Acute kidney injury(AKI)presents a significant challenge in the management of critically ill patients,as it is as-sociated with increased mortality,prolonged hospital stays,and increased healthcare costs.In certain co...Acute kidney injury(AKI)presents a significant challenge in the management of critically ill patients,as it is as-sociated with increased mortality,prolonged hospital stays,and increased healthcare costs.In certain conditions,such as during sepsis or after cardiac surgery,AKI is one of the most frequent complications,affecting 30%-50%of patients.Over time,even after the resolution of AKI,it can evolve into chronic kidney disease,a leading global cause of mortality,and cardiovascular complications.Despite significant improvement in the care of critically ill patients over the past two decades,the incidence of AKI remains stable,and novel approaches aiming at reducing its occurrence or improving AKI outcomes are still mostly lacking.However,recent insights into the pathophys-iology of AKI within critical care settings have shed light on new pathways for both prevention and treatment,providing various new therapeutic targets aimed to mitigating kidney injury.These advancements highlight the intricate and multifaceted nature of the mechanisms underlying AKI,which could explain the challenge of iden-tifying an effective treatment.Among these targets,modulation of the inflammatory responses and the cellular metabolism,hemodynamic regulation and enhancement of cellular repair mechanisms,have emerged as promis-ing options.These multifaceted approaches offer renewed hope for limiting the incidence and severity of AKI in critically ill patients.Several ongoing clinical trials are evaluating the efficacy of these different strategies and we are facing an exiting time with multiple therapeutic interventions being tested to prevent or treat AKI.In this review,we aim to provide a summary of the new drugs evaluated for preventing or treating AKI in critical care and surgical settings.展开更多
Background:Cancer patients who are exposed to sepsis and had previous chemotherapy may have increased severity. Among chemotherapeutic agents, anthracyclines have been associated with cardiac toxicity. Like other chem...Background:Cancer patients who are exposed to sepsis and had previous chemotherapy may have increased severity. Among chemotherapeutic agents, anthracyclines have been associated with cardiac toxicity. Like other chemotherapeutic agents, they may cause endothelial toxicity. The aim of this study was to evaluate the effect of anthracycline treatment on the outcome of cancer patients with sepsis.Methods:Data from cancer patients admitted to intensive care units (ICUs) for sepsis or septic shock were extracted from the Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique database (1994-2015). Comparison between patients who received anthracycline and those who did not was performed using a propensity score, including confounding variables (age and underlying diseases). A competing risk adjusted for severity of illness (Sequential Organ Failure Assessment [SOFA] score) was used to analyze the duration of vasopressor requirement.Results:Among 2046 patients, 1070 (52.3%) patients who received anthracycline were compared with 976 (47.7%) who did not. The underlying disease was mostly acute hematological malignancy (49.2%). Sepsis, mostly pneumonia (47.7%), had developed 2 days (interquartile range [IQR]:1-4 days) prior to ICU admission. Most patients (n=1156/1980,58.4%) required vasopressors for 3 days (IQR: 2-6 days). Factors associated with the need for vasopressors were aplasia (hazard ratio [HR]=1.72, 95% confidence interval [CI]: 1.21 to 2.47, P=0.002) and day 1 respiratory SOFA score (HR=7.07, 95% CI: 2.75 to 22.1, P <0.001). Previous anthracycline treatment was not associated with an increased risk of vasopressor use. The duration of vasopressors was not different between patients who received anthracycline and those who did not (P=0.79). Anthracycline was not associated with ICU mortality.Conclusion:Previous anthracycline treatment did not alter the course of sepsis in a cohort of cancer patients admitted to intensive care with sepsis.展开更多
Background:It is unknown whether lung-protective ventilation is applied in burn patients and whether they benefit from it.This study aimed to determine ventilation practices in burn intensive care units(ICUs)and inves...Background:It is unknown whether lung-protective ventilation is applied in burn patients and whether they benefit from it.This study aimed to determine ventilation practices in burn intensive care units(ICUs)and investigate the association between lung-protective ventilation and the number of ventilator-free days and alive at day 28(VFD-28).Methods:This is an international prospective observational cohort study including adult burn patients requiring mechanical ventilation.Low tidal volume(V_(T))was defined as V_(T)≤8 mL/kg predicted body weight(PBW).Levels of positive end-expiratory pressure(PEEP)and maximum airway pressures were collected.The association between V_(T) and VFD-28 was analyzed using a competing risk model.Ventilation settings were presented for all patients,focusing on the first day of ventilation.We also compared ventilation settings between patients with and without inhalation trauma.Results:A total of 160 patients from 28 ICUs in 16 countries were included.Low V_(T) was used in 74%of patients,median V_(T) size was 7.3[interquartile range(IQR)6.2–8.3]mL/kg PBW and did not differ between patients with and without inhalation trauma(p=0.58).Median VFD-28 was 17(IQR 0–26),without a difference between ventilation with low or high V_(T)(p=0.98).All patients were ventilated with PEEP levels≥5 cmH_(2)O;80%of patients had maximum airway pressures<30 cmH_(2)O.Conclusion:In this international cohort study we found that lung-protective ventilation is used in the majority of burn patients,irrespective of the presence of inhalation trauma.Use of low V_(T) was not associated with a reduction in VFD-28.Trial registration:Clinicaltrials.gov NCT02312869.Date of registration:9 December 2014.展开更多
文摘Acute kidney injury(AKI)presents a significant challenge in the management of critically ill patients,as it is as-sociated with increased mortality,prolonged hospital stays,and increased healthcare costs.In certain conditions,such as during sepsis or after cardiac surgery,AKI is one of the most frequent complications,affecting 30%-50%of patients.Over time,even after the resolution of AKI,it can evolve into chronic kidney disease,a leading global cause of mortality,and cardiovascular complications.Despite significant improvement in the care of critically ill patients over the past two decades,the incidence of AKI remains stable,and novel approaches aiming at reducing its occurrence or improving AKI outcomes are still mostly lacking.However,recent insights into the pathophys-iology of AKI within critical care settings have shed light on new pathways for both prevention and treatment,providing various new therapeutic targets aimed to mitigating kidney injury.These advancements highlight the intricate and multifaceted nature of the mechanisms underlying AKI,which could explain the challenge of iden-tifying an effective treatment.Among these targets,modulation of the inflammatory responses and the cellular metabolism,hemodynamic regulation and enhancement of cellular repair mechanisms,have emerged as promis-ing options.These multifaceted approaches offer renewed hope for limiting the incidence and severity of AKI in critically ill patients.Several ongoing clinical trials are evaluating the efficacy of these different strategies and we are facing an exiting time with multiple therapeutic interventions being tested to prevent or treat AKI.In this review,we aim to provide a summary of the new drugs evaluated for preventing or treating AKI in critical care and surgical settings.
文摘Background:Cancer patients who are exposed to sepsis and had previous chemotherapy may have increased severity. Among chemotherapeutic agents, anthracyclines have been associated with cardiac toxicity. Like other chemotherapeutic agents, they may cause endothelial toxicity. The aim of this study was to evaluate the effect of anthracycline treatment on the outcome of cancer patients with sepsis.Methods:Data from cancer patients admitted to intensive care units (ICUs) for sepsis or septic shock were extracted from the Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique database (1994-2015). Comparison between patients who received anthracycline and those who did not was performed using a propensity score, including confounding variables (age and underlying diseases). A competing risk adjusted for severity of illness (Sequential Organ Failure Assessment [SOFA] score) was used to analyze the duration of vasopressor requirement.Results:Among 2046 patients, 1070 (52.3%) patients who received anthracycline were compared with 976 (47.7%) who did not. The underlying disease was mostly acute hematological malignancy (49.2%). Sepsis, mostly pneumonia (47.7%), had developed 2 days (interquartile range [IQR]:1-4 days) prior to ICU admission. Most patients (n=1156/1980,58.4%) required vasopressors for 3 days (IQR: 2-6 days). Factors associated with the need for vasopressors were aplasia (hazard ratio [HR]=1.72, 95% confidence interval [CI]: 1.21 to 2.47, P=0.002) and day 1 respiratory SOFA score (HR=7.07, 95% CI: 2.75 to 22.1, P <0.001). Previous anthracycline treatment was not associated with an increased risk of vasopressor use. The duration of vasopressors was not different between patients who received anthracycline and those who did not (P=0.79). Anthracycline was not associated with ICU mortality.Conclusion:Previous anthracycline treatment did not alter the course of sepsis in a cohort of cancer patients admitted to intensive care with sepsis.
文摘Background:It is unknown whether lung-protective ventilation is applied in burn patients and whether they benefit from it.This study aimed to determine ventilation practices in burn intensive care units(ICUs)and investigate the association between lung-protective ventilation and the number of ventilator-free days and alive at day 28(VFD-28).Methods:This is an international prospective observational cohort study including adult burn patients requiring mechanical ventilation.Low tidal volume(V_(T))was defined as V_(T)≤8 mL/kg predicted body weight(PBW).Levels of positive end-expiratory pressure(PEEP)and maximum airway pressures were collected.The association between V_(T) and VFD-28 was analyzed using a competing risk model.Ventilation settings were presented for all patients,focusing on the first day of ventilation.We also compared ventilation settings between patients with and without inhalation trauma.Results:A total of 160 patients from 28 ICUs in 16 countries were included.Low V_(T) was used in 74%of patients,median V_(T) size was 7.3[interquartile range(IQR)6.2–8.3]mL/kg PBW and did not differ between patients with and without inhalation trauma(p=0.58).Median VFD-28 was 17(IQR 0–26),without a difference between ventilation with low or high V_(T)(p=0.98).All patients were ventilated with PEEP levels≥5 cmH_(2)O;80%of patients had maximum airway pressures<30 cmH_(2)O.Conclusion:In this international cohort study we found that lung-protective ventilation is used in the majority of burn patients,irrespective of the presence of inhalation trauma.Use of low V_(T) was not associated with a reduction in VFD-28.Trial registration:Clinicaltrials.gov NCT02312869.Date of registration:9 December 2014.
