada Article History: Received Date: 23/04/2003 Accepted Date: 25/04/2003 Article note: Electronic Publication

Byline: M. S. Miletin (1), A. S. Detsky (2), S. E. Lapinsky (1), S. Mehta (1) Author Affiliation: (1) Department of Medicine, Mount Sinai Hospital and University of Toronto, 600 University Avenue, Suite 1818, Toronto, Ontario, Canada M5G 1X5 e-mail: geeta.mehta@utoronto.ca Tel.: + 1-4 16-5 86 46 79 Fax: + 1-4 16-5 86 59 81), CA (2) Department of Medicine, Mount Sinai Hospital and University of Toronto, 600 University Avenue, Suite 427, Toronto, Ontario, Canada M5G 1X5, CA Article note: Accepted: 18 September 1999

Byline: S. E. Lapinsky (1), M. Aubin (1), S. Mehta (1), P. Boiteau (1), A. S. Slutsky (1) Keywords: Key words Mechanical ventilation; Respiratory distress syndrome, adult; Lung physiopathology; APLung recruitment Abstract: Objective: To assess the safety and efficacy of a sustained inflation, used as a lung volume recruitment maneuver in ventilated patients with hypoxemic respiratory failure.APDesign: Prospective data collection as part of a quality assurance program following introduction of a lung volume recruitment guideline in the intensive care unit.APSetting: Academic medical-surgical critical care unit.APPatients: Hypoxemic patients with bilateral pulmonary infiltrates. Patients with chronic obstructive pulmonary disease, pulmonary barotrauma and hemodynamic instability were excluded.APInterventions: A sustained inflation using a pressure of 30 to 45 cm[H.sub.2]O was applied for 20 s. The pressure was determined as the lesser of 45 cm[H.sub.2]O or the peak pressure while ventilated at a tidal volume of 12 ml/kg. Intra-arterial blood pressure and pulse oximetry were monitored continuously.APMeasurements and results: Significant improvement in oxygenation occurred in the majority of patients within 10 min. The mean oxygen saturation improved from 86.9 +- 5.5 to 94.3 +- 2.3 % (p < 0.01). No significant adverse effects were noted: hypotension and mild oxygen desaturation occurred in some patients during the 20-s inflation, reversing rapidly after inflation was terminated. No barotrauma occurred.APConclusions: A sustained inflation is a safe, clinically applicable method of lung volume recruitment which improves oxygenation in selected patients and may have a role in ventilatory management. Author Affiliation: (1) Critical Care Unit, Department of Medicine, Mount Sinai Hospital Critical Care Medicine Programme, and Respiratory Division, University of Toronto, Toronto, Ontario, Canada, CA Article note: Received: 12 February 1999/Accepted: 8 September 1999

A mechanical ventilation strategy to prevent trauma to the lungs does not appear to reduce mortality and may produce serious complications. Researchers compared traditional ventilation and a limited ventilation consisting of lower pressures and volumes in 120 patients at risk of acute respiratory distress syndrome. Mortality rates were similar in both groups and those in the limited ventilation group were more likely to have elevated blood levels of carbon dioxide. The incidence of lung trauma was similar in both groups but those in the limited ventilation group were more likely to develop kidney failure.