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Carboxyhemoglobin predicts oxygenator performance and imminent oxygenator change in extracorporeal membrane oxygenation ICMx Pub Date : 2024-04-24 Rolf Erlebach, Alix Buhlmann, Rea Andermatt, Benjamin Seeliger, Klaus Stahl, Christian Bode, Reto Schuepbach, Pedro David Wendel-Garcia, Sascha David
The continuous exposure of blood to a non-biological surface during extracorporeal membrane oxygenation (ECMO) may lead to progressive thrombus formation in the oxygenator, hemolysis and consequently impaired gas exchange. In most centers oxygenator performance is monitored only on a once daily basis. Carboxyhemoglobin (COHb) is generated upon red cell lysis and is routinely measured with any co-oximetry
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Epstein–Barr virus, Cytomegalovirus, and Herpes Simplex-1/2 reactivations in critically ill patients with COVID-19 ICMx Pub Date : 2024-04-22 Alessia Mattei, Lorenzo Schiavoni, Elisabetta Riva, Massimo Ciccozzi, Roberta Veralli, Angela Urselli, Vincenzo Citriniti, Antonio Nenna, Giuseppe Pascarella, Fabio Costa, Rita Cataldo, Felice Eugenio Agrò, Massimiliano Carassiti
To assess the incidences of Herpes Simplex-1 and 2 (HSV-1, HSV-2), Cytomegalovirus (CMV), Epstein–Barr Virus (EBV) reactivations in critically ill COVID-19 patients. To determine the association between viral reactivation and in-hospital mortality, Intensive Care Unit Bloodstream infection (ICU–BSI), ventilator-associated pneumonia (VAP). Observational retrospective cohort study. COVID-19 Intensive
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Immediate inflammatory response to mechanical circulatory support in a porcine model of severe cardiogenic shock ICMx Pub Date : 2024-04-22 Emilie Gregers, Peter H. Frederiksen, Nanna L. J. Udesen, Louise Linde, Ann Banke, Amalie L. Povlsen, Jeppe P. Larsen, Christian Hassager, Lisette O. Jensen, Jens F. Lassen, Henrik Schmidt, Hanne B. Ravn, Peter M. H. Heegaard, Jacob E. Møller
In selected cases of cardiogenic shock, veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is combined with trans valvular micro axial flow pumps (ECMELLA). Observational studies indicate that ECMELLA may reduce mortality but exposing the patient to two advanced mechanical support devices may affect the early inflammatory response. We aimed to explore inflammatory biomarkers in a porcine
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Ineffectiveness of hemoadsorption in large animals with abdominal sepsis: a randomized controlled porcine study ICMx Pub Date : 2024-04-18 Vaclav Tegl, Jan Horak, Lukas Nalos, Michala Horakova, Milan Stengl, Martin Matejovic, Jan Benes
The use of hemoadsorption (HA) has become popular in the treatment of vasoplegic states associated with massive cytokine release, including septic shock. However, this approach does not seem to be based on robust evidence, and it does not follow international guidelines. To understand the pathophysiological rationale and timing of HA, we conducted a large animal septic shock experiment. Prospective
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Hyperoxemia and hypoxemia impair cellular oxygenation: a study in healthy volunteers ICMx Pub Date : 2024-04-15 Bashar N. Hilderink, Reinier F. Crane, Bas van den Bogaard, Janesh Pillay, Nicole P. Juffermans
Administration of oxygen therapy is common, yet there is a lack of knowledge on its ability to prevent cellular hypoxia as well as on its potential toxicity. Consequently, the optimal oxygenation targets in clinical practice remain unresolved. The novel PpIX technique measures the mitochondrial oxygen tension in the skin (mitoPO2) which allows for non-invasive investigation on the effect of hypoxemia
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Oxygenation and ventilation during prolonged experimental cardiopulmonary resuscitation with either continuous or 30:2 compression-to-ventilation ratios together with 10 cmH20 positive end-expiratory pressure ICMx Pub Date : 2024-04-12 Jukka Kopra, Erik Litonius, Pirkka T. Pekkarinen, Merja Laitinen, Juho A. Heinonen, Luca Fontanelli, Markus B. Skrifvars
In refractory out-of-hospital cardiac arrest, the patient is commonly transported to hospital with mechanical continuous chest compressions (CCC). Limited data are available on the optimal ventilation strategy. Accordingly, we compared arterial oxygenation and haemodynamics during manual asynchronous continuous ventilation and compressions with a 30:2 compression-to-ventilation ratio together with
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The ongoing journey in targeting hemodynamic interventions: missing miles for missing the last micron? ICMx Pub Date : 2024-04-09 Johannes Heymer, Daniel Raepple
With great interest we followed the original work by Bruno et al. [1] assessing sublingual microcirculatory perfusion variables in shock and the following discussion by Hilty et al. [2]. The authors critique the study for its use of unvalidated software and the absence of an effective, hemodynamic monitoring-based treatment plan. They also highlight the study's failure to address different shock types
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Impact of respiratory cycle during mechanical ventilation on beat-to-beat right ventricle stroke volume estimation by pulmonary artery pulse wave analysis ICMx Pub Date : 2024-04-09 Arnoldo Santos, M. Ignacio Monge-García, João Batista Borges, Jaime Retamal, Gerardo Tusman, Anders Larsson, Fernando Suarez-Sipmann
The same principle behind pulse wave analysis can be applied on the pulmonary artery (PA) pressure waveform to estimate right ventricle stroke volume (RVSV). However, the PA pressure waveform might be influenced by the direct transmission of the intrathoracic pressure changes throughout the respiratory cycle caused by mechanical ventilation (MV), potentially impacting the reliability of PA pulse wave
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Isoflurane, like sepsis, decreases CYP1A2 liver enzyme activity in intensive care patients: a clinical study and network model ICMx Pub Date : 2024-04-08 Thomas Köhler, Elke Schwier, Janina Praxenthaler, Carmen Kirchner, Günther Winde, Björn Koos, Dietrich Henzler
Liver function of intensive care patients is routinely monitored by static blood pathology. For specific indications, liver specific cytochrome activity may be measured by the commercially available maximum liver function capacity (LiMAx) test via quantification of the cytochrome P450 1A2 (CYP1A2) dependent C-methacetin metabolism. Sedation with the volatile anesthetic isoflurane was suspected to abrogate
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Reinforcement learning for intensive care medicine: actionable clinical insights from novel approaches to reward shaping and off-policy model evaluation ICMx Pub Date : 2024-03-25 Luca F. Roggeveen, Ali el Hassouni, Harm-Jan de Grooth, Armand R. J. Girbes, Mark Hoogendoorn, Paul W. G. Elbers
Reinforcement learning (RL) holds great promise for intensive care medicine given the abundant availability of data and frequent sequential decision-making. But despite the emergence of promising algorithms, RL driven bedside clinical decision support is still far from reality. Major challenges include trust and safety. To help address these issues, we introduce cross off-policy evaluation and policy
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Determinants of acute kidney injury during high-power mechanical ventilation: secondary analysis from experimental data ICMx Pub Date : 2024-03-21 Simone Gattarello, Fabio Lombardo, Federica Romitti, Rosanna D’Albo, Mara Velati, Isabella Fratti, Tommaso Pozzi, Rosmery Nicolardi, Antonio Fioccola, Mattia Busana, Francesca Collino, Peter Herrmann, Luigi Camporota, Michael Quintel, Onnen Moerer, Leif Saager, Konrad Meissner, Luciano Gattinoni
The individual components of mechanical ventilation may have distinct effects on kidney perfusion and on the risk of developing acute kidney injury; we aimed to explore ventilatory predictors of acute kidney failure and the hemodynamic changes consequent to experimental high-power mechanical ventilation. Secondary analysis of two animal studies focused on the outcomes of different mechanical power
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Flow-controlled ventilation decreases mechanical power in postoperative ICU patients ICMx Pub Date : 2024-03-19 Julien P. Van Oosten, Juliette E. Francovich, Peter Somhorst, Philip van der Zee, Henrik Endeman, Diederik A. M. P. J. Gommers, Annemijn H. Jonkman
Mechanical power (MP) is the energy delivered by the ventilator to the respiratory system and combines factors related to the development of ventilator-induced lung injury (VILI). Flow-controlled ventilation (FCV) is a new ventilation mode using a constant low flow during both inspiration and expiration, which is hypothesized to lower the MP and to improve ventilation homogeneity. Data demonstrating
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The ESICM datathon and the ESICM and ICMx data science strategy ICMx Pub Date : 2024-03-12 Paul Elbers, Patrick Thoral, Lieuwe D. J. Bos, Massimiliano Greco, Pedro D. Wendel-Garcia, Ari Ercole
In this issue of Intensive Care Medicine Experimental we celebrate the success of the ESICM datathons. The fifth consecutive edition was held in the months of May and June, 2023, continuing the tradition of uniting teams of data scientists and intensive care professionals to spend up to 6 weeks to use large intensive care databases to take on clinically relevant challenges and provide new insights
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Impact of age on the host response to sepsis in a murine model of fecal-induced peritonitis ICMx Pub Date : 2024-03-08 Neha Sharma, Alex Chen, Leah Heinen, Ruth Liu, Dhruva J. Dwivedi, Ji Zhou, Manoj M. Lalu, Asher A. Mendelson, Braedon McDonald, Colin A. Kretz, Alison E. Fox-Robichaud, Patricia C. Liaw
Despite older adults being more vulnerable to sepsis, most preclinical research on sepsis has been conducted using young animals. This results in decreased scientific validity since age is an independent predictor of poor outcome. In this study, we explored the impact of aging on the host response to sepsis using the fecal-induced peritonitis (FIP) model developed by the National Preclinical Sepsis
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Individualised flow-controlled ventilation reduces applied mechanical power and improves ventilation efficiency in a porcine intra-abdominal hypertension model ICMx Pub Date : 2024-03-07 Julia Abram, Patrick Spraider, Julian Wagner, Gabriel Putzer, Manuela Ranalter, Sarah Rinner, Andrea Katharina Lindner, Bernhard Glodny, Tobias Hell, Tom Barnes, Dietmar Enk, Judith Martini
Aim of this study was to evaluate feasibility and effects of individualised flow-controlled ventilation (FCV), based on compliance guided pressure settings, compared to standard of pressure-controlled ventilation (PCV) in a porcine intra-abdominal hypertension (IAH) model. The primary aim of this study was to investigate oxygenation. Secondary aims were to assess respiratory and metabolic variables
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The association between coronary artery calcification and vectorcardiography in mechanically ventilated COVID-19 patients: the Maastricht Intensive Care COVID cohort ICMx Pub Date : 2024-03-07 Eda Aydeniz, Frank van Rosmalen, Jip de Kok, Bibi Martens, Alma M. A. Mingels, Mustafa Emin Canakci, Casper Mihl, Kevin Vernooy, Frits W. Prinzen, Joachim E. Wildberger, Iwan C. C. van der Horst, Bas C. T. van Bussel, Rob G. H. Driessen
Coronary artery calcification (CAC) is associated with poor outcome in critically ill patients. A deterioration in cardiac conduction and loss of myocardial tissue could be an underlying cause. Vectorcardiography (VCG) and cardiac biomarkers provide insight into these underlying causes. The aim of this study was to investigate whether a high degree of CAC is associated with VCG-derived variables and
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Six methods to determine expiratory time constants in mechanically ventilated patients: a prospective observational physiology study ICMx Pub Date : 2024-03-07 Filip Depta, Caitlyn M. Chiofolo, Nicolas W. Chbat, Neil R. Euliano, Michael A. Gentile, Dušan Rybár, Viliam Donič, Marko Zdravkovic
Expiratory time constant (τ) objectively assesses the speed of exhalation and can guide adjustments of the respiratory rate and the I:E ratio with the goal of achieving complete exhalation. Multiple methods of obtaining τ are available, but they have not been compared. The purpose of this study was to compare six different methods to obtain τ and to test if the exponentially decaying flow corresponds
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Glucocorticoid use in acute respiratory failure from pulmonary causes and association with early changes in the systemic host immune response ICMx Pub Date : 2024-03-05 Nameer Al-Yousif, Seyed M. Nouraie, Matthew J. Broerman, Yingze Zhang, Tomeka L. Suber, John Evankovich, William G. Bain, Georgios D. Kitsios, Bryan J. McVerry, Faraaz A. Shah
Glucocorticoids are commonly used in patients with or at-risk for acute respiratory distress syndrome (ARDS), but optimal use remains unclear despite well-conducted clinical trials. We performed a secondary analysis in patients previously enrolled in the Acute Lung Injury and Biospecimen Repository at the University of Pittsburgh. The primary aim of our study was to investigate early changes in host
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Can we rely on “calibrated” central venous pressure to measure pleural pressure at the bedside? ICMx Pub Date : 2024-03-04 Alessandro Protti, Maurizio Cecconi
Measuring the transpulmonary (alveolar–pleural) pressure may be important. However, estimating pleural pressure requires esophageal manometry, which is only available at selected centers. Previous studies have suggested that ventilation-induced changes in central venous pressure (∆CVP) may reflect those in pleural pressure (∆Ppl) [1], but results have been conflicting. In this issue of the Journal
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Esmolol increases the fecal abundance of Lactobacillus in a rat model of sepsis ICMx Pub Date : 2024-03-04 Bo Yao, Fu-hua Wang, Xiao-ning Han, Jun Yang, Ping Xue, Qi Qi, Guang-yao Wei, Jin-yan Xing
Disorders of the gut microbiome could be responsible for the progression of multiple organ dysfunction syndrome. In this study, we examined the effect of esmolol on the gut microbiome in a rat model of sepsis induced by cecal ligation and puncture (CLP). The animals (n = 32) were randomly divided into 3 groups: Sham group (sham operation + normal saline treatment, n = 8), CLP group (cecal ligation
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Development of personalized non-invasive ventilation masks for critically ill children: a bench study ICMx Pub Date : 2024-03-01 Rosemijne R. W. P. Pigmans, Rozalinde Klein-Blommert, Monica C. van Gestel, Dick G. Markhorst, Peter Hammond, Pim Boomsma, Tim Daams, Julia M. A. de Jong, Paul M. Heeman, Job B. M. van Woensel, Coen D. Dijkman, Reinout A. Bem
Obtaining a properly fitting non-invasive ventilation (NIV) mask to treat acute respiratory failure is a major challenge, especially in young children and patients with craniofacial abnormalities. Personalization of NIV masks holds promise to improve pediatric NIV efficiency. As current customization methods are relatively time consuming, this study aimed to test the air leak and surface pressure performance
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Lung- and diaphragm-protective strategies in acute respiratory failure: an in silico trial ICMx Pub Date : 2024-02-28 Damian Ratano, Binghao Zhang, Jose Dianti, Dimitrios Georgopoulos, Laurent J. Brochard, Timothy C. Y. Chan, Ewan C. Goligher
Lung- and diaphragm-protective (LDP) ventilation may prevent diaphragm atrophy and patient self-inflicted lung injury in acute respiratory failure, but feasibility is uncertain. The objectives of this study were to estimate the proportion of patients achieving LDP targets in different modes of ventilation, and to identify predictors of need for extracorporeal carbon dioxide removal (ECCO2R) to achieve
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BET-inhibitor DYB-41 reduces pulmonary inflammation and local and systemic cytokine levels in LPS-induced acute respiratory distress syndrome: an experimental rodent study ICMx Pub Date : 2024-02-26 Manuela Iten, Camille Gschwend, Alessandro Ostini, David Robert Cameron, Christine Goepfert, David Berger, Matthias Haenggi
Acute respiratory distress syndrome (ARDS) is a form of respiratory failure stemming from various underlying conditions that ultimately lead to inflammation and lung fibrosis. Bromodomain and Extra-Terminal motif (BET) inhibitors are a class of medications that selectively bind to the bromodomains of BET motif proteins, effectively reducing inflammation. However, the use of BET inhibitors in ARDS treatment
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Association between intravenous fluid administration and endothelial glycocalyx shedding in humans: a systematic review ICMx Pub Date : 2024-02-26 Sara Sukudom, Lisa Smart, Stephen Macdonald
Several studies have demonstrated associations between greater rate/volume of intravenous (IV) fluid administration and poorer clinical outcomes. One postulated mechanism for harm from exogenous fluids is shedding of the endothelial glycocalyx (EG). A systematic review using relevant search terms was performed using Medline, EMBASE and Cochrane databases from inception to October 2023. Included studies
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Sepsis and obesity: a scoping review of diet-induced obesity murine models ICMx Pub Date : 2024-02-23 Mikaela Eng, Keshikaa Suthaaharan, Logan Newton, Fatima Sheikh, Alison Fox-Robichaud
Sepsis, the life-threatening host response to infection, is a major cause of mortality. Obesity increases vulnerability to sepsis; however, some degree of obesity may be protective, called the “obesity paradox”. This scoping review systematically maps the literature on outcomes associated with diet-induced obesity and sepsis-induced organ injury, focusing on non-transgenic murine models. A literature
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Correspondence regarding the article by Murugan et al. on “Precision net ultrafiltration dosing in continuous kidney replacement therapy: a practical approach” ICMx Pub Date : 2024-02-20 Rinaldo Bellomo
To the Editor, We read the article on precision net ultrafiltration by Murugan et al. [1] with concern. In this article, in addition to the misplaced use of the term continuous kidney replacement therapy instead of continuous renal replacement therapy (CRRT) [2], the main author subverts the very definition of net ultrafiltration (NUF), which he had previously espoused, advocated, and published [3
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Response Letter to: Correspondence regarding the article by Murugan et al on Precision net ultrafiltration dosing in continuous kidney replacement therapy: a practical approach ICMx Pub Date : 2024-02-20 Raghavan Murugan, Kianoush Kashani, Paul M. Palevsky
To the Editor, We read with interest the letter by Bellomo and colleagues in response to our recent article entitled “Precision net ultrafiltration dosing in continuous kidney replacement therapy: a practical approach” [1]. The authors state that we have misplaced the term continuous kidney replacement therapy (CKRT) instead of continuous renal replacement therapy. While we support the use of interchangeable
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The impact of ECPELLA on haemodynamics and global oxygen delivery: a comprehensive simulation of biventricular failure ICMx Pub Date : 2024-02-16 Hiroki Matsushita, Keita Saku, Takuya Nishikawa, Shohei Yokota, Kei Sato, Hidetaka Morita, Yuki Yoshida, Masafumi Fukumitsu, Kazunori Uemura, Toru Kawada, Ken Yamaura
ECPELLA, a combination of veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) and Impella, a percutaneous left ventricular (LV) assist device, has emerged as a novel therapeutic option in patients with severe cardiogenic shock (CS). Since multiple cardiovascular and pump factors influence the haemodynamic effects of ECPELLA, optimising ECPELLA management remains challenging. In this study
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HS-GC–MS analysis of volatile organic compounds after hyperoxia-induced oxidative stress: a validation study ICMx Pub Date : 2024-02-12 Thijs A. Lilien, Dominic W. Fenn, Paul Brinkman, Laura A. Hagens, Marry R. Smit, Nanon F. L. Heijnen, Job B. M. van Woensel, Lieuwe D. J. Bos, Reinout A. Bem
Exhaled volatile organic compounds (VOCs), particularly hydrocarbons from oxidative stress-induced lipid peroxidation, are associated with hyperoxia exposure. However, important heterogeneity amongst identified VOCs and concerns about their precise pathophysiological origins warrant translational studies assessing their validity as a marker of hyperoxia-induced oxidative stress. Therefore, this study
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Mesenchymal stem cells-based therapies for severe ARDS with ECMO: a review ICMx Pub Date : 2024-02-09 Jing-Ke Cao, Xiao-Yang Hong, Zhi-Chun Feng, Qiu-Ping Li
Acute respiratory distress syndrome (ARDS) is the primary cause of respiratory failure in critically ill patients. Despite remarkable therapeutic advances in recent years, ARDS remains a life-threatening clinical complication with high morbidity and mortality, especially during the global spread of the coronavirus disease 2019 (COVID-19) pandemic. Previous studies have demonstrated that mesenchymal
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Positive end-expiratory pressure limits inspiratory effort through modulation of the effort-to-drive ratio: an experimental crossover study ICMx Pub Date : 2024-02-05 Hannes Widing, Mariangela Pellegrini, Elena Chiodaroli, Per Persson, Katarina Hallén, Gaetano Perchiazzi
How assisted spontaneous breathing should be used during acute respiratory distress syndrome is questioned. Recent evidence suggests that high positive end-expiratory pressure (PEEP) may limit the risk of patient self-inflicted lung injury (P-SILI). The aim of this study was to assess the effects of PEEP on esophageal pressure swings, inspiratory drive, and the neuromuscular efficiency of ventilation
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Validation of a low-cost continuous renal replacement therapy dialysate fluid controller for experimental purposes ICMx Pub Date : 2024-02-02 Yuri de Albuquerque Pessoa dos Santos, Viviane Flor Park, Luis Carlos Maia Cardozo Junior, Bruno Adler Maccagnan Pinheiro Besen, Pedro Vitale Mendes, Marcelo Park
Continuous renal replacement therapy (CRRT) support is crucial for critically ill patients and it is underexplored in specific situations. Experimental CRRT offers a means to gain insights into these scenarios, but the prohibitive cost of CRRT machines limits their accessibility. This study aimed to develop and validate a low-cost and precise dialysate controller for experimental CRRT. Our results
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Understanding the pathophysiology of acute critical illness: translational lessons from zebrafish models ICMx Pub Date : 2024-01-31 Kensuke Fujii, Kazuma Yamakawa, Yuriko Takeda, Natsuko Okuda, Akira Takasu, Fumihito Ono
The models used to investigate the pathophysiological mechanisms of acute critical illness are not limited to mammalian species. The zebrafish (Danio rerio) is a popular model organism for studying diseases due to its transparency and rapid development. The genes and signaling pathways involved in acute critical illness appear highly conserved among zebrafish and humans. Forward genetics such as random
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Recombinant antithrombin attenuates acute kidney injury associated with rhabdomyolysis: an in vivo animal study ICMx Pub Date : 2024-01-29 Tomotaka Miura, Tomoki Okuda, Kodai Suzuki, Hideshi Okada, Hiroyuki Tomita, Chihiro Takada, Kosuke Mori, Hirotaka Asano, Soichiro Kano, Yugo Wakayama, Yohei Fukuda, Hirotsugu Fukuda, Ayane Nishio, Yuki Kawasaki, Ayumi Kuroda, Keiko Suzuki, Ryo Kamidani, Haruka Okamoto, Tetsuya Fukuta, Yuichiro Kitagawa, Takahito Miyake, Keita Nakane, Akio Suzuki, Takahiro Yoshida, Nobuyuki Tetsuka, Shozo Yoshida, Takuya
Rhabdomyolysis is characterized by the destruction and necrosis of skeletal muscle tissue, resulting in acute kidney injury (AKI). Recombinant antithrombin (rAT) has DNA repair and vascular endothelial-protection properties. Herein, we investigated whether rAT therapy has beneficial effects against rhabdomyolysis-induced AKI. Ten-week-old male B6 mice were injected with 5 mL/kg of 50% glycerol intramuscularly
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Estimation of normal lung weight index in healthy female domestic pigs ICMx Pub Date : 2024-01-26 Antonio Fioccola, Rosmery Valentina Nicolardi, Tommaso Pozzi, Isabella Fratti, Federica Romitti, Francesca Collino, Verena Reupke, Gianluigi Li Bassi, Alessandro Protti, Alessandro Santini, Massimo Cressoni, Mattia Busana, Onnen Moerer, Luigi Camporota, Luciano Gattinoni
Lung weight is an important study endpoint to assess lung edema in porcine experiments on acute respiratory distress syndrome and ventilatory induced lung injury. Evidence on the relationship between lung–body weight relationship is lacking in the literature. The aim of this work is to provide a reference equation between normal lung and body weight in female domestic piglets. 177 healthy female domestic
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Validation of an alternative technique for RQ estimation in anesthetized pigs ICMx Pub Date : 2024-01-25 Jacob Karlsson, Anders Svedmyr, Mats Wallin, Magnus Hallbäck, Per-Arne Lönnqvist
Respiratory quotient (RQ) is an important variable when assessing metabolic status in intensive care patients. However, analysis of RQ requires cumbersome technical equipment. The aim of the current study was to examine a simplified blood gas-based method of RQ assessment, using Douglas bag measurement of RQ (Douglas-RQ) as reference in a laboratory porcine model under metabolic steady state. In addition
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Current clinical practice in using adjunctive extracorporeal blood purification in sepsis and septic shock: results from the ESICM “EXPLORATION” survey ICMx Pub Date : 2024-01-19 Klaus Stahl, Christian Bode, Benjamin Seeliger, Pedro David Wendel-Garcia, Sascha David
Despite a lack of clear evidence extracorporeal blood purification (EBP) is increasingly used as an adjunctive treatment in septic shock based on its biological plausibility. However, current state of praxis and believes in both efficacy and level of evidence are very heterogeneous. The “EXPLORATION” (Current Clinical Practice in using adjunctive extracorporeal blood purification in septic shock),
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Estimating the change in pleural pressure using the change in central venous pressure in various clinical scenarios: a pig model study ICMx Pub Date : 2024-01-15 Miyako Kyogoku, Soichi Mizuguchi, Taku Miyasho, Yusuke Endo, Yu Inata, Kazuya Tachibana, Yuji Fujino, Kazuto Yamashita, Muneyuki Takeuchi
We have previously reported a simple correction method for estimating pleural pressure (Ppl) using central venous pressure (CVP). However, it remains unclear whether this method is applicable to patients with varying levels of intravascular volumes and/or chest wall compliance. This study aimed to investigate the accuracy of our method under different conditions of intravascular volume and chest wall
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Immunophenotyping patients with sepsis and underlying haematological malignancy reveals defects in monocyte and lymphocyte function ICMx Pub Date : 2024-01-11 Timothy Arthur Chandos Snow, Aimee Serisier, David Brealey, Mervyn Singer, Nishkantha Arulkumaran
To the Editor, Sepsis is a common reason for intensive care unit (ICU) admission of patients with haematological malignancy [1]. The main focus is placed on neutropenia, with little attention paid to other white cell lineage such as monocytes and lymphocytes. Immune dysfunction in these cells is well-described in non-cancer septic patients and associated with an increased mortality risk [2,3,4]. Features
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Doxycycline reduces liver and kidney injuries in a rat hemorrhagic shock model ICMx Pub Date : 2024-01-09 Regina Sordi, Luana Bojko, Filipe R. M. B. Oliveira, Thiele Osvaldt Rosales, Camila Fernandes Souza, Lucas Wenceslau Moreno, Gustavo Ferreira Alves, José Carlos Rebuglio Vellosa, Daniel Fernandes, Jose Rosa Gomes
Hemorrhagic shock (HS), which causes insufficient tissue perfusion, can result in multiple organ failure (MOF) and death. This study aimed to evaluate whether doxycycline (DOX) protects cardiovascular, kidney, and liver tissue from damage in a rat model of HS. Immediately before the resuscitation, DOX (10 mg/kg; i.v.) was administered, and its protective effects were assessed 24 h later. Mean arterial
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Mastering the brain in critical conditions: an update ICMx Pub Date : 2024-01-05 Chiara Robba, Elisa R. Zanier, Carmen Lopez Soto, Soojin Park, Romain Sonneville, Raimund Helbolk, Aarti Sarwal, Virginia F. J. Newcombe, Mathieu van der Jagt, Jan Gunst, Tobias Gauss, Samy Figueiredo, Jacques Duranteau, Markus B. Skrifvars, Carolina Iaquaniello, Susanne Muehlschlegel, Victoria Metaxa, Claudio Sandroni, Giuseppe Citerio, Geert Meyfroidt
Acute brain injuries, such as traumatic brain injury and ischemic and hemorragic stroke, are a leading cause of death and disability worldwide. While characterized by clearly distict primary events—vascular damage in strokes and biomechanical damage in traumatic brain injuries—they share common secondary injury mechanisms influencing long-term outcomes. Growing evidence suggests that a more personalized
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Metabolic disturbances potentially attributable to clogging during continuous renal replacement therapy ICMx Pub Date : 2023-12-21 Mattia M. Müller, Larina Caspar, Onur Sazpinar, Daniel A. Hofmaenner, Rolf Erlebach, Rea Andermatt, Christoph C. Ganter, Reto A. Schuepbach, Pedro D. Wendel-Garcia, Sascha David
Clogging is characterized by a progressive impairment of transmembrane patency in renal replacement devices and occurs due to obstruction of pores by unknown molecules. If citrate-based anti-coagulation is used, clogging can manifest as a metabolic alkalosis accompanied by hypernatremia and hypercalcemia, primarily a consequence of Na3Citrate infusion. An increased incidence of clogging has been observed
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The effect of inspiratory rise time on mechanical power calculations in pressure control ventilation: dynamic approach ICMx Pub Date : 2023-12-20 Özlem Acicbe, Canan Yazıcı Özgür, Payam Rahimi, Emral Canan, Sinan Aşar, Zafer Çukurova
Mechanical power may serve as a valuable parameter for predicting ventilation-induced injury in mechanically ventilated patients. Over time, several equations have been developed to calculate power in both volume control ventilation (VCV) and pressure control ventilation (PCV). Among these equations, the linear model mechanical power equation (MPLM) closely approximates the reference method when applied
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A model of hemodialysis after acute kidney injury in rats ICMx Pub Date : 2023-12-20 J. Mallet, P.-A. Billiet, M. Scarton, N. Benichou, M. Bobot, K. Chaibi, A. Hertig, J. Hadchouel, D. Dreyfuss, S. Gaudry, S. Placier
Acute kidney injury (AKI) is frequent among critically ill patients. Renal replacement therapy (RRT) is often required to deal with severe complications of AKI. This technique is however associated with side effects such as hemodynamic instability and delayed renal recovery. In this study, we aimed to describe a novel model of hemodialysis in rats with AKI and depict a dialysis membrane performance
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Capillary leak and endothelial permeability in critically ill patients: a current overview ICMx Pub Date : 2023-12-20 Babak Saravi, Ulrich Goebel, Lars O. Hassenzahl, Christian Jung, Sascha David, Aarne Feldheiser, Matthias Stopfkuchen-Evans, Jakob Wollborn
Capillary leak syndrome (CLS) represents a phenotype of increased fluid extravasation, resulting in intravascular hypovolemia, extravascular edema formation and ultimately hypoperfusion. While endothelial permeability is an evolutionary preserved physiological process needed to sustain life, excessive fluid leak—often caused by systemic inflammation—can have detrimental effects on patients’ outcomes
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Publisher Correction: ESICM LIVES 2023 ICMx Pub Date : 2023-12-18
Publisher Correction: Intensive Care Medicine Experimental 2023, 11(Suppl 1):72 https://doi.org/10.1186/s40635-023-00546-y Following publication of the original article [1], it came to the journal’s attention that due to a technical error, the abstract of the following details had been omitted from the supplement: Starting with recognition: using education to improve CAM-ICU assessment in a District
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Phrenic nerve stimulation to prevent diaphragmatic dysfunction and ventilator-induced lung injury ICMx Pub Date : 2023-12-18 Alessandro Panelli, Michael A. Verfuß, Martin Dres, Laurent Brochard, Stefan J. Schaller
Side effects of mechanical ventilation, such as ventilator-induced diaphragmatic dysfunction (VIDD) and ventilator-induced lung injury (VILI), occur frequently in critically ill patients. Phrenic nerve stimulation (PNS) has been a valuable tool for diagnosing VIDD by assessing respiratory muscle strength in response to magnetic PNS. The detection of pathophysiologically reduced respiratory muscle strength
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Pressure-support compared with pressure-controlled ventilation mitigates lung and brain injury in experimental acute ischemic stroke in rats ICMx Pub Date : 2023-12-15 Adriana L. da Silva, Camila M. Bessa, Nazareth N. Rocha, Eduardo B. Carvalho, Raquel F. Magalhaes, Vera L. Capelozzi, Chiara Robba, Paolo Pelosi, Cynthia S. Samary, Patricia R. M. Rocco, Pedro L. Silva
We aimed to evaluate the pulmonary and cerebral effects of low-tidal volume ventilation in pressure-support (PSV) and pressure-controlled (PCV) modes at two PEEP levels in acute ischemic stroke (AIS). In this randomized experimental study, AIS was induced by thermocoagulation in 30 healthy male Wistar rats. After 24 h, AIS animals were randomly assigned to PSV or PCV with VT = 6 mL/kg and PEEP = 2
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Time spent above optimal cerebral perfusion pressure is not associated with failure to improve in outcome in traumatic brain injury ICMx Pub Date : 2023-12-14 Kevin Y. Stein, Logan Froese, Alwyn Gomez, Amanjyot Singh Sainbhi, Nuray Vakitbilir, Younis Ibrahim, Abrar Islam, Izabella Marquez, Fiorella Amenta, Tobias Bergmann, Frederick A. Zeiler
Optimal cerebral perfusion pressure (CPPopt) has emerged as a promising personalized medicine approach to the management of moderate-to-severe traumatic brain injury (TBI). Though literature demonstrating its association with poor outcomes exists, there is yet to be work done on its association with outcome transition due to a lack of serial outcome data analysis. In this study we investigate the association
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Muscle ultrasound shear wave elastography for detection of early onset lower limb ischemia in patients with veno-arterial extracorporeal membrane oxygenation ICMx Pub Date : 2023-12-11 Mariya Maslarska, Sven Piepenburg, Dirk Westermann, Alexander Supady, Christoph Hehrlein
Limb ischemia or compartment syndrome, requiring surgery, are some of the frequent cannula-related complications in patients supported with veno-arterial extracorporeal membrane oxygenation (VA-ECMO). The purpose of this exploratory study is to depict and evaluate the dynamic changes in the lower limb muscles with ultrasound shear wave elastography as marker for early lower limb ischemia. Eleven patients
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Comment on: Effects of changes in trunk inclination on ventilatory efficiency in ARDS patients: quasi‑experimental study ICMx Pub Date : 2023-12-11 Francesco Marrazzo, Stefano Spina, Francesco Zadek, Roberto Fumagalli, Thomas Langer
To the editor: We have read with great interest the study conducted by Benites et al., which explores the impact of trunk inclination on ventilator efficiency in patients with ARDS [1]. Similarly to our own studies [2,3,4], and understandably given the historical period, most studied patients (18/22) had COVID-related ARDS. However, some results presented by Benites differ from what we have described
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Identifying a target group for selenium supplementation in high-risk cardiac surgery: a secondary analysis of the SUSTAIN CSX trial ICMx Pub Date : 2023-12-08 Quirin Notz, Daren K. Heyland, Zheng-Yii Lee, Johannes Menger, Johannes Herrmann, Thilo S. Chillon, Stephen Fremes, Siamak Mohammadi, Gunnar Elke, C. David Mazer, Aileen Hill, Markus Velten, Sascha Ott, Maren Kleine-Brueggeney, Patrick Meybohm, Lutz Schomburg, Christian Stoppe
Recent data from the randomized SUSTAIN CSX trial could not confirm clinical benefits from perioperative selenium treatment in high-risk cardiac surgery patients. Underlying reasons may involve inadequate biosynthesis of glutathione peroxidase (GPx3), which is a key mediator of selenium's antioxidant effects. This secondary analysis aimed to identify patients with an increase in GPx3 activity following
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Interobserver reliability for manual analysis of sidestream darkfield videomicroscopy clips after resizing in ImageJ ICMx Pub Date : 2023-12-08 Raushan C. B. Lala, Ryan A. P. Homes, Jeffrey Lipman, Mark J. Midwinter
Direct assessment of microcirculatory function remains a critical care research tool but approaches for analysis of microcirculatory videomicroscopy clips are shifting from manual to automated algorithms, with a view to clinical application in the intensive care unit. Automated analysis software associated with current sidestream darkfield videomicroscopy systems is demonstrably unreliable; therefore
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Pathophysiological implications of ventriculoarterial coupling in septic shock ICMx Pub Date : 2023-12-07 Michael R. Pinsky, Fabio Guarracino
Proper ventriculo-arterial coupling results in optimal cardiac output, adequate peripheral organ perfusion, and efficient circulation. The relation between stroke volume and the developed arterial pressure defined by the relative elastances of the left ventricle and arterial circuit reflect ventriculo-arterial coupling. Decoupling of either or both commonly occur in sepsis and are associated with inefficient
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Robotic-assisted early mobilization and virtual reality: a perspective on innovative support strategies for critically ill patients ICMx Pub Date : 2023-12-06 Claudio Parco, Vanessa Kreuels, Malte Kelm, Christian Jung, Georg Wolff
To the Editor Survivors of critical illness frequently suffer from physical, psychosocial and cognitive impairments which result in a substantial loss in quality of life. Many research groups are working on structured rehabilitation programs to reduce the burden and there are preventive approaches like early mobilization, which innovative technical solutions may help to integrate into daily practice:
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Circulating endothelial extracellular vesicle signatures correspond with ICU requirement: an exploratory study in COVID-19 patients ICMx Pub Date : 2023-11-30 Johannes Zipperle, Johannes Oesterreicher, Matthias Hackl, Teresa Lara Krammer, Helena Thumfart, Madhusudhan Reddy Bobbili, Marion Wiegele, Johannes Grillari, Marcin F. Osuchowski, Herbert Schöchl, Wolfgang Holnthoner, Christoph J. Schlimp, Judith Schiefer, Marco Valerio Pesce, Stefan Ulbing, Johannes Gratz
Extracellular vesicles (EVs) represent nanometer-sized, subcellular spheres, that are released from almost any cell type and carry a wide variety of biologically relevant cargo. In severe cases of coronavirus disease 2019 (COVID-19) and other states of systemic pro-inflammatory activation, EVs, and their cargo can serve as conveyors and indicators for disease severity and progression. This information
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Impact of critical illness on cholesterol and fatty acids: insights into pathophysiology and therapeutic targets ICMx Pub Date : 2023-11-28 Caroline Lauwers, Lauren De Bruyn, Lies Langouche
Critical illness is characterized by a hypercatabolic response encompassing endocrine and metabolic alterations. Not only the uptake, synthesis and metabolism of glucose and amino acids is majorly affected, but also the homeostasis of lipids and cholesterol is altered during acute and prolonged critical illness. Patients who suffer from critically ill conditions such as sepsis, major trauma, surgery
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Precision net ultrafiltration dosing in continuous kidney replacement therapy: a practical approach ICMx Pub Date : 2023-11-28 Raghavan Murugan, Kianoush Kashani, Paul M. Palevsky
Fluid overload occurs in more than two-thirds of critically ill patients with acute kidney injury (AKI) receiving kidney replacement therapy (KRT) and is independently associated with morbidity and mortality [1, 2]. International consensus guidelines recommend extracorporeal net fluid removal when a life-threatening fluid overload occurs in a patient with oliguric AKI refractory to diuretics [3,4,5]
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Understanding the mechanisms of ventilator-induced lung injury using animal models ICMx Pub Date : 2023-11-27 Pedro Leme Silva, Martin Scharffenberg, Patricia Rieken Macedo Rocco
Mechanical ventilation is a life-saving therapy in several clinical situations, promoting gas exchange and providing rest to the respiratory muscles. However, mechanical ventilation may cause hemodynamic instability and pulmonary structural damage, which is known as ventilator-induced lung injury (VILI). The four main injury mechanisms associated with VILI are as follows: barotrauma/volutrauma caused
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Ultra-low tidal volume ventilation during cardiopulmonary resuscitation shows no mitigating effect on pulmonary end-organ damage compared to standard ventilation: insights from a porcine model ICMx Pub Date : 2023-11-25 Katja Mohnke, Philipp Conzelmann, Miriam Renz, Julian Riedel, René Rissel, Andrea Urmann, Johanna Hain, Bastian Duenges, Alexander Ziebart, Robert Ruemmler
This study aimed to determine whether ultra-low tidal volume ventilation (ULTVV) applied during cardiopulmonary resuscitation (CPR) compared with standard ventilation (intermittent positive pressure ventilation, IPPV) can reduce pulmonary end-organ damage in the post-resuscitation period. A prospective, randomized trial was conducted using a porcine model (n = 45). The animals were divided into three