Elderly Patients and Management in Intensive Care Units (ICU): Clinical Challenges

Clinical Interventions in Aging, Journal Year: 2023, Volume and Issue: Volume 18, P. 93 - 112

Published: Jan. 1, 2023

Abstract: There is a growing population of older adults requiring admission to the intensive care unit (ICU). This outpaces ability clinicians with geriatric training assist in their management. Specific and education for intensivists patients valuable help understand inform clinical care, as physiologic changes aging affect each organ system. review highlights some these processes discusses implications vulnerable population. Other considerations when caring ICU include functional outcomes morbidity, opposed merely focus on mortality. An overall holistic approach incorporating physiology aging, applying current evidence, including patient family should be used ICU. Keywords: syndrome, critical illness, dysfunction, shock, respiratory failure

Language: Английский

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Improving Outcomes After Post–Cardiac Arrest Brain Injury: A Scientific Statement From the International Liaison Committee on Resuscitation

Circulation, Journal Year: 2024, Volume and Issue: 150(7)

Published: June 27, 2024

This scientific statement presents a conceptual framework for the pathophysiology of post–cardiac arrest brain injury, explores reasons previous failure to translate preclinical data clinical practice, and outlines potential paths forward. Post–cardiac injury is characterized by 4 distinct but overlapping phases: ischemic depolarization, reperfusion repolarization, dysregulation, recovery repair. Previous research has been challenging because limitations laboratory models; heterogeneity in patient populations enrolled; overoptimistic estimation treatment effects leading suboptimal sample sizes; timing route intervention delivery; limited or absent evidence that engaged mechanistic target; postresuscitation care, prognostication, withdrawal life-sustaining treatments. Future trials must tailor their interventions subset patients most likely benefit deliver this at appropriate time, through route, dose. The complexity suggests monotherapies are unlikely be as successful multimodal neuroprotective therapies. Biomarkers should developed identify with targeted mechanism quantify its severity, measure response therapy. Studies need adequately powered detect effect sizes realistic meaningful patients, families, clinicians. Study designs optimized accelerate evaluation promising interventions. Multidisciplinary international collaboration will essential realize goal developing effective therapies injury.

Language: Английский

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The immunology of the post-cardiac arrest syndrome

Resuscitation, Journal Year: 2022, Volume and Issue: 179, P. 116 - 123

Published: Aug. 24, 2022

Language: Английский

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Temperature control after cardiac arrest

Critical Care, Journal Year: 2022, Volume and Issue: 26(1)

Published: Nov. 24, 2022

Abstract Most of the patients who die after cardiac arrest do so because hypoxic-ischemic brain injury (HIBI). Experimental evidence shows that temperature control targeted at hypothermia mitigates HIBI. In 2002, one randomized trial and quasi-randomized showed 32–34 °C improved neurological outcome mortality in are comatose arrest. However, following publication these trials, other studies have questioned neuroprotective effects hypothermia. 2021, largest study conducted far on (the TTM-2 trial) including 1900 adults resuscitation no effect 33 compared with normothermia or fever control. A systematic review 32 trials published between 2001 2021 concluded a target prevention did not result an improvement survival (RR 1.08; 95% CI 0.89–1.30) favorable functional 1.21; 0.91–1.61) 90–180 days resuscitation. There was substantial heterogeneity across certainty low. Based results, International Liaison Committee Resuscitation currently recommends monitoring core actively preventing (37.7 °C) for least 72 h from Future needed to identify potential patient subgroups may benefit aimed comparing

Language: Английский

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Lower or higher oxygenation targets in the intensive care unit: an individual patient data meta-analysis

Intensive Care Medicine, Journal Year: 2024, Volume and Issue: 50(8), P. 1275 - 1286

Published: July 11, 2024

Optimal oxygenation targets for patients with acute hypoxemic respiratory failure in the intensive care unit (ICU) are not clearly defined due to substantial variability design of previous trials. This study aimed perform a pre-specified individual patient data meta-analysis Handling Oxygenation Targets ICU (HOT-ICU) and coronavirus disease 2019 (COVID-19) (HOT-COVID) trials compare targeting partial pressure arterial oxygen (PaO2) 8–12 kPa adult patients, assessing both benefits harms. We assessed 90-day all-cause mortality days alive without life support 90 using generalised mixed model. Heterogeneity treatment effects (HTE) was evaluated 14 subgroups, results graded Instrument assess Credibility Effect Modification Analyses (ICEMAN). At days, 40.4% (724/1792) 8 group 40.9% (733/1793) 12 (risk ratio, 0.99; 95% confidence interval [CI] 0.92–1.07; P = 0.80). No difference observed number support. Subgroup analyses indicated more COVID-19 (P 0.04) (moderate credibility), lower 0.03) 0.02) cancer-patients (low credibility). reported no overall differences comparing PaO2 target on or days. suggested HTE credibility) cancer

Language: Английский

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Artificial Intelligence and Machine Learning Applications in Critically Ill Brain Injured Patients

Seminars in Neurology, Journal Year: 2024, Volume and Issue: 44(03), P. 342 - 356

Published: April 3, 2024

Abstract The utilization of Artificial Intelligence (AI) and Machine Learning (ML) is paving the way for significant strides in patient diagnosis, treatment, prognostication neurocritical care. These technologies offer potential to unravel complex patterns within vast datasets ranging from clinical data EEG (electroencephalogram) readings advanced cerebral imaging facilitating a more nuanced understanding conditions. Despite their promise, implementation AI ML faces substantial hurdles. Historical biases training data, challenge interpreting multifaceted streams, “black box” nature algorithms present barriers widespread adoption. Moreover, ethical considerations around privacy need transparent, explainable models remain paramount ensure trust efficacy decision-making. This article reflects on emergence as integral tools care, discussing roles perspective both scientific promise associated challenges. We underscore importance extensive validation diverse settings generalizability models, particularly considering inform critical medical decisions such withdrawal life-sustaining therapies. Advancement computational capabilities essential implementing settings, allowing real-time analysis decision support at point As are poised become commonplace practice, it incumbent upon health care professionals understand oversee these technologies, ensuring they adhere highest safety standards contribute realization personalized medicine. engagement will be pivotal integrating into optimizing outcomes through informed data-driven

Language: Английский

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Improving Outcomes After Post–Cardiac Arrest Brain Injury: A Scientific Statement From the International Liaison Committee on Resuscitation

Resuscitation, Journal Year: 2024, Volume and Issue: 201, P. 110196 - 110196

Published: June 27, 2024

Language: Английский

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Fever management with or without a temperature control device after out‐of‐hospital cardiac arrest and resuscitation (TEMP‐CARE): A study protocol for a randomized clinical trial

Acta Anaesthesiologica Scandinavica, Journal Year: 2025, Volume and Issue: 69(5)

Published: April 13, 2025

Fever is associated with brain injury after cardiac arrest. It unknown whether fever management a feedback-controlled device impacts patient-centered outcomes in arrest patients. This trial aims to investigate or without temperature control out-of-hospital The TEMP-CARE part of the 2 × factorial Sedation, TEmperature and Pressure Cardiac Arrest REsuscitation (STEPCARE) trial, randomized, international, multicenter, parallel-group, investigator-initiated, superiority that will evaluate sedation strategies, management, blood pressure targets simultaneously nontraumatic/nonhemorrhagic patients following hospital admission. For component described this protocol, be randomly allocated device. those managed device, if ≥37.8°C occurs within 72 h post-randomization started targeting ≤37.5°C. Standard treatment, as recommended by local guidelines, including pharmacological agents, provided participants both groups. two other components STEPCARE strategies. Apart from interventions, all aspects general intensive care according practices participating site. A physician blinded intervention determine neurological prognosis European Resuscitation Council Society Intensive Care Medicine guidelines. primary outcome all-cause mortality at six months post-randomization. To detect 5.6% absolute risk reduction (90% power, alpha .05), 3500 enrolled. Secondary include poor functional months, care-related serious adverse events, overall health status months. post-cardiac affects patient-important

Language: Английский

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A Bayesian Interpretation of a Pediatric Cardiac Arrest Trial (THAPCA-OH)

NEJM Evidence, Journal Year: 2022, Volume and Issue: 2(1)

Published: Dec. 14, 2022

BackgroundPediatric out-of-hospital cardiac arrest results in high morbidity and mortality. Currently, there are no recommended therapies beyond supportive care. The THAPCA-OH (Therapeutic Hypothermia after Pediatric Cardiac Arrest Out-of-Hospital) trial compared hypothermia (33.0°C) with normothermia (36.8°C) 295 children. Good neurobehavioral outcome survival at 1 year were higher the group (20 vs. 12% 38 29%, respectively). These differences did not meet planned statistical threshold of P<0.05. To ensure that a potentially efficacious therapy is prematurely discarded, we reassessed using Bayesian perspective.MethodsWe performed analysis, interpreting probabilistic terms (i.e., probability therapeutic had any benefit, overall absolute improvements greater than 2%, 5%, 10% for 1-year survival). Our primary analyses used noninformative priors, meaning based on observed data without information added by priors. In absence pediatric trials to derive informative prior distributions, used: (1) downweighted priors from adult trials; (2) previously published set critical care span equipoise, harm.ResultsIn analyses, benefit was 94% both year. For outcomes, >75% all integrations results, except those most pessimistic priors.ConclusionsThere provides modest (ClinicalTrials.gov number, NCT00878644.)

Language: Английский

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Prospective comparison of prognostic scores for prediction of outcome after out-of-hospital cardiac arrest: results of the AfterROSC1 multicentric study

Annals of Intensive Care, Journal Year: 2023, Volume and Issue: 13(1)

Published: Oct. 11, 2023

Out-of-hospital cardiac arrest (OHCA) is a heterogeneous entity with multiple origins and prognoses. An early, reliable assessment of the prognosis useful to adapt therapeutic strategy, tailor intensity care, inform relatives. We aimed primarily undertake prospective multicentric study evaluate predictive performance Cardiac Arrest Prognosis (CAHP) Score as compare historical dataset systematically collected after OHCA (Utstein style criteria). Our secondary aim was other dedicated scores for predicting outcome them Utstein criteria.

Language: Английский

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