Review
Clinical Neurology
Carl-Henrik Nordstrom, Axel Forsse, Rasmus Peter Jakobsen, Simon Molstrom, Troels Halfeldt Nielsen, Palle Toft, Urban Ungerstedt
Summary: The microdialysis technique was initially developed for monitoring neurotransmitters in animals and has since been adopted for clinical use. It has shown potential in studying cerebral energy metabolism and evaluating blood-brain barrier function. Understanding the different biochemical information obtained from various techniques is important, as microdialysis reflects variables in a narrow zone of interstitial fluid surrounding the probe. Bedside microdialysis primarily reflects cerebral energy metabolism through measured levels of glucose, lactate, pyruvate, and the lactate to pyruvate ratio.
FRONTIERS IN NEUROLOGY
(2022)
Article
Critical Care Medicine
Barry Burstein, Saraschandra Vallabhajosyula, Bradley Ternus, Gregory W. Barsness, Kianoush Kashani, Jacob C. Jentzer
Summary: Admission lactate levels are strongly associated with increased hospital mortality among CICU patients, independently of established ICU prognostic scores, and dependent on admission diagnosis, which may help inform clinicians caring for CICU patients.
Article
Health Care Sciences & Services
Jennifer K. Walter, Douglas Hill, William A. Drust, Amy Lisanti, Aaron DeWitt, Amanda Seelhorst, Ma Luisa Hasiuk, Robert Arnold, Chris Feudtner
Summary: This study aimed to optimize the preparation of interprofessional teams and parents in conducting shared decision-making (SDM) in family meetings in the CICU through a codesign process. The study found that the codesign process was feasible and resulted in the development of support documents, role assignments, and communication skills training.
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
(2022)
Article
Anesthesiology
Mitsunori Nakano, Yohei Nomura, Glenn Whitman, Marc Sussman, Stefano Schena, Ahmet Kilic, Chun W. Choi, Kei Akiyoshi, Karin J. Neufeld, Jennifer Lawton, Elizabeth Colantuoni, Atsushi Yamaguchi, Matthew Wen, Peter Smielewski, Ken Brady, Brian Bush, Charles W. Hogue, Charles H. Brown
Summary: This study characterized cerebral autoregulation during cardiac surgery and early ICU care, finding altered autoregulation metrics in the ICU that may be clinically relevant to delirium. Further investigation is needed to determine the potential benefits of autoregulation-based MAP targeting in the ICU.
BRITISH JOURNAL OF ANAESTHESIA
(2021)
Article
Medicine, General & Internal
Chun-Hui Dong, Chao-Nan Gao, Xiao-Hua An, Na Li, Le Yang, De-Cai Li, Qi Tan
Summary: This study found that prophylactic nocturnal administration of Dexmedetomidine significantly reduced the incidence of PICS following cardiac surgery, particularly reducing the occurrence of psychological impairments. However, this treatment was also associated with a higher rate of hypotension.
Article
Rehabilitation
Suzimara Monteiro Pieczkoski, Amanda Lino de Oliveira, Mauren Porto Haeffner, Aline de Cassia Meine Azambuja, Graciele Sbruzzi
Summary: In postoperative cardiac surgery patients, positive expiratory pressure blow-bottle device and expiratory positive airway pressure showed similar effects on pulmonary function compared to conventional physiotherapy. Although there were significant reductions in pulmonary function and respiratory muscle strength after surgery, there were no significant differences between the three groups in terms of these outcomes.
CLINICAL REHABILITATION
(2021)
Article
Medicine, General & Internal
Jing-Bin Huang, Zhao-Ke Wen, Chang-Chao Lu, Jian-Rong Yang, Jun-Jun Li
Summary: This study aimed to identify the risk factors for prolonged intensive care unit (ICU) stay after cardiac surgery for infective endocarditis (IE) and to reduce the operative risk of mortality and morbidity. The results showed that factors such as male gender, age, weight, vegetation length, paravalvular leak, aortic cross-clamp time, cardiopulmonary bypass time, mechanical ventilation time, and other factors were associated with prolonged ICU stay.
Review
Pediatrics
Luke Burton, Vidit Bhargava, Michele Kong
Summary: Ultrasonography has been widely used in medicine for decades, and now it is also used at the bedside by clinicians to help assess and manage patients. However, there are still challenges in its adoption across different disciplines, particularly in terms of training, competency, and standardization of usage.
FRONTIERS IN PEDIATRICS
(2022)
Article
Chemistry, Multidisciplinary
Jin Li, Diane J. Burgess
Summary: This study focuses on improving diabetes management by monitoring stress biomarkers, revealing that pH, lactate, and glucose levels changed more significantly under stress conditions, with long-acting insulin treatment shown to shorten these changes. Subcutaneous pH was identified as a sensitive stress biomarker for diabetic rats, emphasizing the importance of accurate glycemic control and the potential for personalized medicine through appropriate biomarker monitoring.
JOURNAL OF CONTROLLED RELEASE
(2021)
Article
Microbiology
M. Edlinger-Stanger, V al Jalali, M. Andreas, W. Jaeger, M. Boehmdorfer, M. Zeitlinger, D. Hutschala
Summary: This study evaluated the pharmacokinetics of high-dose ceftaroline in plasma and lung tissue in cardiac surgery patients, showing that continuous administration achieved higher drug concentrations in lung tissue and a significantly longer time above the minimal inhibitory concentration compared to intermittent administration, supporting its use for pneumonia caused by susceptible pathogens in critically ill patients undergoing major cardiothoracic surgery.
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
(2021)
Article
Cardiac & Cardiovascular Systems
Zhigang Wang, Yubei Kang, Zheyun Wang, Jingfang Xu, Dandan Han, Lifang Zhang, Dongjin Wang
Summary: This study retrospectively analyzed patients who underwent planned re-explorations for bleeding following cardiac surgery at our center from January 2019 to December 2021, comparing reoperations performed in the operating room (OR) and the Cardiac Intensive Care Unit (CICU). The results showed that re-explorations performed in the CICU were not associated with an increased risk of major complications compared to those performed in the OR, and there was no significant difference in mortality between the two groups.
REVIEWS IN CARDIOVASCULAR MEDICINE
(2023)
Review
Health Care Sciences & Services
Luan Oliveira Ferreira, Victoria Winkler Vasconcelos, Janielle de Sousa Lima, Jaime Rodrigues Vieira Neto, Giovana Escribano da Costa, Jordana de Castro Esteves, Sallatiel Cabral de Sousa, Jonathan Almeida Moura, Felipe Ruda Silva Santos, Joao Monteiro Leitao Filho, Matheus Ramos Protasio, Pollyana Sousa Araujo, Claudio Jose da Silva Lemos, Karina Dias Resende, Dielly Catrina Favacho Lopes
Summary: Patients undergoing coronary revascularization with extracorporeal circulation or cardiopulmonary bypass may develop systemic inflammatory response due to biochemical changes in the microcirculation. Inflammatory signaling pathways can be activated by surgical incision, reperfusion injury, and blood contact with non-endothelial membranes, leading to the production and activation of inflammatory cells, cytokine production, and oxidative stress. Addressing new perspectives for intraoperative treatment and management may reduce this inflammatory storm, improve prognosis, and potentially lower mortality rates in these patients.
JOURNAL OF PERSONALIZED MEDICINE
(2023)
Article
Pediatrics
Chelsea M. Torres, Andrew S. Geneslaw, Leanne Svoboda, Arthur J. Smerling, Katherine R. Schlosser Metitiri
Summary: This study evaluated the relationship between intravenous acetaminophen and opioid exposure after cardiac surgery. Comparing before and after the implementation of a standardized pain pathway, it was found that opioid exposure decreased (0.38 milligram per kilogram of morphine equivalents [IQR 0.10-0.81] vs 0.26 milligram per kilogram of morphine equivalents [0.09-0.56], P =.01) and acetaminophen exposure increased (3 [2-4] vs 4 [4-5] doses, P <.001).
JOURNAL OF PEDIATRICS
(2023)
Article
Multidisciplinary Sciences
Simon Molstrom, Troels Halfeld Nielsen, Carl H. Nordstrom, Axel Forsse, Soren Moller, Soren Veno, Dmitry Mamaev, Tomas Tencer, Henrik Schmidt, Palle Toft
Summary: The study indicates that jugular bulb microdialysis (JBM) is feasible and safe, and may be used to monitor biochemical variables reflecting ongoing brain damage and mitochondrial dysfunction in comatose OHCA patients, which are associated with unfavorable outcome.
SCIENTIFIC REPORTS
(2021)
Article
Gastroenterology & Hepatology
Rakhi Maiwall, Samba Siva Rao Pasupuleti, Harsh Vardhan Tevethia, Shiv Kumar Sarin
Summary: This study developed a dynamic model called PIRO-CIC for predicting mortality and determining futility of care in critically ill patients with cirrhosis. The model incorporated various factors including coagulation function, kidney function, and inflammatory response. The results showed that the PIRO-CIC model accurately predicted one-month mortality and outperformed other prognostic scores. The limitations of the study were its inapplicability to acute-on-chronic liver failure and patients requiring emergency liver transplant.
HEPATOLOGY INTERNATIONAL
(2023)
Article
Critical Care Medicine
Ines Verlinden, Fabian Guiza, Karolijn Dulfer, Hanna Van Cleemput, Pieter J. Wouters, Gonzalo Garcia Guerra, Koen F. Joosten, Sascha C. Verbruggen, Ilse Vanhorebeek, Greet Van den Berghe
Summary: The study found that PICU patients face long-term developmental impairments, with significant deficits in height, executive functioning, and intelligence, and partial recovery in memory deficits and harm caused by early parenteral nutrition.
PEDIATRIC CRITICAL CARE MEDICINE
(2022)
Article
Anesthesiology
Chao-Yuan Huang, Fabian Guiza, Greet De Vlieger, Pieter Wouters, Jan Gunst, Michael Casaer, Ilse Vanhorebeek, Inge Derese, Greet Van den Berghe, Geert Meyfroidt
Summary: The purpose of this study was to develop and validate prediction models for AKI recovery in critically ill patients. The models showed poor performance in the general ICU population but had acceptable discrimination in cardiac surgery patients.
JOURNAL OF CLINICAL MONITORING AND COMPUTING
(2023)
Article
Geriatrics & Gerontology
Lisa Van Dyck, Fabian Guiza, Inge Derese, Lies Pauwels, Michael P. Casaer, Greet Hermans, Pieter J. Wouters, Greet Van den Berghe, Ilse Vanhorebeek
Summary: This study found that critically ill patients have different DNA methylation signatures in skeletal muscle compared to healthy controls, which may provide a biological basis for the long-term persistence of weakness in ICU survivors.
JOURNAL OF CACHEXIA SARCOPENIA AND MUSCLE
(2022)
Article
Medicine, General & Internal
Arno Teblick, Lisa Van Dyck, Nathalie Van Aerde, Sarah Van der Perre, Lies Pauwels, Inge Derese, Yves Debaveye, Pieter J. Wouters, Ilse Vanhorebeek, Lies Langouche, Greet Van den Berghe
Summary: This study found tissue-specific expression changes of receptor-regulatory factors in critically ill patients, which adaptively guide the action of glucocorticoids in different tissues. These findings are important for understanding the importance of glucocorticoid resistance and glucocorticoid treatment.
Review
Medicine, Research & Experimental
Arno Teblick, Jan Gunst, Lies Langouche, Greet Van den Berghe
Summary: Sepsis is a life-threatening organ dysfunction caused by a dysregulated response to infection. Preclinical and clinical research have shown that there is a biphasic pattern in the neuroendocrine responses to sepsis, contributing to the development of severe metabolic alterations. Early full feeding in the acute phase induced harm, while the benefits of metabolic alterations such as hyperglycemia are still unclear.
Article
Multidisciplinary Sciences
Ruben Weckx, Chloe Goossens, Sarah Derde, Lies Pauwels, Sarah Vander Perre, Greet Van den Berghe, Lies Langouche
Summary: This study investigated the therapeutic efficacy and safety of ketone ester 3HHB in septic mice. Continuous infusion of 3HHB improved muscle force and avoided toxicity, while bolus injections of 3HHB increased severity of illness and mortality.
SCIENTIFIC REPORTS
(2022)
Article
Biochemistry & Molecular Biology
Gregoire Coppens, Ilse Vanhorebeek, Ines Verlinden, Inge Derese, Pieter J. Wouters, Koen F. Joosten, Sascha C. Verbruggen, Fabian Guiza, Greet Van den Berghe
Summary: Critically ill children who receive early parenteral nutrition in the pediatric intensive care unit (PICU) may experience impaired physical and neurocognitive development 2 years later, which can be partially prevented. This study found differential DNA methylation in former PICU patients compared to healthy children, with hypomethylation at majority of CpG sites and abnormal methylation in pathways related to physical and neurocognitive development.
Article
Oncology
Ines Verlinden, Gregoire Coppens, Ilse Vanhorebeek, Fabian Gueiza, Inge Derese, Pieter J. Wouters, Koen F. Joosten, Sascha C. Verbruggen, Greet van den Berghe
Summary: This study found that paediatric critical illness and nutritional management in the paediatric intensive care unit (PICU) can affect DNA methylation changes in childhood development. Former PICU patients, especially those aged 6 years or older at the time of illness, showed epigenetic age deceleration and stunted growth in height compared to healthy children.
CLINICAL EPIGENETICS
(2023)
Article
Endocrinology & Metabolism
Ilse Vanhorebeek, Jan Gunst, Michael P. Casaer, Inge Derese, Sarah Derde, Lies Pauwels, Johan Segers, Greet Hermans, Rik Gosselink, Greet van den Berghe
Summary: This study investigated the impact of critical illness on muscular expression of irisin, kynurenine aminotransferases, and amylase, and their association with clinical outcomes, as well as the effects of interventions that attenuate muscle wasting/weakness. The findings showed that critically ill patients had lower mRNA expression levels of FNDC5, KYAT1, and amylase compared to controls. Lower expression of FNDC5 was associated with higher ICU mortality and ICU-acquired weakness, while lower amylase expression was associated with longer ICU stay. Lower KYAT1 expression was associated with a lower risk of weakness. The study also found that neuromuscular electrical stimulation increased FNDC5 expression and that late parenteral nutrition patients had higher KYAT1 expression compared to early parenteral nutrition patients.
JOURNAL OF THE ENDOCRINE SOCIETY
(2023)
Review
Critical Care Medicine
Ilse Vanhorebeek, Greet Van den Berghe
Summary: Purpose of review: This review examines the link between critically ill patients and long-term physical, mental, and neurocognitive impairments, and suggests that epigenetic changes may be the underlying cause. The review also discusses the impact of nutritional management on these epigenetic changes and their long-term consequences.
CURRENT OPINION IN CRITICAL CARE
(2023)
Article
Oncology
Ilse Vanhorebeek, Gregoire Coppens, Fabian Gueiza, Inge Derese, Pieter J. Wouters, Koen F. Joosten, Sascha C. Verbruggen, Greet van den Berghe
Summary: Former critically ill children, especially those older than 6 years, show epigenetic age deceleration and stunted growth in height 2 years after paediatric intensive care unit (PICU) admission. Abnormal DNA methylation within genes involved in steroid hormone synthesis or sulphation/desulphation may contribute to this stunted growth, partly affected by glucocorticoid treatment. The abnormal methylation of steroidogenic genes is associated with shorter height at 4-year follow-up.
CLINICAL EPIGENETICS
(2023)
Review
Critical Care Medicine
Jan Gunst, Michael. P. P. Casaer, Jean-Charles Preiser, Jean Reignier, Greet van den Berghe
Summary: Recent randomized controlled trials have shown that early full nutritional support does not benefit critically ill patients and may cause harm. The absence of benefit may not be due to low nutritional risk patients or low amino acid doses, as previously hypothesized. Mechanistic studies suggest that the lack of benefit is due to anabolic resistance and suppression of recovery-enhancing pathways induced by feeding. Large randomized controlled trials have not investigated the impact of different feeding strategies initiated after the acute phase in patients recovering from critical illness.
