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Objective: To report the feasibility, complications, and outcomes of emergency extracorporeal life support (ECLS) in refractory cardiac arrests in medical intensive care unit (ICU)., Design and Setting: Prospective cohort study in the medical ICU in a university hospital in collaboration with the cardiosurgical team of a neighboring hospital., Patients: Seventeen patients (poisonings: 12/17) admitted over a 2-year period for cardiac arrest unresponsive to cardiopulmonary resuscitation (CPR) and advanced cardiac life support, without return of spontaneous circulation., Interventions: ECLS femoral implantation under continuous cardiac massage, using a centrifugal pump connected to a hollow-fiber membrane oxygenator., Measurements and Results: Stable ECLS was achieved in 14 of 17 patients. Early complications included massive transfusions (n=8) and the need for surgical revision at the cannulation site for bleeding (n=1). Four patients (24%) survived at medical ICU discharge. Deaths resulted from multiorgan failure (n=8), thoracic bleeding(n=2), severe sepsis (n=2), and brain death (n=1). Massive hemorrhagic pulmonary edema during CPR (n=5) and major capillary leak syndrome (n=6) were observed. Three cardiotoxic-poisoned patients (18%, CPR duration: 30, 100, and 180 min) were alive at 1-year follow-up without sequelae. Two of these patients survived despite elevated plasma lactate concentrations before cannulation (39.0 and 20.0 mmol/l). ECLS was associated with a significantly lower ICU mortality rate than that expected from the Simplified Acute Physiology Score II (91.9%) and lower than the maximum Sequential Organ Failure Assessment score (>90%)., Conclusions: Emergency ECLS is feasible in medical ICU and should be considered as a resuscitative tool for selected patients suffering from refractory cardiac arrest.

Purpose: Patients receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) frequently develop arterial hyperoxaemia, which may be harmful. However, lower oxygen saturation targets may also lead to harmful episodes of hypoxaemia. Methods: In this registry-embedded, multicentre trial, we randomly assigned adult patients receiving VA-ECMO in an intensive care unit (ICU) to either a conservative (target SaO2 92–96%) or to a liberal oxygen strategy (target SaO2 97–100%) through controlled oxygen administration via the ventilator and ECMO gas blender. The primary outcome was the number of ICU-free days to day 28. Secondary outcomes included ICU-free days to day 60, mortality, ECMO and ventilation duration, ICU and hospital lengths of stay, and functional outcomes at 6 months. Results: From September 2019 through June 2023, 934 patients who received VA-ECMO were reported to the EXCEL registry, of whom 300 (192 cardiogenic shock, 108 refractory cardiac arrest) were recruited. We randomised 149 to a conservative and 151 to a liberal oxygen strategy. The median number of ICU-free days to day 28 was similar in both groups (conservative: 0 days [interquartile range (IQR) 0–13.7] versus liberal: 0 days [IQR 0–13.7], median treatment effect: 0 days [95% confidence interval (CI) – 3.1 to 3.1]). Mortality at day 28 (59/159 [39.6%] vs 59/151 [39.1%]) and at day 60 (64/149 [43%] vs 62/151 [41.1%] were similar in conservative and liberal groups, as were all other secondary outcomes and adverse events. The conservative group experienced 44 (29.5%) major protocol deviations compared to 2 (1.3%) in the liberal oxygen group (P < 0.001). Conclusions: In adults receiving VA-ECMO in ICU, a conservative compared to a liberal oxygen strategy, did not affect the number of ICU-free days to day 28. [ABSTRACT FROM AUTHOR]

The article discusses the relationship between acute kidney injury (AKI) and acute respiratory distress syndrome (ARDS) in critically ill patients. The study analyzed data from 10 randomized controlled trials conducted in the United States between 1996 and 2018. The authors found that AKI occurred in approximately 43.7% of patients with ARDS, with a higher incidence of AKI stage 3 and acute kidney disease (AKD) in patients with more severe AKI. The study also found that AKI was associated with higher mortality rates at 28 and 90 days. However, the study has some limitations, including the lack of consideration for certain variables and the heterogeneity of ARDS and AKI subphenotypes. Further research is needed to better understand the relationship between AKI and ARDS and to identify strategies for improving outcomes. [Extracted from the article]

This article discusses the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a treatment for acute myocardial infarction-related cardiogenic shock (AMI-CS). The article highlights that while there has been a significant increase in the use of VA-ECMO, there is a lack of evidence from randomized controlled trials (RCTs) to support its effectiveness. The article presents the findings of several RCTs and a meta-analysis, which suggest that routine VA-ECMO does not significantly reduce mortality in AMI-CS patients. The article also discusses the safety concerns associated with VA-ECMO, such as bleeding and peripheral ischemic complications. The limitations of the current evidence and the need for further research to identify specific patient subgroups that may benefit from VA-ECMO are also discussed. Overall, the article concludes that routine immediate VA-ECMO is not beneficial for the majority of AMI-CS patients, and further research is needed to determine its effectiveness in specific situations. [Extracted from the article]

Purpose: Severe acute respiratory distress syndrome (ARDS) with PaO2/FiO2 < 80 mmHg is a life-threatening condition. The optimal management strategy is unclear. The aim of this meta-analysis was to compare the effects of low tidal volumes (Vt), moderate Vt, prone ventilation, and venovenous extracorporeal membrane oxygenation (VV-ECMO) on mortality in severe ARDS. Methods: We performed a frequentist network meta-analysis of randomised controlled trials (RCTs) with participants who had severe ARDS and met eligibility criteria for VV-ECMO or had PaO2/FiO2 < 80 mmHg. We applied the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) methodology to discern the relative effect of interventions on mortality and the certainty of the evidence. Results: Ten RCTs including 812 participants with severe ARDS were eligible. VV-ECMO reduces mortality compared to low Vt (risk ratio [RR] 0.77, 95% confidence interval [CI] 0.59–0.99, moderate certainty) and compared to moderate Vt (RR 0.75, 95% CI 0.57–0.98, low certainty). Prone ventilation reduces mortality compared to moderate Vt (RR 0.78, 95% CI 0.66–0.93, high certainty) and compared to low Vt (RR 0.81, 95% CI 0.63–1.02, moderate certainty). We found no difference in the network comparison of VV-ECMO compared to prone ventilation (RR 0.95, 95% CI 0.72–1.26), but inferences were based solely on indirect comparisons with very low certainty due to very wide confidence intervals. Conclusions: In adults with ARDS and severe hypoxia, both VV-ECMO (low to moderate certainty evidence) and prone ventilation (moderate to high certainty evidence) improve mortality relative to low and moderate Vt strategies. The impact of VV-ECMO versus prone ventilation remains uncertain. [ABSTRACT FROM AUTHOR]

This article discusses the importance of hemostasis testing in the intensive care unit (ICU) for critically ill patients who often experience bleeding and thrombotic complications. The article explores the utility of hemostasis testing in guiding clinical decisions and improving patient outcomes. It highlights the different coagulation abnormalities associated with underlying diseases such as sepsis-induced coagulopathy (SIC), disseminated intravascular coagulation (DIC), and COVID-19-associated coagulopathy. The article also emphasizes the significance of monitoring coagulation parameters during active bleeding and the use of anti-Xa monitoring in patients on extracorporeal membrane oxygenation (ECMO). Overall, the article suggests that a personalized approach to hemostasis testing can lead to more targeted and effective interventions, minimizing complications. [Extracted from the article]

Purpose: The outcomes of immunocompromised patients with cardiogenic shock treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) are seldom documented, making ECMO candidacy decisions challenging. This study aims (1) to report outcomes of immunocompromised patients treated with VA-ECMO, (2) to identify pre-ECMO predictors of 90-day mortality, (3) to assess the impact of immunodepression on 90-day mortality, and (4) to describe the main ECMO-related complications. Methods: This is a retrospective, propensity-weighted study conducted in two French experienced ECMO centers. Results: From January 2006 to January 2022, 177 critically ill immunocompromised patients (median (interquartile range, IQR) age 49 (32–60) years) received VA-ECMO. The main causes of immunosuppression were long-term corticosteroids/immunosuppressant treatment (29%), hematological malignancy (26%), solid organ transplant (20%), and solid tumor (13%). Overall 90-day and 1-year mortality were 70% (95% confidence interval (CI) 63–77%) and 75% (95% CI 65–79%), respectively. Older age and higher pre-ECMO lactate were independently associated with 90-day mortality. Across immunodepression causes, 1-year mortality ranged from 58% for patients with infection by human immunodeficiency virus (HIV) or asplenia, to 89% for solid organ transplant recipients. Hemorrhagic and infectious complications affected 39% and 54% of patients, while more than half the stay in intensive care unit (ICU) was spent on antibiotics. In a propensity score-weighted model comparing the 177 patients with 942 non-immunocompromised patients experiencing cardiogenic shock on VA-ECMO, immunocompromised status was independently associated with a higher 90-day mortality (odds ratio 2.53, 95% CI 1.72–3.79). Conclusion: Immunocompromised patients undergoing VA-ECMO treatment face an unfavorable prognosis, with higher 90-day mortality compared to non-immunocompromised patients. This underscores the necessity for thorough evaluation and careful selection of ECMO candidates within this frail population. [ABSTRACT FROM AUTHOR]

The article discusses the challenges in diagnosing non-occlusive mesenteric ischemia (NOMI), a rare condition that primarily affects critically ill patients in the intensive care unit (ICU). The lack of specific symptoms and established biomarkers makes it difficult to diagnose NOMI, leading to high mortality rates. Computed tomography angiography (CTA) is the standard diagnostic tool for acute mesenteric ischemia (AMI), but its accuracy is low for NOMI. The authors suggest that colonoscopy can be a useful complementary diagnostic tool for confirming or ruling out colon ischemia, particularly in ICU patients. [Extracted from the article]

A recent article in Intensive Care Medicine examined the outcomes of immunocompromised patients with cardiogenic shock who were treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO). The study found that immunocompromised patients had a high 90-day mortality rate of 70%, and that being immunocompromised was independently associated with mortality. However, there are some uncertainties in the study's findings. The causes of death in the immunocompromised patients were unclear, and it is important to determine if VA-ECMO was associated with these deaths. Additionally, the variation in adjunctive therapy during VA-ECMO management was not evaluated, and there may have been selection bias in the study. Further research is needed to better understand the use of VA-ECMO in immunocompromised patients. [Extracted from the article]

The article discusses the routine use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in the intensive care unit (ICU) and raises the question of whether patients are ready for it. While VA-ECMO is commonly used in managing critical patients with cardiac failure, recent trials have shown higher rates of complications such as limb ischemia and severe bleeding. The article highlights the psychological and emotional burden on patients and families, especially when patients remain in a state of non-improvement on ECMO. The decision to use VA-ECMO should involve shared responsibility and decision-making with patients, considering the limited evidence and divided opinions within the medical community. [Extracted from the article]

Annual flu seasons are typically characterized by changes in types and subtypes of influenza, with variations in terms of severity. Despite remarkable improvements in the prevention and management of patients with suspected or laboratory-confirmed diagnosis of influenza, annual seasonal influenza continues to be associated with a high morbidity and mortality. Admission to the intensive care unit is required for patients with severe forms of seasonal influenza infection, with primary pneumonia being present in most of the cases. This review summarizes the most recent knowledge on the diagnosis and treatment strategies in critically ill patients with influenza, focused on diagnostic testing methods, antiviral therapy, use of corticosteroids, antibacterial and antifungal therapy, and supportive measures. The review focuses on diagnostic testing methods, antiviral therapy, use of corticosteroids, antibacterial and antifungal therapy, supportive measures and relevant existing evidence, in order to provide the non-expert clinician a useful overview. An enhanced understanding of current diagnostic and treatment aspects of influenza infection can contribute to improve outcomes and reduce mortality among ICU patients with influenza. [ABSTRACT FROM AUTHOR]

Purpose: To describe the characteristics, outcomes, and risk factors associated with poor outcome of venoarterial extracorporeal membrane oxygenation (VA-ECMO)-treated patients with refractory shock post-cardiac arrest.Methods: We retrospectively analyzed data collected prospectively (March 2007-January 2015) in a 26-bed tertiary hospital intensive care unit. All patients implanted with VA-ECMO for refractory cardiogenic shock after successful resuscitation from cardiac arrest were included. Refractory cardiac arrest patients, given VA-ECMO under cardiopulmonary resuscitation, were excluded.Results: Ninety-four patients received VA-ECMO for refractory shock post-cardiac arrest. Their hospital and 12-month survival rates were 28 and 27 %, respectively. All 1-year survivors were cerebral performance category 1. Multivariable analysis retained INR >2.4 (OR 4.9; 95 % CI 1.4-17.2), admission SOFA score >14 (OR 5.3; 95 % CI 1.7-16.5), and shockable rhythm (OR 0.3; 95 % CI 0.1-0.9) as independent predictors of hospital mortality, but not SAPS II, out-of-hospital cardiac arrest score, or other cardiac arrest variables. Only 10 % of patients with an admission SOFA score >14 survived, whereas 50 % of those with scores ≤14 were alive at 1 year. Restricting the analysis to the 67 patients with out-of-hospital cardiac arrest of coronary cause yielded similar results.Conclusion: Among 94 patients implanted with VA-ECMO for refractory cardiogenic shock post-cardiac arrest resuscitation, the 24 (27 %) 1-year survivors had good neurological outcomes, but survival was significantly better for patients with admission SOFA scores <14, shockable rhythm, and INR ≤2.4. VA-ECMO might be considered a rescue therapy for patients with refractory cardiogenic shock post-cardiac arrest resuscitation. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether protein C zymogen (protein C concentrates or human protein C) improves clinically relevant outcomes in adult patients with severe sepsis and septic shock.Methods: This is a randomized, double-blind, placebo-controlled, parallel-group trial that from September 2012 to June 2014 enrolled adult patients with severe sepsis or septic shock and high risk of death and of bleeding (e.g., APACHE II greater than 25, extracorporeal membrane oxygenation or disseminated intravascular coagulopathy). All patients completed their follow-up 90 days after randomization and data were analyzed according to the intention-to-treat principle. Follow-up was performed at 30 and 90 days after randomization. The primary endpoint was a composite outcome of prolonged intensive care unit (ICU) stay and/or 30-day mortality. Secondary endpoints included mortality.Results: The study was stopped early in a situation of futility for the composite outcome of prolonged ICU stay and/or 30-day mortality that was 79 % (15 patients) in the protein C zymogen group and 67 % (12 patients) in the placebo group (p = 0.40) and for a concomitant safety issue: ICU mortality was 79 % (15 patients) in the protein C zymogen group vs 39 % (7 patients) in the placebo group (p = 0.020), and 30-day mortality was 68 vs 39 % (p = 0.072).Conclusion: Protein C zymogen did not improve clinically relevant outcomes in severe sepsis and septic shock adult patients. Given its high cost and the potential increase in mortality, the use of this drug in adult patients should be discouraged. [ABSTRACT FROM AUTHOR]

The article offers information on the use of extracorporeal membrane oxygenation (ECMO) for immunosuppressed patients with acute respiratory distress syndrome. It discusses that challenges in providing care to the intensive care unit patients. It mentions that challenges in increasingly encountering immunosuppressed patients with acute respiratory distress syndrome.

Despite expensive life-sustaining interventions delivered in the ICU, mortality and morbidity in patients with acute respiratory failure (ARF) remain unacceptably high. Extracorporeal membrane oxygenation (ECMO) has emerged as a promising intervention that may provide more efficacious supportive care to these patients. Improvements in technology have made ECMO safer and easier to use, allowing for the potential of more widespread application in patients with ARF. A greater appreciation of the complications associated with the placement of an artificial airway and mechanical ventilation has led clinicians and researchers to seek viable alternatives to providing supportive care in these patients. Thus, this review will summarize the current knowledge regarding the use of venovenous (VV)-ECMO for ARF and describe some of the recent controversies in the field, such as mechanical ventilation, anticoagulation and transfusion therapy, and ethical concerns in patients supported with VV-ECMO. [ABSTRACT FROM AUTHOR]

Purpose: The frequency of neurological events and their impact on patients receiving venovenous extracorporeal membrane oxygenation (VV-ECMO) are unknown. We therefore study the epidemiology, risk factors, and impact of cerebral complications occurring in VV-ECMO patients.Methods: Observational study conducted in a tertiary referral center (2006-2012) on patients developing a neurological complication (ischemic stroke or intracranial bleeding) while on VV-ECMO versus those who did not, and a systematic review on this topic.Results: Among 135 consecutive patients who had received VV-ECMO, 18 (15 assessable) developed cerebral complications on ECMO: cerebral bleeding in 10 (7.5 %), ischemic stroke in 3 (2 %), or diffuse microbleeds in 2 (2 %), occurring after respective medians (IQR) of 3 (1-11), 21 (10-26), and 36 (8-63) days post-ECMO onset. Intracranial bleeding was independently associated with renal failure at intensive care unit admission and rapid PaCO2 decrease at ECMO initiation, but not with age, comorbidities, or hemostasis disorders. Seven (70 %) patients with intracranial bleeding and one (33 %) with ischemic stroke died versus 40 % of patients without neurological event. A systematic review found comparable intracranial bleeding rates (5 %).Conclusions: Neurological events occurred frequently in patients on VV-ECMO. Intracranial bleeding, the most frequent, occurred early and was associated with higher mortality. Because it was independently associated with rapid hypercapnia decrease, the latter should be avoided at ECMO onset, but its exact role remains to be determined. These findings may have major implications for the care of patients requiring VV-ECMO. [ABSTRACT FROM AUTHOR]

The article discusses the implications of using adjuvants in the treatment of acute respiratory distress syndrome (ARDS). Topics include the types o pharmacologic adjuvants including diuretics, corticosteroids, neuromuscular blocking agents and the reports showing data on the administration of pharmacologic adjuvants in patients. Also discussed is a report showing the effectivity of non-pharmacologic agents and the factors affecting the use of adjuvant therapy in treating ARDS.

Purpose: This study was designed to identify factors associated with in-intensive care unit (ICU) death and develop a practical mortality risk score for venoarterial-extracorporeal membrane oxygenation (VA-ECMO)-treated acute myocardial infarction (AMI) patients. Long-term survivors' health-related quality of life (HRQOL), anxiety, depression, and post-traumatic stress disorder (PTSD) frequencies were also assessed.Methods: Data from 138 ECMO-treated AMI patients admitted to two French ICUs (2008-2013) were analyzed. ICU survivors contacted >6 months post-ICU discharge were assessed for HRQOL, psychological and PTSD status.Results: Sixty-five patients (47%) survived to ICU discharge. On the basis of multivariable logistic regression analyses, the ENCOURAGE score was constructed with seven pre-ECMO parameters: age >60, female sex, body mass index >25 kg/m(2), Glasgow coma score <6, creatinine >150 μmol/L, lactate (<2, 2-8, or >8 mmol/L), and prothrombin activity <50%. Six months after ECMO, probabilities of survival were 80, 58, 25, 20, and 7% for ENCOURAGE score classes 0-12, 13-18, 19-22, 23-27, and ≥28, respectively. The ENCOURAGE score ROC AUC [0.84 (95% CI 0.77-0.91)] was significantly better than those of the SAVE, SAPS II, and SOFA scores. Survivors' HRQOL evaluated after median follow-up of 32 months revealed satisfactory mental health but persistent physical and emotional-related difficulties, with 34% (95% CI 20-49%) anxiety, 20% (95% CI 8-32%) depression, and 5% (95% CI 0-12%) PTSD symptoms reported.Conclusions: The ENCOURAGE score might be a useful tool to predict mortality of severe cardiogenic shock AMI patients who received VA-ECMO. However, it now needs prospective validation on other populations of AMI patients. [ABSTRACT FROM AUTHOR]

The article focus on immunocompromised patients. Topics discussed include neutropenic enterocolitis as a factor independently associated with survival identified in study by Mokart et al, assessment of incidence of acute respiratory distress syndrome (ARDS) within 6 months of renal transplantation by Wan et al and study by Mokart et al. revealing patients receiving both non-invasive ventilation (NIV) and high-flow nasal cannula oxygen therapy (HFNC) have a lower mortality.

In this article, the authors focus on outcomes for acute respiratory distress syndrome (ARDS) treated with extracorporeal membrane oxygenation (ECMO) as of 2013. They inform that risk of bleeding is increased by the ECMO and depressive symptoms and memory complaints persist for five years after post-ARDS. They also mention that muscles undergo active proteolysis within hours of intensive care unit admission.

Purpose: In view of the expected 2009 influenza A(H1N1) pandemic, the Italian Health Authorities set up a national referral network of selected intensive care units (ICU) able to provide advanced respiratory care up to extracorporeal membrane oxygenation (ECMO) for patients with acute respiratory distress syndrome (ARDS). We describe the organization and results of the network, known as ECMOnet. Methods: The network consisted of 14 ICUs with ECMO capability and a national call center. The network was set up to centralize all severe patients to the ECMOnet centers assuring safe transfer. An ad hoc committee defined criteria for both patient transfer and ECMO institutions. Results: Between August 2009 and March 2010, 153 critically ill patients (53% referred from other hospitals) were admitted to the ECMOnet ICU with suspected H1N1. Sixty patients (48 of the referred patients, 49 with confirmed H1N1 diagnosis) received ECMO according to ECMOnet criteria. All referred patients were successfully transferred to the ECMOnet centers; 28 were transferred while on ECMO. Survival to hospital discharge in patients receiving ECMO was 68%. Survival of patients receiving ECMO within 7 days from the onset of mechanical ventilation was 77%. The length of mechanical ventilation prior to ECMO was an independent predictor of mortality. Conclusions: A network organization based on preemptive patient centralization allowed a high survival rate and provided effective and safe referral of patients with severe H1N1-suspected ARDS. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Predictors of insufficient amikacin peak concentration in critically ill patients receiving a 25 mg/kg total body weight regimen" by E. de Montmollin and colleagues.

The article discusses the study that existence of acute respiratory distress syndrome (ARDS) resource-constrained settings. The author highlights that the diagnostic procedure for ARDS in resource-constrained settings such as for Rwandan hospital's interpretation of ARDS cannot be compared to resource-rich settings due to the differences in methods employed in both settings. Also discussed are factors that affect the diagnosis which include the limited equipments available for use.

Objective: To describe the use of inhaled isoflurane in a series of children with life-threatening asthma.Design: Retrospective case series.Setting: Pediatric intensive care unit of a tertiary-care children's hospital. Ten children ranging in age from 1 to 16 years with 11 episodes of severe asthma requiring invasive mechanical ventilation in the pediatric intensive care unit over a 5-year period.Results: Isoflurane resulted in an improvement in arterial pH and a reduction in partial pressure of arterial carbon dioxide (PaCO(2)) in all the 11 instances. This effect was sustained in 10 cases and led to clinical improvement and rapid weaning from mechanical ventilation. One child failed to show sustained response and was placed on veno-venous extracorporeal membrane oxygenation. One child died secondary to anoxic brain injury sustained prior to hospitalization. Hypotension was the major side effect, and occurred in 8 children necessitating vasopressor support.Conclusions: Isoflurane improves arterial pH and reduces partial pressure of arterial carbon dioxide in mechanically ventilated children with life-threatening status asthmaticus who are not responsive to conventional management. [ABSTRACT FROM AUTHOR]

Objective: Veno-venous extracorporeal membrane oxygenation (ECMO) is an established therapy for the treatment of respiratory failure. Traditionally ECMO has been used to support patients with an acute, reversible disease process, with a predictable outcome. We report the successful use of veno-venous ECMO for an unusual indication.Patient: A 10-year old girl was admitted to intensive care with severe, hypoxic respiratory failure on the background of a 2-month history of worsening respiratory symptoms. She required high levels of conventional positive pressure ventilation, and high frequency oscillation. Lung biopsy confirmed a non-specific interstitial pneumonia, and the patient was commenced on immune suppressive therapy. Her clinical course was further complicated by pulmonary haemorrhage and severe air leak.Interventions: On day 20 after admission the patient was placed on veno-venous ECMO for lung rest while awaiting a response to continued medical treatment. She required ECMO for 20 days, during which time sedation was reduced, and she was able to interact with those around her. The patient's ventilatory requirements after decannulation were minimal, and she subsequently made a steady clinical recovery.Conclusions: ECMO was safely and successfully used to provide a period of lung rest and time for medical therapy to take effect in a child with an unusual indication for support: a rare disease with an uncertain outcome on the background of prolonged mechanical ventilation. [ABSTRACT FROM AUTHOR]

The article discusses the results of clinical research studies on the management of acute respiratory distress syndrome (ARDS). Topics discussed include the reason behind the use of prone position in the management of patients with ARDS, influence of extracorporeal membrane oxygenation on mortality rate in intensive care units, prevention of ARDS, and long-term outcome.

Objective: To compare the effects of inhaled nitric oxide (NO) and an infusion of prostacyclin (PGI2) on right ventricular function in patients with severe acute respiratory distress syndrome (ARDS).Design: Randomized prospective short-term study.Setting: Post-surgical ICU in an university hospital.Patients: 10 patients with severe ARDS referred to our hospital for intensive care.Interventions: In random sequence the patients inhaled NO at a concentration of 18 parts per million (ppm) followed by 36 ppm, and received an intravenous infusion of PGI2 (4 ng.kg-1.min-1).Measurements and Results: Inhalation of 18 ppm NO reduced the mean (+/- SE) pulmonary artery pressure (PAP) from 33 +/- 2 to 28 +/- 1 mmHg (p = 0.008), increased right ventricular ejection fraction (RVEF), as assessed by thermodilution technique, from 28 +/- 2 to 32 +/- 2% (p = 0.005), decreased right ventricular end-diastolic volume index from 114 +/- 6 to 103 +/- 8 ml.m-2 (p = 0.005) and right ventricular end-systolic volume index from 82 +/- 4 to 70 +/- 5 ml.m-2 (p = 0.009). Mean arterial pressure (MAP) and cardiac index (CI) did not change significantly. The effects of 36 ppm NO were not different from the effects of 18 ppm NO. Infusion of PGI2 reduced PAP from 34 +/- 2 to 30 +/- 2 mmHg (p = 0.02), increased RVEF from 29 +/- 2 to 32 +/- 2% (p = 0.02). Right ventricular end-diastolic and end-systolic volume indices did not change significantly. MAP decreased from 80 +/- 4 to 70 +/- 5 mmHg (p = 0.03), and CI increased from 4.0 +/- 0.5 to 4.5 +/- 0.5 l.min-1.m-2 (p = 0.02).Conclusions: Using a new approach to selective pulmonary vasodilation by inhalation of NO, we demonstrate in this group of ARDS patients that an increase in RVEF is not necessarily associated with a rise in CI. The increase in CI during PGI2 infusion is probably related to the systemic effect of this substance. [ABSTRACT FROM AUTHOR]

The article offers information on the cardiac intensive care units (ICU) in Croatia. Topics discussed include the number of cardiac ICUs per million inhabitants in Croatia according to data from a Web survey in September and October 2016, impact of the introduction of an extracorporeal membrane oxygenation (ECMO) program in Croatia in 2008, and role of the country's financial development in the improvement in Croatian cardiac ICU network organisation.

The article explores the ethical challenges posed by decision-making for patients on extracorporeal life support or veno-arterial extracorporeal membrane oxygenation (ECMO). Topics covered include impact of deferring the decision to discontinue ECMO on the patient or surrogate, the burden that some intensive care staff may feel in the event of the cessation of ECMO, and recommendations to clinicians and intensivists in addressing common ethical questions.

A letter to the editor is presented in response to the article "Mortality in children with respiratory failure transported using high-frequency oscillatory ventilation" by P. Jones and colleagues.

A letter to the editor is presented in response to the article on acute respiratory distress syndrome (ARDS) and extracorporeal membrane oxygenation (ECMO), weaning, mechanical ventilation, noninvasive ventilation, pediatrics and miscellanea by M. Antonelli and colleagues.

A response from the authors of the article "Incorporation of a Hemofilter Circuit Into Venoarterial Extracorporeal Membrane Oxygenation: A Novel Approach to Provide More Oxygenation," published in the journal "Intensive Care Medicine" in 2015, is presented. [ABSTRACT FROM AUTHOR]

The article discusses research on mortality in children with respiratory failure transported using high-frequency oscillatory ventilation (HFOV) at the Hôpital Robert Debré. Topics covered include how the study showed that HFOV during transport could lower the overall numbers of children being connected to extracorporeal membrane oxygenation (ECMO).

A letter to the editor is presented in response to the article "Incorporation of a Hemofilter Circuit Into Venoarterial Extracorporeal Membrane Oxygenation: A Novel Approach to Provide More Oxygenation" by Z. Zhang et al., published in the journal "Intensive Care Medicine" in 2015. [ABSTRACT FROM AUTHOR]