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1. Treatments for intracranial hypertension in acute brain-injured patients: grading, timing, and association with outcome. Data from the SYNAPSE-ICU study

Author

Robba, Chiara, Graziano, Francesca, Guglielmi, Angelo, Rebora, Paola, Galimberti, Stefania, Taccone, Fabio S, Citerio, Giuseppe, Walter Videtta, Gustavo Domeniconi, María Estrella Giménez, Mariela Fumale, Edgar Daniel Amundarain, Matias Casanova, Michael Reade, Elizabeth Hallt, David Pearson, Ian Seppelt, Raimund Helbok, Valery Davidovich, Geert Meyfroidt, Ilaria Alice Crippa, Liese Mebis, Patrick Biston, Stijn Van De Velde, Glorieux Denis, Pedro Kurtz, Samia Yasin Wayhs, Mypinder Sekhon, Donald Griesdale, Andrea Rigamonti, José Miguel Montes, Rodrigo Pérez-Araos, Jorge H Mejia-Mantilla, Andrés Gempeler, Ray Mendoza, Natasa Kovac, Hedgar Berty Gutiérrez, Vera Spatenkova, Marek Fencl, Roman Gal, Ondrej Hrdy, Kamil Vrbica, Josef Skola, Eva Provaznikova, Jakub Kletecka, Pavel Lavicka, Piergiorgio Bresil, Marianne Levin, Josefine Thomsen, Thomas Egmose Larsen, Henrik Westy Hoffmeyer, Morten Olskjaer Holm, Jesper Borg Andersen, Birgitte Majholm, Margit Smitt, Heidi Shil Eddelien, Manuel Jibaja, Freddy Maldonado, María Fernanda García, Karim Asehnoune, Bertrand Pons, Gérard Audibert, Manon Lucca, Guillaume Besch, Pierluigi Banco, Raphael Cinotti, Hervé Q Uintard, Benjamin Soyer, Anais Caillard, Clement Gakuba, Romain Sonneville, Stefan Wolf, Kristina Fuest, Lea Albrecht, Sarah Grotheer, Sandro M Krieg, Stefan J Schaller, Charikleia Vrettou, Eftychia Kontoudaki, Anna Efthymiou, Elena Palli, Demosthenes Makris, Chrysi Diakaki, Christina Iasonidou, Aikaterini Dimoula, Georgios Koukoulitsios, George Kyriazopoulos, Nikolas Pantelas, Syragoula Tsikriki, Electra Eleni Stamou, Achileas Giannopoulos, Eleni Mouloudi, Ping Shum Hoi, Yan Chan Cheuk, Hewa Kandamby Darshana, Krisztián Tánczos, Gabor Nardai, Zoltan Szentkereszty, Harsh Sapra, Deepak Gupta, Kaveri Sharma, Saurabh Anand, Ankur Luthra, Summit Bloria, Rajeev Chauhan, Nidhi Panda, Ahmad Ozair, Bram Kilapong, Anass Alsudani, Giuseppe Citerio, Alessandra Soragni, Alessandro Motta, Andrea Marudi, Elisabetta Bertellini, Anselmo Caricato, Camilla Gelormini, Eleonora Ioannoni, Eleonora Stival, Serena Silva, Federico Pozzi, Iole Brunetti, Andrea Cortegiani, Edoardo Picetti, Federico Villa, Italo Calamai, Maria Chiara Casadio, Maria Concetta Quartarone, Marzia Grandis, Federico Magni, Silvia Del Bianco, Claudia Bonetti, Virginia Buldini, Aimone Giugni, Simone Maria Zerbi, Marco Carbonara, Antonella Cotoia, Antonio Izzi, Olegs Sabelnikovs, Muhammed Elhadi, Hazem Ahmed, Silvio A Ñamendys Silva, Gilberto Adrian Gasca López, Gentle S Shrestha, Shirish Maskey, Tamanna Bajracharya, Khadka Nilam, Prakash Kafle, Laleet Rajbanshi, Yam Bahadur Roka, Olufemi Idowu, Khan Muhammad Mukhtar, Juan Luis Pinedo Portilla, Klaudyna Kojder, Irene Aragao, Ricardo Freitas, Marco Simoes, Dario Batista, Cecília Pacheco, Fátima Assunção, Luís Lencastre, Pedro Cavaleiro, Mohamed Abdelaty, Alex Gritsan, Sergey Khomiakov Sergey, Dovbysh Nikolay, Yaseen Arabi, Primoz Gradisek, Petra Forjan, Mara Škoti, Suada Filekovic Ribaric, Nataša Milivojevic, Sergeja Kozar, Rafael Badenes, Aaron Blandino Ortiz, Mikel Celaya Lopez, Laura Galarza, Luisa Corral, Africa Lores, Ricard Soley, Laura Pariente, Pablo López Ojeda, Maria Dolores Arias Verdu, Luis Javier Yuste Dominguez, Maria Isabel Gonzalez Perez, Mireia Anglada, Patricia Duque, Ainhoa Serrano, Berta Monleon, Vanessa Blazquez, Mauro Oddo, Samia Abed Maillard, Paola Morelli, John-Paul Miroz, Eva Favre, Walid Sellami, Massimo Lamperti, Jamil Dibu, Richard Sivities, Angelos Kolias, Chris Thompson, Christopher Hawthorne, Justin Roberts, Lara Prisco, Roger Lightfoot, Josè I Suarez, Luci Rivera-Lara, Susanne Muehlschlegel, Juan Padilla, Sanjeev Sivakumar, Daiwai Olson, Robba, C, Graziano, F, Guglielmi, A, Rebora, P, Galimberti, S, Taccone, F, Citerio, G, Robba, Chiara, Graziano, Francesca, Guglielmi, Angelo, Rebora, Paola, Galimberti, Stefania, Taccone, Fabio S, Citerio, Giuseppe, and Walter Videtta, Gustavo Domeniconi, María Estrella Giménez, Mariela Fumale, Edgar Daniel Amundarain, Matias Casanova, Michael Reade, Elizabeth Hallt, David Pearson, Ian Seppelt, Raimund Helbok, Valery Davidovich, Geert Meyfroidt, Ilaria Alice Crippa, Liese Mebis, Patrick Biston, Stijn Van De Velde, Glorieux Denis, Pedro Kurtz, Samia Yasin Wayhs, Mypinder Sekhon, Donald Griesdale, Andrea Rigamonti, José Miguel Montes, Rodrigo Pérez-Araos, Jorge H Mejia-Mantilla, Andrés Gempeler, Ray Mendoza, Natasa Kovac, Hedgar Berty Gutiérrez, Vera Spatenkova, Marek Fencl, Roman Gal, Ondrej Hrdy, Kamil Vrbica, Josef Skola, Eva Provaznikova, Jakub Kletecka, Pavel Lavicka, Vera Spatenkova, Piergiorgio Bresil, Marianne Levin, Piergiorgio Bresil, Josefine Thomsen, Thomas Egmose Larsen, Henrik Westy Hoffmeyer, Morten Olskjaer Holm, Jesper Borg Andersen, Birgitte Majholm, Margit Smitt, Heidi Shil Eddelien, Manuel Jibaja, Freddy Maldonado, María Fernanda García, Karim Asehnoune, Bertrand Pons, Gérard Audibert, Manon Lucca, Guillaume Besch, Pierluigi Banco, Karim Asehnoune, Raphael Cinotti, Hervé Q Uintard, Benjamin Soyer, Anais Caillard, Clement Gakuba, Romain Sonneville, Stefan Wolf, Kristina Fuest, Lea Albrecht, Sarah Grotheer, Sandro M Krieg, Stefan J Schaller, Charikleia Vrettou, Eftychia Kontoudaki, Anna Efthymiou, Elena Palli, Demosthenes Makris, Chrysi Diakaki, Christina Iasonidou, Aikaterini Dimoula, Georgios Koukoulitsios, George Kyriazopoulos, Nikolas Pantelas, Syragoula Tsikriki, Electra Eleni Stamou, Charikleia Vrettou, Achileas Giannopoulos, Eleni Mouloudi, Ping Shum Hoi, Yan Chan Cheuk, Hewa Kandamby Darshana, Krisztián Tánczos, Gabor Nardai, Zoltan Szentkereszty, Harsh Sapra, Deepak Gupta, Kaveri Sharma, Saurabh Anand, Ankur Luthra, Summit Bloria, Rajeev Chauhan, Nidhi Panda, Ahmad Ozair, Bram Kilapong, Anass Alsudani, Giuseppe Citerio, Alessandra Soragni, Alessandro Motta, Andrea Marudi, Elisabetta Bertellini, Anselmo Caricato, Camilla Gelormini, Eleonora Ioannoni, Eleonora Stival, Serena Silva, Federico Pozzi, Iole Brunetti, Andrea Cortegiani, Edoardo Picetti, Federico Villa, Italo Calamai, Maria Chiara Casadio, Maria Concetta Quartarone, Marzia Grandis, Federico Magni, Silvia Del Bianco, Claudia Bonetti, Virginia Buldini, Aimone Giugni, Simone Maria Zerbi, Marco Carbonara, Antonella Cotoia, Antonio Izzi, Olegs Sabelnikovs, Muhammed Elhadi, Hazem Ahmed, Silvio A Ñamendys Silva, Gilberto Adrian Gasca López, Gentle S Shrestha, Shirish Maskey, Tamanna Bajracharya, Khadka Nilam, Prakash Kafle, Laleet Rajbanshi, Yam Bahadur Roka, Olufemi Idowu, Khan Muhammad Mukhtar, Juan Luis Pinedo Portilla, Klaudyna Kojder, Irene Aragao, Ricardo Freitas, Marco Simoes, Dario Batista, Cecília Pacheco, Fátima Assunção, Luís Lencastre, Pedro Cavaleiro, Mohamed Abdelaty, Alex Gritsan, Sergey Khomiakov Sergey, Dovbysh Nikolay, Yaseen Arabi, Primoz Gradisek, Petra Forjan, Mara Škoti, Suada Filekovic Ribaric, Primoz Gradisek, Nataša Milivojevic, Sergeja Kozar, Rafael Badenes, Aaron Blandino Ortiz, Mikel Celaya Lopez, Laura Galarza, Luisa Corral, Africa Lores, Ricard Soley, Laura Pariente, Pablo López Ojeda, Maria Dolores Arias Verdu, Luis Javier Yuste Dominguez, Maria Isabel Gonzalez Perez, Mireia Anglada, Patricia Duque, Ainhoa Serrano, Berta Monleon, Vanessa Blazquez, Mauro Oddo, Samia Abed Maillard, Paola Morelli, John-Paul Miroz, Eva Favre, Walid Sellami, Massimo Lamperti, Jamil Dibu, Richard Sivities, Angelos Kolias, Chris Thompson, Christopher Hawthorne, Justin Roberts, Lara Prisco, Roger Lightfoot, Josè I Suarez, Luci Rivera-Lara, Susanne Muehlschlegel, Juan Padilla, Sanjeev Sivakumar, Daiwai Olson

Subjects
Subarachnoid haemorrhage, Traumatic brain injury, Intracranial pressure, Therapy intensity level, Critical Care and Intensive Care Medicine, Intracranial haemorrhage
Abstract

Purpose: Uncertainties remain about the safety and efficacy of therapies for managing intracranial hypertension in acute brain injured (ABI) patients. This study aims to describe the therapeutical approaches used in ABI, with/without intracranial pressure (ICP) monitoring, among different pathologies and across different countries, and their association with sixmonths mortality and neurological outcome. Methods: A preplanned subanalysis of the SYNAPSE-ICU study, a multicentre, prospective, international, observational cohort study, describing the ICP treatment, graded according to Therapy Intensity Level (TIL) scale, in patients with ABI during the first week of intensive care unit (ICU) admission. Results: 2320 patients were included in the analysis. The median age was 55 (I-III quartiles = 39-69) years, and 800 (34.5%) were female. During the first week from ICU admission, no-basic TIL was used in 382 (16.5%) patients, mild-moderate in 1643 (70.8%), and extreme in 295 cases (eTIL, 12.7%). Patients who received eTIL were younger (median age 49 (I-III quartiles = 35-62) vs 56 (40-69) years, p

Published
2023
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2. Clinical and organizational factors associated with mortality during the peak of first COVID-19 wave

Author

Greco, Massimiliano, De Corte, Thomas, Ercole, Ari, Antonelli, Massimo, Azoulay, Elie, Citerio, Giuseppe, Morris, Andy Conway, De Pascale, Gennaro, Duska, Frantisek, Elbers, Paul, Einav, Sharon, Forni, Lui, Galarza, Laura, Girbes, Armand R J, Grasselli, Giacomo, Gusarov, Vitaly, Jubb, Alasdair, Kesecioglu, Jozef, Lavinio, Andrea, Delgado, Maria Cruz Martin, Mellinghoff, Johannes, Myatra, Sheila Nainan, Ostermann, Marlies, Pellegrini, Mariangela, Povoa, Pedro, Schaller, Stefan J, Teboul, Jean-Louis, Wong, Adrian, De Waele, Jan J, Cecconi, Maurizio, Marco, Bezzi, Alicia, Gira, Philipp, Eller, Tarikul, Hamid, Injamam Ull Haque, Wim De Buyser, Antonella, Cudia, Daniel De Backer, Pierre, Foulon, Vincent, Collin, Jan De Waele, Jolien Van Hecke, Elisabeth De Waele, Claire Van Malderen, Jean-Baptiste, Mesland, Patrick, Biston, Michael, Piagnerelli, Lionel, Haentjens, Nicolas De Schryver, Jan Van Leemput, Philippe, Vanhove, Pierre, Bulpa, Viktoria, Ilieva, David, Katz, Alexandra, Binnie, Anna, Geagea, Fernando, Tirapegui, Gustavo, Lago, Jerónimo, Graf, Rodrigo, Perez-Araos, Patricio, Vargas, Felipe, Martinez, Eduardo, Labarca, Daniel Molano Franco, Daniela, Parra-Tanoux, Luis Felipe Reyes, David, Yepes, Filip, Periš, Sanda Stojanović Stipić, Cynthia Vanessa Campozano Burgos, Paulo Roberto Navas Boada, Jose Luis Barberan Brun, Juan Pablo Paredes Ballesteros, Gamal, Abdelnasser, Ahmed, Hammouda, Omar, Elmandouh, Ahmed, Azzam, Aliae Mohamed Hussein, Islam, Galal, Awad, Ahmed K., Azab, Mohammed A., Maged, Abdalla, Hebatallah, Assal, Mostafa, Alfishawy, Sherief, Ghozy, Samar, Tharwat, Abdullah, Eldaly, Anneli, Ellervee, Veronika, Reinhard, Anne, Chrisment, Chrystelle, Poyat, Julio, Badie, Fernando Berdaguer Ferrari, Björn, Weiss, Clara, Schellenberg, Grunow, Julius J., Marco, Lorenz, Schaller, Stefan J., Peter, Spieth, Marc, Bota, Falk, Fichtner, Kristina, Fuest, Tobias, Lahmer, Johannes, Herrmann, Patrick, Meybohm, Nikolaos, Markou, Georgia, Vasileiadou, Evangelia, Chrysanthopoulou, Panagiotis, Papamichalis, Ioanna, Soultati, Sameer, Jog, Kushal, Kalvit, Sheila Nainan Myatra, Ivan, Krupa, Aisa, Tharwat, Alistair, Nichol, Aine, Mccarthy, Ata, Mahmoodpoor, Tommaso, Tonetti, Paolo, Isoni, Savino, Spadaro, Carlo Alberto Volta, Lucia, Mirabella, Alberto, Noto, Gaetano, Florio, Amedeo, Guzzardella, Chiara, Paleari, Federica, Baccanelli, Marzia, Savi, Massimo, Antonelli, Gennaro De Pascale, San, Luca, Barbara, Vaccarini, Giorgia, Montrucchio, Gabriele, Sales, Donadello, Katia, Leonardo, Gottin, Marta, Nizzero, Enrico, Polati, De Rosa, Silvia, Demet, Sulemanji, Abdurraouf, Abusalama, Muhammed, Elhadi, Montelongo De FelipeJesus, Daniel Rodriguez Gonzalez, Victor Hugo Madrigal Robles, Nancy, Canedo, Alejandro Esquivel Chavez, Tarek, Dendane, Bart, Grady, Ben de Jong, Eveline van der Heiden, Patrick, Thoral, Bas van den Bogaard, Spronk, Peter E., Sefanja, Achterberg, Melanie, Groeneveld, Ralph K. L., So, Calvin de Wijs, Harm, Scholten, Albertus, Beishuizen, Cornet, Alexander D., Reidinga, Auke C., Hetty, Kranen, Roos, Mensink, Spaarne, Gasthuis, Sylvia den Boer, Marcel de Groot, Oliver, Beck, Carina, Bethlehem, Bas van Bussel, Tim, Frenzel, Celestine de Jong, Rob, Wilting, Jozef, Kesecioglu, Jannet, Mehagnoul-Schipper, Datonye, Alasia, Ashok, Kumar, Ahad, Qayyum, Muhammad, Rana, Mustafa Abu Jayyab, Rosario Quispe Sierra, Aaron Mark Hernandez, José de Almeida, Lúcia, Taborda, Mónica, Anselmo, Tiago, Ramires, Catarina, Silva, Carolina, Roriz, Rui, Morais, Pedro, Póvoa, Patricia, Patricio, André, Pinto, Maria Lurdes Santos, Vasco, Costa, Pedro, Cunha, Celina, Gonçalves, Sandra, Nunes, João, Camões, Diana, Adrião, Ana, Oliveira, Ali, Omrani, Muna Al Maslamani, Abdurrahmaan Suei elbuzidi, Bara Mahmoud Al qudah, Abdel Rauof Akkari, Mohamed, Alkhatteb, Anas, Baiou, Ahmed, Husain, Mohamed, Alwraidat, Ibrahim Abdulsalam Saif, Dana, Bakdach, Amna, Ahmed, Mohamed, Aleef, Awadh, Bintaher, Cristina, Petrisor, Evgeniy, Popov, Ksenia, Popova, Mariia, Dementienko, Boris, Teplykh, Alexey, Pyregov, Liubov, Davydova, Belskii, Vladislav, Elena, Neporada, Ivan, Zverev, Svetlana, Meshchaninova, Dmitry, Sokolov, Elena, Gavrilova, Irina, Shlyk, Igor, Poliakov, Marina, Vlasova, Ohoud, Aljuhani, Amina, Alkhalaf, Felwa Bin Humaid, Yaseen, Arabi, Ahmed, Kuhail, Omar, Elrabi, Ghannam, Madihah E., Ng Teng Fong, Amit, Kansal, Vui Kian Ho, Jensen, Ng, Raquel Rodrígez García, Xiana Taboada Fraga, Mª del Pilar García-Bonillo, Antonio, Padilla-Serrano, Marta Martin Cuadrado, Carlos, Ferrando, Ignacio, Catalan-Monzon, Laura, Galarza, Fernando, Frutos-Vivar, Jorge, Jimenez, Carmen, Rodríguez-Solis, Enric, Franquesa-Gonzalez, Guillermo Pérez Acosta, Luciano Santana Cabrera, Juan Pablo Aviles Parra, Francisco Muñoyerro Gonzalez, Maria del Carmen Lorente Conesa, Ignacio Yago Martinez Varela, Orville Victoriano Baez Pravia, Maria Cruz Martin Delgado, Carlos Munoz de Cabo, Ana-Maria, Ioan, Cesar, Perez-Calvo, Arnoldo, Santos, Ane, Abad-Motos, Javier, Ripolles-Melchor, Belén Civantos Martin, Santiago Yus Teruel, Juan Higuera Lucas, Aaron Blandino Ortiz, Raúl de Pablo Sánchez, Jesús Emilio Barrueco-Francioni, Lorena Forcelledo Espina, Bonell-Goytisolo, José M., Iñigo, Salaverria, Antonia Socias Mir, Emilio, Rodriguez-Ruiz, Virginia Hidalgo Valverde, Patricia Jimeno Cubero, Francisca Arbol Linde, Nieves Cruza Leganes, Juan Maria Romeu, Pablo, Concha, José Angel Berezo-Garcia, Virginia, Fraile, Cristina, Cuenca-Rubio, David, Pérez-Torres, Ainhoa, Serrano, Clara Martínez Valero, Andrea Ortiz Suner, Leire, Larrañaga, Noemi, Legaristi, Gerardo, Ferrigno, Safa, Khlafalla, Rosita, Bihariesingh-Sanchit, Hallands, Sjukhus, Frank, Zoerner, Jonathan, Grip, Kristina, Kilsand, Johan, Mårtensson, Jonas, Österlind, Akademiska, Sjukhuset, Magnus von Seth, Västerviks, Sjukhus, Johan, Berkius, Samuele, Ceruti, Andrea, Glotta, Seval, Izdes, Işıl Özkoçak Turan, Ahmet, Cosar, Burcin, Halacli, Necla, Dereli, Mehmet, Yilmaz, Türkay, Akbas, Gülseren, Elay, Selin, Eyüpoğlu, Yelíz, Bílír, Kemal Tolga Saraçoğlu, Ebru, Kaya, Ayca Sultan Sahin, Pervin Korkmaz Ekren, Tuğçe, Mengi, Kezban Ozmen Suner, Yakup, Tomak, Ahmet, Eroglu, Asad, Alsabbah, Katie, Hanlon, Kevin, Gervin, Sean, Mcmahon, Samantha, Hagan, Higenbottam, Caroline V., Randeep, Mullhi, Lottie, Poulton, Tomasz, Torlinski, Allen, Gareth, Nick, Truman, Gopal, Vijayakumar, Chris, Hall, Alasdair, Jubb, Lenka, Cagova, Nicola, Jones, Sam, Graham, Nicole, Robin, Amanda, Cowton, Adrian, Donnelly, Natalia, Singatullina, Melanie, Kent, Carole, Boulanger, Zoë, Campbell, Elizabeth, Potter, Natalie, Duric, Tamas, Szakmany, Royal, Brompton, Orinta, Kviatkovske, Nandor, Marczin, Caroline, Ellis, Rajnish, Saha, Chunda, Sri-Chandana, John, Allan, Lana, Mumelj, Harish, Venkatesh, Vera Nina Gotz, Anthony, Cochrane, Barbara, Ficial, Shruthi, Kamble, Nuttha, Lumlertgul, Christopher, Oddy, Susan, Jain, Giulia Beatrice Crapelli, Aikaterini, Vlachou, David, Golden, Sweyn, Garrioch, Jeremy, Henning, Gupta, Loveleena, Miriam, Davey, Lina, Grauslyte, Erika, Salciute-Simene, Martin, Cook, Danny, Barling, Phil, Broadhurst, Sarah, Purvis, Michael, Spivey, Benjamin, Shuker, Irina, Grecu, Daniel, Harding, Dean, James T., Nielsen, Nathan D., Sama, Al-Bayati, Mohammed, Al-Sadawi, Mariane, Charron, Peter, Stubenrauch, Jairo, Santanilla, Catherine, Wentowski, Dorothea, Rosenberger, Polikseni, Eksarko, and Randeep Jawa, Greco, Massimiliano [0000-0003-1003-4637], De Corte, Thomas [0000-0001-5011-6640], Ercole, Ari [0000-0001-8350-8093], Antonelli, Massimo [0000-0003-3007-1670], Azoulay, Elie [0000-0002-8162-1508], Citerio, Giuseppe [0000-0002-5374-3161], Morris, Andy Conway [0000-0002-3211-3216], De Pascale, Gennaro [0000-0002-8255-0676], Duska, Frantisek [0000-0003-1559-4078], Elbers, Paul [0000-0003-0447-6893], Einav, Sharon [0000-0001-8963-9633], Forni, Lui [0000-0002-0617-5309], Galarza, Laura [0000-0002-4658-748X], Girbes, Armand RJ [0000-0002-0711-0494], Grasselli, Giacomo [0000-0002-1735-1400], Gusarov, Vitaly [0000-0002-2900-1459], Jubb, Alasdair [0000-0001-5593-866X], Kesecioglu, Jozef [0000-0002-3007-8445], Lavinio, Andrea [0000-0002-8832-918X], Delgado, Maria Cruz Martin [0000-0002-7468-4594], Mellinghoff, Johannes [0000-0002-5455-8953], Myatra, Sheila Nainan [0000-0001-6761-163X], Ostermann, Marlies [0000-0001-9500-9080], Pellegrini, Mariangela [0000-0001-5668-7399], Povoa, Pedro [0000-0002-7069-7304], Schaller, Stefan J [0000-0002-6683-9584], Teboul, Jean-Louis [0000-0002-5748-7820], Wong, Adrian [0000-0003-4968-7328], De Waele, Jan J [0000-0003-1017-9748], Cecconi, Maurizio [0000-0002-4376-6538], Apollo - University of Cambridge Repository, Intensive care medicine, ACS - Diabetes & metabolism, AII - Infectious diseases, Greco, M, De Corte, T, Ercole, A, Antonelli, M, Azoulay, E, Citerio, G, Morris, A, De Pascale, G, Duska, F, Elbers, P, Einav, S, Forni, L, Galarza, L, Girbes, A, Grasselli, G, Gusarov, V, Jubb, A, Kesecioglu, J, Lavinio, A, Delgado, M, Mellinghoff, J, Myatra, S, Ostermann, M, Pellegrini, M, Povoa, P, Schaller, S, Teboul, J, Wong, A, De Waele, J, Cecconi, M, UCL - SSS/DDUV/GECE - Génétique cellulaire, UCL - (SLuc) Service de soins intensifs, investigators, ESICM UNITE-COVID, Girbes, Armand R. J. [0000-0002-0711-0494], Schaller, Stefan J. [0000-0002-6683-9584], and De Waele, Jan J. [0000-0003-1017-9748]

Subjects
Adult, Anestesi och intensivvård, Anesthesiology and Intensive Care, Original, SARS-CoV-2, Critical Illness, Other Research Radboud Institute for Health Sciences [Radboudumc 0], ACUTE KIDNEY INJURY, COVID-19, CORONAVIRUS DISEASE 2019, Pneumonia, Acute Kidney Injury, Critical Care and Intensive Care Medicine, Respiration, Artificial, Surge capacity, Critical care, Intensive Care Units, Settore MED/41 - ANESTESIOLOGIA, Medicine and Health Sciences, Humans, CRITICALLY-ILL PATIENTS
Abstract

Purpose To accommodate the unprecedented number of critically ill patients with pneumonia caused by coronavirus disease 2019 (COVID-19) expansion of the capacity of intensive care unit (ICU) to clinical areas not previously used for critical care was necessary. We describe the global burden of COVID-19 admissions and the clinical and organizational characteristics associated with outcomes in critically ill COVID-19 patients. Methods Multicenter, international, point prevalence study, including adult patients with SARS-CoV-2 infection confirmed by polymerase chain reaction (PCR) and a diagnosis of COVID-19 admitted to ICU between February 15th and May 15th, 2020. Results 4994 patients from 280 ICUs in 46 countries were included. Included ICUs increased their total capacity from 4931 to 7630 beds, deploying personnel from other areas. Overall, 1986 (39.8%) patients were admitted to surge capacity beds. Invasive ventilation at admission was present in 2325 (46.5%) patients and was required during ICU stay in 85.8% of patients. 60-day mortality was 33.9% (IQR across units: 20%-50%) and ICU mortality 32.7%. Older age, invasive mechanical ventilation, and acute kidney injury (AKI) were associated with increased mortality. These associations were also confirmed specifically in mechanically ventilated patients. Admission to surge capacity beds was not associated with mortality, even after controlling for other factors. Conclusions ICUs responded to the increase in COVID-19 patients by increasing bed availability and staff, admitting up to 40% of patients in surge capacity beds. Although mortality in this population was high, admission to a surge capacity bed was not associated with increased mortality. Older age, invasive mechanical ventilation, and AKI were identified as the strongest predictors of mortality. Correction in: Intensive Care Medicine, vol. 48, issue 8, pages 1130-1131.DOI: 10.1007/s00134-022-06801-2

Published
2022
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3. Outcome of elderly patients with circulatory failure

Author

Cesar Aldecoa, Jacques Devriendt, Patrick Biston, C Madl, Didier Chochrad, Daniel De Backer, and Jean Louis Vincent

Subjects
Adult, medicine.medical_specialty, Organ Dysfunction Scores, health care facilities, manpower, and services, CIRCULATORY FAILURE, Critical Care and Intensive Care Medicine, Young Adult, Age Distribution, Anesthesiology, Outcome Assessment, Health Care, Humans, Multicenter Studies as Topic, Vasoconstrictor Agents, Medicine, Hospital Mortality, Young adult, Intensive care medicine, Survival rate, APACHE, Aged, Randomized Controlled Trials as Topic, Aged, 80 and over, business.industry, Mortality rate, Shock, Middle Aged, Survival Rate, Shock (circulatory), Circulatory system, Emergency medicine, medicine.symptom, business
Abstract

The proportion of elderly patients admitted to the ICU is increasing. Mortality rates are known to increase with age but the impact of age on outcomes after circulatory shock has not been well defined.We performed a secondary analysis of data from a large randomized trial comparing the effects of dopamine and norepinephrine on outcome in the ICU. Patients were separated into not old (75 years), old (75-84 years), and very old (≥85 years).Of the 1,679 patients included in the initial trial, 1,651 had sufficient age data available: 1,157 (70%) were not old, 410 (25%) were old, and 84 (5%) were very old. There were minor differences among the age groups in the APACHE II score calculated without the age component (not old, 17 ± 9; old, 18 ± 9; very old, 19 ± 9; p = 0.047), but SOFA scores were similar (not old, 9 ± 4; old, 9 ± 3; very old, 9 ± 3; p = 0.76). Mortality rates were higher in old and very old patients at 28 days, at hospital discharge, and after 6 and 12 months. Most very old patients were dead at 6 (92%) and 12 months (97%). Mortality rates increased with age in all types of shock. Using multivariable analysis, the risk of death was higher in very old patients as compared to not old (adjusted OR 0.33, 95% CI 0.2-0.56, p0.001).Ageing is independently associated with higher mortality rates in patients with circulatory failure, whatever the etiology. By 1 year after admission, most patients 85 years of age and older were dead.

Published
2013
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4. Severe hyperkalemia in critically ill patients treated with prophylactic doses of enoxaparin

Author

Patrick Biston, Eric Carlier, Pierre Defrance, Michael Piagnerelli, and Christine Danguy

Subjects
Creatinine, Hyperkalemia, business.industry, Potassium, Insulin, medicine.medical_treatment, chemistry.chemical_element, Heparin, Critical Care and Intensive Care Medicine, medicine.disease, Fondaparinux, Sepsis, chemistry.chemical_compound, chemistry, Anesthesia, medicine, medicine.symptom, business, Sodium Polystyrene Sulfonate, medicine.drug
Abstract

Dear Editor, Low-molecular-weight heparin (LMWH) is extensively used in intensive care unit (ICU) patients for prevention of thrombosis, with few adverse effects [1]. We report three cases of severe hyperkalemia induced by prophylactic doses of enoxaparin. A 71-year-old diabetic man was admitted for sepsis, with creatinine and serum potassium concentrations of 1.5 mg/dL and 2.0 mEq/L. Potassium increased to 4.7 mEq/L with 60 mEq/day supplement. On day 4, potassium supplement was stopped and enoxaparin started [40 mg subcutaneously (SC) once daily (o.d.)]. By day 6, potassium had increased to 6.1 mEq/L and was resistant to insulin/dextrose and sodium polystyrene sulfonate (SPS) treatments. Enoxaparin was discontinued, and potassium decreased in 4 days. A few days later, enoxaparin (20 mg o.d.) was reintroduced and potassium increased to 5.2 mEq/L. The patient was treated with SPS and discharged without thrombosis prophylaxis (Fig. 1a). A 63-year-old diabetic woman was admitted with cardiogenic shock. Creatinine was 0.7 mg/dL. Enoxaparin 20 mg o.d. was started and increased to 40 mg o.d. after 4 days. Serum potassium increased to 6.1 mEq/L within 3 days. The hyperkalemia was resistant to SPS treatment, and enoxaparin was withdrawn, following which there was a decrease in the potassium level. A few days later, enoxaparin was reintroduced and potassium increased again to 5.3 mEq/L rapidly. Enoxaparin was switched to fondaparinux (2.5 mg o.d.), and the potassium returned to normal values (Fig. 1b). A 71-year-old woman, treated for arterial hypertension, was admitted for spinal cord injury. Her creatinine concentration was 0.4 mg/dL. Five days after surgery, enoxaparin (40 mg o.d.) was started. Potassium rapidly increased, needing treatment with SPS. Enoxaparin was switched to fondaparinux (2.5 mg o.d.), resulting in a decrease in potassium to 4.6 mEq/L. A few days later

Published
2012
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5. End-tidal carbon dioxide and arterial pressure for predicting volume responsiveness by the passive leg raising test: a commentary

Author

Patrick Biston and Michael Piagnerelli

Subjects
Male, Mechanical ventilation, ARDS, education.field_of_study, business.industry, medicine.medical_treatment, Population, Carbon Dioxide, Critical Care and Intensive Care Medicine, medicine.disease, Pulse pressure, Passive leg raising test, Preload, Blood pressure, Lower Extremity, Anesthesia, medicine, Humans, Arterial Pressure, Female, Cardiac Output, business, education, Tidal volume
Abstract

Dear Editor, We read with interest the manuscript by Monnet et al. [1] concerning the role of end-tidal carbon dioxide (etCO2) in predicting volume responsiveness by the passive leg raising (PLR) test. If we agree with these distinguished experts that it is important to study indices of preload dependence, in order to limit the deleterious effects of overfilling of critically ill patients, we just want to draw readers’ attention to some limitations of this study. Indeed, we believe that the inclusion criteria for patients were not optimal to reach the same conclusions as the authors. First, the authors included 65 patients of which 17 % had arrhythmias [1]. We agree with the authors that the aim of this work is not to study the prediction of volume responsiveness by the pulse pressure analysis and, as reported by the authors [1] as well as in a meta-analysis [2], the sensitivity of PLR remains good despite arrhythmia. However, a comparison of results between patients with or without arrhythmia could enhance the benefit of etCO2 on volume responsiveness by the PLR test. In addition, the article does not mention the proportion of patients with arrhythmia that were included in the PLR test. Second, 97 % of the patients included were in septic shock with ARDS [1]. As described by the same authors in other works, introduction of or change in norepinephrine dosage could influence the cardiac preload and minimize the variation of pulse pressure. Were modifications of norepinephrine between measurements in the patients studied? Moreover, do we see the same results in patients without norepinephrine? Third, the tidal volume used (6.4 ± 0.8 ml/kg of predicted body weight) in these patients was in the range recommended for this particular population. However, it is important to remember the effects of mechanical ventilation on the measurement of the pulse pressure variation as a low tidal volume [3], impaired respiratory system compliance or elevated respiratory rate [4], as all these patients should certainly have had. In other words, the results obtained were perhaps different in patients without ARDS. The authors should be commended for their excellent work, and as mentioned in the discussion, for the importance of these findings in treating the very specific population studied [1]. Further studies on other categories of patients (severe sepsis, without low tidal volume) may confirm the interest of etCO2 as a measure of preload dependence in critically ill patients.

Published
2013
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