Review
Medicine, General & Internal
Jing Zhou, Zhimin Lin, Xiumei Deng, Baiyun Liu, Yu Zhang, Yongxin Zheng, Haichong Zheng, Yingzhi Wang, Yan Lai, Weixiang Huang, Xiaoqing Liu, Weiqun He, Yuanda Xu, Yimin Li, Yongbo Huang, Ling Sang
Summary: In mechanically ventilated patients without ARDS, higher PEEP was associated with significantly higher PaO2/FiO2 ratio and increased incidence of pneumothorax. However, no significant differences were observed among the four levels of PEEP in terms of other outcomes.
FRONTIERS IN MEDICINE
(2021)
Article
Critical Care Medicine
Alessandro Protti, Alessandro Santini, Francesca Pennati, Chiara Chiurazzi, Massimo Cressoni, Michele Ferrari, Giacomo E. Iapichino, Luca Carenzo, Ezio Lanza, Giorgio Picardo, Pietro Caironi, Andrea Aliverti, Maurizio Cecconi
Summary: Patients with early ARDS due to COVID-19 have a large potential for lung recruitment, but their compliance and Pa-CO2 may not improve with higher PEEP, possibly due to hyperinflation.
Article
Critical Care Medicine
Tommaso Pettenuzzo, Annalisa Boscolo, Alessandro De Cassai, Nicolo Sella, Francesco Zarantonello, Paolo Persona, Laura Pasin, Giovanni Landoni, Paolo Navalesi
Summary: The study found that for ICU patients not suffering from ARDS, the use of higher positive end-expiratory pressure (PEEP) was not significantly associated with hospital mortality compared to lower PEEP. However, it was associated with improved oxygenation, higher respiratory system compliance, and reduced risk of hypoxemia and ARDS.
Article
Critical Care Medicine
Saida Rezaiguia-Delclaux, Leo Ren, Aurelie Gruner, Calypso Roman, Thibaut Genty, Francois Stephan
Summary: The aim of this study is to compare the effects of driving pressure and PaO2/FiO2 ratio in determining the best PEEP level. The results show that the best PEEP level varies depending on the method chosen, but it is unclear which method is superior in terms of patient outcomes.
Article
Medicine, General & Internal
William R. Barnett, Aadil Maqsood, Nithin Kesireddy, Waleed Khokher, Zachary Holtzapple, Fadi A. Safi, Ragheb Assaly
Summary: This study examined the occurrence of ventilator-associated events and the effectiveness of using higher baseline PEEP to reduce VAEs. The results showed that starting PEEP of 8 cmH(2)O was not significantly effective in reducing VAE probabilities, suggesting hospitals should consider alternative methods to reduce VAEs until specific CDC guidelines are established.
FRONTIERS IN MEDICINE
(2021)
Article
Critical Care Medicine
Monica Rodrigues da Cruz, Luciana Moises Camilo, Tiago Batista da Costa Xavier, Gabriel Casulari da Motta Ribeiro, Denise Machado Medeiros, Luis Felipe da Fonseca Reis, Bruno Leonardo da Silva Guimaraes, Andre Miguel Japiassu, Alysson Roncally Silva Carvalho
Summary: This study investigated the relationship between airway driving pressure (dP(aw)) and positive-end expiratory pressure (PEEP) in ARDS patients with COVID-19. The majority of patients exhibited a J-shaped curve, while a smaller proportion had a U-shaped or inverted J-shaped curve. Patients with inverted J-shaped curves had higher BMI and lower baseline partial pressure of arterial oxygen/FiO(2) ratio. These findings suggest that adjusting PEEP based on dP(aw) changes can enable individualized protective ventilation.
Article
Medicine, General & Internal
Chun Pan, Cong Lu, Xiaobin She, Haibo Ren, Huazhang Wei, Liang Xu, Yingzi Huang, Jia'an Xia, Yuetian Yu, Lu Chen, Bin Du, Haibo Qiu
Summary: Different PEEP strategies for COVID-19-induced ARDS patients were compared, with the ARDSnet low PEEP/FIO2 table and the best-oxygenation strategy leading to higher PEEP levels and potentially higher risk of ventilator-induced lung injury compared to the best-compliance strategy.
FRONTIERS IN MEDICINE
(2021)
Article
Critical Care Medicine
Clement Brault, Yoann Zerbib, Loay Kontar, Mathieu Carpentier, Julien Maizel, Michel Slama
Summary: In this study, airway closure was observed in patients with coronavirus disease 2019-related acute respiratory distress syndrome. Among the patients, 44% had an airway opening pressure above 5 cmH(2)O, with a median value of 8 cmH(2)O.
JOURNAL OF CRITICAL CARE
(2021)
Article
Physiology
Liangyu Mi, Yi Chi, Siyi Yuan, Huaiwu He, Yun Long, Inez Frerichs, Zhanqi Zhao
Summary: There is significant variability in the optimal positive end-expiratory pressure (PEEP) between supine and prone positions in acute respiratory distress syndrome (ARDS) patients. Not all patients show a decrease in optimal PEEP during prone positioning. Patients with a higher body mass index exhibit lower optimal PEEP in the prone position, as well as better oxygenation and ventilation homogeneity.
FRONTIERS IN PHYSIOLOGY
(2022)
Article
Health Care Sciences & Services
Arne Peine, Ahmed Hallawa, Johannes Bickenbach, Guido Dartmann, Lejla Begic Fazlic, Anke Schmeink, Gerd Ascheid, Christoph Thiemermann, Andreas Schuppert, Ryan Kindle, Leo Celi, Gernot Marx, Lukas Martin
Summary: The VentAI reinforcement learning algorithm provides reproducible high performance by dynamically suggesting an optimized, individualized ventilation strategy for critically ill patients. Compared to standard clinical care by physicians, VentAI significantly increased performance returns and recommended actions more frequently with specific settings for PEEP, FiO(2), and tidal volume. VentAI's preference for lower tidal volumes, certain PEEP levels, and avoiding high FiO(2) values could potentially benefit critically ill patients.
NPJ DIGITAL MEDICINE
(2021)
Article
Critical Care Medicine
Christoph Boesing, Peter T. Graf, Fabian Schmitt, Manfred Thiel, Paolo Pelosi, Patricia R. M. Rocco, Thomas Luecke, Joerg Krebs
Summary: The study demonstrates that prone positioning combined with appropriate PEEP levels can increase transpulmonary pressures, improve oxygenation, and stabilize hemodynamics in patients with moderate to severe ARDS. Using a lower PEEP strategy (PEEPARDSNetwork) in conjunction with prone positioning may be an effective lung protective ventilation strategy for these patients.
Article
Medicine, Research & Experimental
Domenico Luca Grieco, Salvatore Maurizio Maggiore, Giacomo Bellani, Savino Spadaro, Elena Spinelli, Tommaso Tonetti, Luca S. Menga, Marco Pozzi, Denise Battaglini, Rosa Di Mussi, Andrea Bruni, Andrea De Gaetano, Carmine Giovanni Iovino, Matteo Brioni, Francesco Mojoli, Giuseppe Foti, Carlo Aberto Volta, Paolo Pelosi, Paolo Navalesi, Salvatore Grasso, V. Marco Ranieri, Massimo Antonelli
Summary: The IPERPEEP trial aims to investigate whether an individualized PEEP setting protocol based on bedside assessment of lung recruitability can improve a composite clinical outcome in patients with moderate-to-severe ARDS.
Article
Critical Care Medicine
Xuesong Liu, Xiao Liu, Jue Meng, Dongdong Liu, Yongbo Huang, Ling Sang, Yonghao Xu, Zhiheng Xu, Weiqun He, Sibei Chen, Rong Zhang, Xiaoqing Liu, Yimin Li
Summary: This study compared the respiratory mechanics in ARDS patients with or without COPD and found that PEEP titration guided by EIT in ARDS patients with COPD resulted in improvements in ventilation ratio, mechanical energy, cardiac index, and oxygen delivery with less adverse impact on hemodynamics.
Article
Medicine, General & Internal
Manuel Tisminetzky, Jose Dianti, Bruno L. Ferreyro, Federico Angriman, Lorenzo Del Sorbo, Sachin Sud, Daniel Talmor, Eddy Fan, Niall D. Ferguson, Ary Serpa Neto, Neill K. J. Adhikari, Ewan C. Goligher
Summary: This study aims to compare the effect of different PEEP selection strategies on all-cause mortality in adult patients with ARDS. Bayesian network meta-analyses will be conducted to obtain pooled estimates of potential head-to-head comparisons. The information gathered may inform clinical decision-making and help in designing future randomized trials.
SYSTEMATIC REVIEWS
(2021)
Article
Critical Care Medicine
Todd Sarge, Elias Baedorf-Kassis, Valerie Banner-Goodspeed, Victor Novack, Stephen H. Loring, Michelle N. Gong, Deborah Cook, Daniel Talmor, Jeremy R. Beitler
Summary: This study found that the effect of Pes-guided PEEP on survival in ARDS patients varied based on the severity of multiorgan dysfunction, and that PEEP titration achieving end-expiratory transpulmonary pressure near 0 cm H2O was associated with lower mortality.
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
(2021)
Letter
Critical Care Medicine
Jean-Louis Vincent, Jacques Creteur
INTENSIVE CARE MEDICINE
(2021)
Article
Critical Care Medicine
Wasineenart Mongkolpun, Peter Bakos, Jean-Louis Vincent, Jacques Creteur
Summary: This study included 42 patients with shock, and found that baseline skin blood flow and its early reduction after initiation of fluid removal using CVVH can predict worsened tissue perfusion, reflected by an increase in blood lactate levels.
ANNALS OF INTENSIVE CARE
(2021)
Review
Medicine, General & Internal
Jean-Louis Vincent, Jacques Creteur
Summary: With increasing life expectancy, more elderly patients are being admitted to ICU, representing a unique subgroup with changes in organ function, reduced daily living activities, decreased mobility, and cognitive decline. Ethical decisions regarding intensive care, life-sustaining interventions, life support withdrawal/withholding, and terminal sedation are more common in elderly patients, and should be personalized to consider individual beliefs and wishes.
JOURNAL OF INTERNAL MEDICINE
(2022)
Article
Surgery
Jonathan Nicholls, Emily N. Kirkham, Liz Haslam, Sharath C. Paravastu, Sachin R. Kulkarni
Summary: This study assessed the association of thrombus burden (TB) with persistent type II endoleaks after infrarenal endovascular aneurysm repair (EVAR). The results showed that low TB was associated with increased rates of persistent type II endoleak, while high TB was associated with increased sac regression and reduced reintervention rates. TB could be used for risk stratification in the planning of infrarenal EVAR and designing a post-EVAR surveillance regimen.
JOURNAL OF VASCULAR SURGERY
(2022)
Article
Medicine, General & Internal
Jean-Louis Vincent
Summary: Intensive care units (ICUs) worldwide have faced significant challenges due to the COVID-19 pandemic, such as resource shortages and ethical dilemmas. Through the discussions prompted by the COVID-19 situation, valuable lessons can be learned about resource allocation, end-of-life decision-making, and staff support.
JOURNAL OF CLINICAL MEDICINE
(2022)
Article
Biochemistry & Molecular Biology
Fabio Silvio Taccone, Fuhong Su, Xinrong He, Lorenzo Peluso, Katia Donadello, Sabino Scolletta, Daniel De Backer, Jean-Louis Vincent
Summary: The effects of correcting hypotension with vasopressors in septic shock may improve cerebral oxygenation but do not reverse the alterations in brain microcirculation or cerebral metabolism.
Review
Virology
Maya Hites, Jean-Louis Vincent
Summary: This article reviews the clinical studies conducted in Belgium on hospitalized patients with COVID-19, showing a limited participation of hospitals, low international collaboration, and a lack of adaptive platform trials.
Article
Medical Informatics
Walter Onen Yagos, Geoffrey Tabo Olok, Emmanuel Ben Moro, Jonathan Huck, Mahesh Nirmalan
Summary: This study explores the use of mobile phones for prosthetics rehabilitative services in the Acholi sub-region of northern Uganda. The results show that many prosthetics users own and use mobile phones to seek information related to their rehabilitation. However, there are challenges such as expensive airtime, limited charging places, and inadequate skills for operating a mobile phone. Therefore, promoting the use of mobile phones for prosthetics rehabilitative services is necessary for prosthetics users in rural areas.
BMC MEDICAL INFORMATICS AND DECISION MAKING
(2022)
Article
Neurosciences
Katia Donadello, Fuhong Su, Filippo Annoni, Sabino Scolletta, Xinrong He, Lorenzo Peluso, Leonardo Gottin, Enrico Polati, Jacques Creteur, Olivier De Witte, Jean-Louis Vincent, Daniel De Backer, Fabio Silvio Taccone
Summary: This study investigated the effects of cooling on cerebral microcirculation, oxygenation and metabolism in a healthy swine model. The results showed that during the cooling phase, cerebral functional capillary density and proportion of small-perfused vessels decreased, while oxygenation increased and metabolism decreased. After rewarming, all variables returned to normal values, except for an increased metabolism in the two groups subjected to hypothermia during the rewarming phase compared to the normothermia group.
Review
Biochemistry & Molecular Biology
Jean-Louis Vincent, Tom van der Poll, John C. Marshall
Summary: Sepsis, a life-threatening organ dysfunction caused by an uncontrolled host response to infection, remains a major challenge for clinicians and trialists. The evaluation of therapeutics targeting components of host response anomalies in sepsis patients is complicated by the inability to identify those who are more likely to benefit from a specific intervention. Furthermore, the existence of multiple and diverse host response aberrations in sepsis and limited knowledge of the dysregulated biological organ system or pathway driving sepsis-induced pathology in individual patients further complicate the development of effective therapies.
Article
Surgery
John Fallon, Emily Kirkham, Manik Chana, Sachin R. Kulkarni, David Cooper, Sharath Paravastu
Summary: This study evaluates the outcome differences and intervention rates between BIF and RIF types of arterio-venous fistulae through a two-year follow-up of patients from a vascular center in the UK.
VASCULAR AND ENDOVASCULAR SURGERY
(2023)
Article
Infectious Diseases
Jean-Louis Vincent
Summary: Sepsis is an infection associated with organ dysfunction, and early recognition and assessment of severity are crucial.
Article
Materials Science, Biomaterials
Jonathan J. Huck, Pamela Atim, Emmanuel B. Moro, Mahesh Nirmalan
Summary: In Northern Uganda, major limb loss is prevalent due to prolonged civil war, but access to rehabilitation services is limited and little is known about the extent of the issue. A study in the Acholi sub-region estimates around 10,117 people with major limb loss requiring long-term rehabilitation services, and approximately 150,512 people with other disabilities. Major limb loss cases are dispersed throughout the region and are more prevalent among males, older individuals, and those with lower levels of education. This research highlights the inadequacy of rehabilitation services for major limb loss and identifies the need for addressing the challenges in service delivery.
Correction
Critical Care Medicine
Alberto Fogagnolo, Fabio Silvio Taccone, Jean Louis Vincent, Giulia Benetto, Elaine Cavalcante, Elisabetta Marangoni, Riccardo Ragazzi, Jacques Creteur, Carlo Alberto Volta, Savino Spadaro
Review
Critical Care Medicine
Carlos A. Santacruz, Jean-Louis Vincent, Andres Bader, Luis A. Rincon-Gutierrez, Claudia Dominguez-Curell, David Communi, Fabio S. Taccone
Summary: Studies suggest that altered CSF concentrations of protein biomarkers related to cytoskeletal damage, inflammation, apoptosis, and oxidative stress may predict worse neurological outcomes in patients with acute brain injuries.