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Rose and Life: Anaphylaxis Following Rose-Thorn Prick Injury
Neeraj Kumar, Amarjeet Kumar, Sanjeev Kumar
2019, 1:72 (27 September 2019)
We report a case of rose-thorn prick injury in a 60-year-old woman. She presented within hours of exposure to rose-thorn prick and after ruling out all other possible reasons of anaphylaxis. We initiated conservative mode of treatment with moist oxygen inhalation through face mask, nebulized adrenalin, intravenous corticosteroids, antihistaminic, and fluid resuscitation. She was immediately shifted to the intensive care unit in view of any airway obstruction and further hemodynamic monitoring. To the best of our knowledge, this is the first reported case of anaphylactic shock caused by rose-thorn injuries. Hence, to combat these life-threatening situations, proper education and training are given to healthcare personnel's and preparation of pre-filled adrenaline syringes for auto-injection should be kept ready in such places, especially in resuscitation areas.
  5,334 274 -
Angiotensin in Clinical Practice
Ehsan Ahmadnia, Anna Hall, Marlies Ostermann
2019, 1:7 (3 January 2019)
Interest in the use of angiotensin (AT) (particularly in the context of shock) had been rekindled by recent randomized trial data (notably the AT II for the Treatment of High-Output Shock-3 study). This review article outlines the renin–AT system in health and during sepsis as well as the proposed clinical uses of AT II. The potential for wider application within critical care is also considered.
  4,540 375 1
The Intensity of Renal Replacement Treatment for Acute Kidney Injury: A Systematic Review and Network Meta-Analysis
Hongliang Wang, Haitao Liu, Yue Wang, Hongshuang Tong, Pulin Yu, Shuangshuang Chen, Guiyue Wang, Miao Liu, Yuhang Li, Nana Guo, Changsong Wang, Kaijiang Yu
2019, 1:61 (27 September 2019)
Background: Acute kidney injury (AKI) is a common and serious complication in critically ill patients. Patients who require renal replacement therapy (RRT) face a high mortality rate. Questions concerning the intensity of RRT in AKI patients led us to integrate direct and indirect evidence using a network meta-analysis to determine the optimal intensity and mode. Materials and Methods: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and Web of Science databases from 1990 to 2017 that included randomized controlled trials (RCTs) comparing different intensities of RRT to treat AKI in adults (18 years or older). Data regarding study characteristics, methods, and outcomes were extracted. We assessed the studies for eligibility, extracted the data, pooled the data, and used the GeMTC package in R to combine direct comparisons with indirect evidence. Results: Ten RCTs including 3354 participants were included in the network meta-analysis. The higher intensity continuous renal replacement treatment (CRRT) (to exceed 35 mL/kg/h) and the higher intensity IRRT (to exceed six times per week) both showed no statistical significance. Further analysis for higher intensity CRRT, lower intensity CRRT, higher intensity IRRT, and lower intensity IRRT also revealed no significance. Conclusions: This meta-analysis showed that increasing the intensity of CRRT to exceed 35 mL/kg/h and six times per week for intermittent RRT (IRRT) did not reduce mortality or the rate of dependence on dialysis among AKI patients.
  4,081 365 -
Pragmatic Studies for Acute Kidney Injury: Fluid Resuscitation in the Peri-Acute Kidney Injury Period
Raghavan Murugan, Haibo Qiu, Thomas Rimmele, Jianguo Li, Zhiyong Peng, Kaijiang Yu, John A Kellum, Claudio Ronco
2019, 1:52 (27 September 2019)
How fluid resuscitation clinical trials should be conducted for either prevention or treatment of acute kidney injury among patients admitted to the intensive care unit is unclear. In 2017, a group of experts in fluid resuscitation and acute kidney injury met at the Acute Disease Quality Initiative (ADQI) XIX consensus conference on “Pragmatic Studies for AKI”, Wuhan, China and developed a research framework. In this report, we summarize the consensus recommendations on the topic of fluid resuscitation in the peri-AKI period based on existing clinical evidence. We also discuss the gaps in our knowledge and identify future research questions. Finally, we examine the feasibility of conducting a pragmatic fluid resuscitation trial to improve outcomes from acute kidney injury.
  3,620 406 -
Ethics and End-of-Life Care
Jozef Kesecioglu
2019, 1:45 (27 September 2019)
  3,428 451 -
Is there a Role for Systematic Tools to Improve the Clinical Management of Patients with Acute Kidney Injury? Consensus Report of Acute Disease Quality Initiative XIX
Marlies Ostermann, Xiumin Xi, Jean-Louis Vincent, Raymond K Hsu
2019, 1:57 (27 September 2019)
Acute kidney injury (AKI) occurs in approximately 20% of hospitalized patients and is associated with increased morbidity and mortality. The care of hospitalized patients with AKI has been shown to be variable in clinical practices. Systematic tools including checklists, care bundles and medical algorithms have been developed and implemented to improve the care and outcomes of AKI patients. However, whether these systematic tools can improve the quality of care and outcomes of AKI patients is still unknown. The committee of the 19th Acute Disease Quality Initiative (ADQI) conference dedicated a workgroup with the task of developing a study protocol to investigate this question. A comprehensive literature search was performed using PubMed and Embase. Key questions and feasibility of potential study proposals were discussed during the conference. Then a two-step Delphi process was used to reach consensus regarding several aspects of the study protocol. The group suggested that patient risk assessment be included in the study protocol and the choice of systematic tool be depending on different clinical contexts. The group also proposed a two-phase study with the use of oliguria and systematic tool to investigate the quality of care and outcomes of AKI patients. Consensus was reached on a study protocol regarding the efficacy of using systematic tools to improve clinical management and outcomes of AKI patients.
  3,480 381 -
Pragmatic Studies for Acute Kidney Injury in China: Renal Replacement Therapy for Acute Kidney Injury and Sepsis Consensus Report of Acute Disease Quality Initiative XIX
John R Prowle, Bin Du, Changsong Wang, Martin Gallagher
2019, 1:48 (27 September 2019)
In this article, we report consensus of 19th Acute Disease Quality Initiative (ADQI) conference and pragmatic trial proposals on renal replacement therapy (RRT) for acute kidney injury (AKI)and sepsis. The committee develop a list of key questions for the pragmatic trials. Then a systematic literature search was performed using PubMed and Embase. Finally the group summarized the proposed trials using PICO(Patient, Intervention, Comparator, Outcome). The groups recommended the first step would be a prospective observational study to document the current clinical practice of RRT in ICUs. Then the second stage would be to develop a quality improvement (QI) tools to improve and standardize the RRT practice in ICUs. The committee also proposed the primary outcome and secondary outcomes of the trial. Consensus had been reached for the pragmatic trial of RRT for AKI and sepsis in Chinese ICUs.
  3,148 431 -
Multimodal Monitoring Technologies for Pathophysiology and Management of Traumatic Brain Injury
Yujie Chen, Qianwei Chen, Jian Sun, Lijun Zhang, Liang Tan, Hua Feng
2019, 1:12 (3 January 2019)
Despite decades of efforts, severe traumatic brain injury (TBI) is still the leading cause for mortality and immobility of children and young adults worldwide and is a great burden to the health-care system. After injury, the oxygen supply is conventionally considered the monitoring parameter in a neurosurgical Intensive Care Unit. However, the overall mortality rate has only slightly improved since the late twentieth century. Evolving evidence suggests that dysfunction of oxygen utilization might be the underlying pathophysiology of secondary brain injury, which should also be a key parameter for multimodal monitoring and management after severe TBI. In this review, we summarize the current and advanced understanding of multimodal monitoring for severe TBI along with novel noninvasive technologies in this field. By continuously monitoring patients with severe TBI, the use of multimodal monitoring technologies including (but not limited to) computed tomography, cerebral microdialysis, near-infrared spectroscopy, magnetic resonance spectroscopy, high-performance liquid chromatography, and magnetic induction phase shift method will be crucial for observing disease changes such as intracranial pressure and brain tissue oxygen partial pressure as well as developing potential therapeutic strategies after severe TBI.
  3,018 425 -
Management of Simultaneously Occurring Multiple Massive Intracerebral Hemorrhages
Luis Rafael Moscote-Salazar, Tariq Janjua, Amit Agrawal, Guru Dutta Satyarthee, Willem Guillermo Calderon-Miranda
2019, 1:69 (27 September 2019)
Occurrence of simultaneous multiple intracerebral hemorrhages (ICHs) in different arterial territories is an uncommon presentation. We report the cases of concurrent ocular and ICHs. The rarity of these lesions leads to delay in the diagnosis. Further lack of clear management guidelines for these pathologies makes further delay in the institution of appropriate therapy. In addition, the pathogenesis, diagnosis, and management along with pertinent literature are also reviewed.
  3,138 240 -
Combining Therapy of Octreotide and Glucocorticoid in the Treatment of a Lung Adenocarcinoma Patient with Acute Respiratory Distress Syndrome
Xue-Zhong Xing, Hai-Jun Wang, Shi-Ning Qu, Chu-Lin Huang
2019, 1:4 (3 January 2019)
A 63-year-old male who was diagnosed with adenocarcinoma of the right lower lobe presented with 1 week of fever, cough, and progressive dyspnea and admitted to the Intensive Care Unit (ICU). After intubation, physical examination revealed copious, light bloody sputum and diffuse crackles and rales on lung auscultation. The patient was diagnosed as Stage IV adenocarcinoma, septic shock (lung infection), and acute respiratory distress syndrome. His oxygenation failed to improve despite sedation, restrictive fluid therapy, and methylprednisolone, antimicrobials therapy, protective ventilation, plasma supplement, and anticoagulation. Respiratory secretions suctioned from her endotracheal tube averaged 1.0 L daily. On day 2 after admission, octreotide was infused to control sputum volume. The patient's respiratory secretions decreased significantly, and on day 8, the ventilator mode was changed to pressure support ventilation, and the patient was extubated and dismissed from ICU.
  3,071 288 -
Translational Critical Care Medicine: Integrating State-of-the-Art Knowledge between Bench and Bedside
Xiaofeng Jia, Zhiyong Peng
2019, 1:2 (3 January 2019)
  2,949 316 -
Using Clinical Decision Support Systems for Acute Kidney Injury Pragmatic Trials
Kianoush Kashani, Nooshin Dalili, Rickey E Carter, John A Kellum, Ravindra L Mehta
2019, 1:28 (3 January 2019)
Following the initial introduction of clinical decision support systems (CDSS) into the clinical practice in the 1970s, the complexity and performance quality of CDSSs have increased. The current literature on the efficacy and effectiveness of such systems shows conflicting results. While some studies show a clear benefit in quality-of-care improvement, others fail to replicate these outcomes. Heterogeneity of studies and the complexity of CDSS characteristics drive these conflicting conclusions. The lower cost and the easier implementation of pragmatic clinical trials provide an excellent platform to prove the effectiveness of CDSS in the real-world scenarios. To achieve better results, a series of explanatory trials are needed to identify the most effective CDSS in controlled settings. Therefore, utilization of both explanatory and pragmatic trial designs is necessary to evaluate the safety and efficacy of CDSS on the care of patients with acute kidney injury (AKI) in the acute setting. In this review, the authors provide an overview of the literature on critical care-related CDSS, its characteristics and dimensions, differences between pragmatic and explanatory trials, and potential proposals for both trial designs for AKI.
  2,754 303 2
The Short- and Long-Term Burden of Acute Kidney Injury
Jonah G Powell-Tuck, Jorge Cerda, Marlies Ostermann
2019, 1:35 (3 January 2019)
Acute kidney injury (AKI) is a common complication of acute illness and carries a significant risk of mortality and morbidity, resulting in high health-care-associated costs. The incidence of AKI appears to be rising, making it ever more important to understand its acute and chronic consequences. In this review, we explore the evolving epidemiology of AKI, describe the impact of AKI on other organs, and discuss the short- and long-term effects of AKI on mortality and morbidity and its economic burden.
  2,762 288 1
Neuromonitoring in Malignant Middle Cerebral Artery Infarction: A Review of Literature
Songyu Chen, Ke Wang, Chengcheng Zhou, Sajan Pandey, Liang Gao
2019, 1:20 (3 January 2019)
Malignant middle cerebral artery infarction is a devastating subtype of ischemic stroke, which carries a significant mortality rate (up to 80%) despite of conservative treatment. On the other hand, surgical decompressive procedure is the only established therapy to rescue the adverse effects of malignant edema and thus improve outcome. Accordingly, the early recognition of a possible malignant course as well as prediction of outcome is crucial for clinical decision-making. Numerous neuromonitoring techniques have been applied to address this issue. In theory, these techniques have the potential to present the information needed to guide targeted and timely intervention before irreversible damage takes place. However, the results were heterogeneous yet conflicting. We examined and summarized the recent evidence in this review, which may shed light on current trends.
  2,765 275 -
The Doctors in ICU Need to Know the Basics of Coagulopathy
Ziwei Hu, He Miao, Xiaochun Ma, Renyu Ding
2021, 2:69 (25 June 2021)
Coagulopathy is common in critically ill patients. Under pathogenic factors, the homeostasis of coagulation, anticoagulation, and fibrinolytic system is disrupted, causing a series of cascade reactions that ultimately lead to coagulopathy. The pathophysiology of coagulopathy markedly varies according to the etiology. For sepsis-induced coagulopathy, inflammation interacts with coagulation. This process involves various cells, including endothelial cells, neutrophils, and platelets. Thrombocytopenia, as a common coagulopathy disorder among intensive care unit (ICU) patients, is indicative of poor outcome, and its differential diagnosis is crucial. However, the standardized diagnostic criteria for disseminated intravascular coagulation are yet to be established, and the existing ones have limitations. Therefore, we used PubMed to search literature related to “thrombocytopenia,” “sepsis,” “coagulopathy,” “disseminated intravascular coagulation,” and “coagulation biomarkers” and expected ICU doctors to fully understand knowledgeable of the pathophysiology of Coagulopathy. The traditional coagulation indicators can be combined with novel coagulation-related biomarkers for the accurate diagnosis and treatment of coagulopathy.
  2,638 399 -
D Vitamin, Coronavirus, and Neurological Injuries
William Andres Florez Perdomo, Harold Enrique Vásquez Ucros, Luis Rafael Moscote-Salazar
2020, 2:64 (31 December 2020)
  2,721 109 1
Preface of Journal of Translational Critical Care Medicine
Kaijiang Yu, Zhiyong Peng
2019, 1:1 (3 January 2019)
  2,390 292 -
Cerebral Venous Thrombosis in Air Travelers during COVID-19 Times: Is the Risk Higher?
Luis Rafael Moscote-Salazar, Tariq Janjua, Pilar Bosque-Varela, Amit Agrawal
2020, 2:47 (31 December 2020)
  2,173 139 -
Fluid Overload and Acute Kidney Injury, Chicken or Eggs?
Hong Bo, Andrew M Harrison, Yan Kang, Xuelian Liao
2020, 1:81 (28 October 2020)
Fluid overload is one of the main complications associated with intravenous fluid therapy. Weight-based fluid accumulation is often calculated for fluid balance status in most researches. Fluid overload was defined as more than a 10% increase in body weight relative to baseline. There are many evidences that fluid overload is associated with an increased risk of acute kidney injury (AKI) and mortality. This review focuses on the pathophysiological link between fluid overload and AKI. Disruption of endothelial glycocalyx induced by fluid overload plays an important role in AKI. In addition, the compositions of the fluids (some colloids and chloride-rich fluids) may also contribute to kidney injury. On the other side, fluid overload is more obvious and the outcome in patients with AKI or with more critical illness. Therefore, the relationship between fluid overload and AKI should be fully understood and carefully managed.
  2,093 187 -
The 19th Acute Disease Quality Initiative (ADQI) Meeting Report
Zhiyong Peng
2019, 1:42 (3 January 2019)
  2,041 228 -
Patients Admitted to the Intensive Care Unit Should Receive Central Venous Pressure Monitoring: We Should Personalize Our Approach
Patrick M Honore, Aude Mugisha, Luc Kugener, Sebastien Redant, Rachid Attou, Andrea Gallerani, David De Bels
2020, 2:66 (31 December 2020)
  1,818 97 -
Etiopathogenic Factors of Cerebrovascular Disease in Young Adults: A Review of the Literature
Ezequiel Garcia-Ballestas, Juan Camilo Medrano Carreazo, Huber Said Padilla-Zambrano, Amit Agrawal, Jose Daniel Charry, Luis Rafael Moscote-Salazar
2020, 1:76 (28 October 2020)
Cerebrovascular disease (CVD) has been studied for many years, representing a cause of high morbidity and mortality; it has a great impact at a social, economic, and psychological level in the young adult population. There are different etiological factors that we do not find in the adult population, for that it is important to know how to differentiate them. There is no definitive etiological factor in this population given that the epidemiologic profile fluctuates considerably throughout regions and provinces, even if the same country is considered to make comparisons. CVD in young adults is caused by many etiological factors, predominantly the rare ones, such as cardioembolic, small vessel disease, due to thrombophilias, and undetermined cause. Despite being the main cause, the undetermined etiology is overestimated because it deserves for a detailed investigation in search of one of the rare causes, also, because of the lack of more complex studies in centers worldwide. No atherosclerotic large vessels diseases, such as cervicocephalic artery dissection, moyamoya disease, systemic vasculitis, and other rare syndromes should be considered to make an accurate diagnosis approach.
  1,773 142 -
Indices of Tissue Perfusion: Triggers of Targets of Resuscitation?
Daniel De Backer, Marie Van Hove, Pierre Foulon, Joe Kadou, Gregoire Michiels, Simone Giglioli
2020, 2:1 (31 December 2020)
Circulatory shock is characterized by a decrease in oxygen delivery to the tissues associated with impairment in oxygen metabolism and tissue hypoxia. Clinical and biological signs of impaired tissue perfusion and tissue hypoxia are used as bedside to detect circulatory failure and trigger resuscitation procedures. The most popular signs of tissue hypoperfusion include mean arterial pressure, capillary refill time and mottling score, central venous oxygen saturation (ScvO2), veno-arterial difference in PCO2 (PvaCO2), microcirculation assessment, and lactate. Both the severity and duration of the alterations in any of these variables are associated with a poor outcome so that it sounds logical to trigger therapy based on these. Using these variables as target for therapy is much more complex. Some of the limits for using some of these variables as targets include an incertitude about the target to reach (should we aim at normalizing or improving the variable, and by how much?) and the time lag between resolution of impaired tissue perfusion/hypoxia and normalization of the variable. The ideal target variable should have a well-defined end point and a rapid response time. Interestingly, hemodynamic resuscitation targeting these variables gave variable results. In this review, we will discuss the interest and limitations of the above-mentioned indices of tissue perfusion and hypoxia as trigger as well as end point of resuscitation in critically ill patients.
  1,534 209 -
Endoplasmic Reticulum Stress and Critical Care Medicine
Ying Shi, Tingting Wang, Xiangrong Zuo
2020, 2:54 (31 December 2020)
Many patients suffer from multiple organ dysfunction syndrome (MODS), which represents a dominant cause of death in the intensive care unit. Current theories about the mechanisms of MODS include inflammation, dysregulated immune response, reduced cellular oxygen utilization, cytopathic hypoxia, and apoptosis. Moreover, an increasing number of studies have shown that endoplasmic reticulum stress (ERS) is related to organ dysfunction. The endoplasmic reticulum is an organelle that is responsible for secretion and membrane protein synthesis and assembly as well as some other physiological activities. Under certain conditions, the homeostasis of ER can be lost, causing the accumulation of unfolded or misfolded protein, which is termed as ERS. During ERS, unfolded protein response (UPR) is activated. Once UPR fails to rebuilt cellular homeostasis, cell function will be impaired and apoptosis will be induced. To better understand the relationship between ERS and severe diseases, we summarize the current research in the context of ERS and UPR signaling associated with various organ dysfunction and severe diseases, including acute lung injury, hepatic injury, heart failure, hemorrhagic shock with multiple organ dysfunction, sepsis, and some other diseases. We also discuss ERS or UPR as a novel therapeutic target and their future directions.
  1,510 165 -
Research Progress on Sepsis-Related Liver Injury
Kai Kang, Na-Na Li, Yang Gao, Xue Du, Xin-Yu Zhang, Ming-Yan Zhao, Kai-Jiang Yu
2020, 2:49 (31 December 2020)
Liver injury is one of the most common critical clinical illnesses and is one of the manifestations of multiple organ dysfunction induced by sepsis. The liver plays a central role in the development of sepsis. The role of the liver in removing bacteria and regulating immune inflammation is crucial, and the liver is the target of sepsis-related injuries. However, the mechanism of liver injury in sepsis is still not clear. This review discusses the pathophysiology, clinical manifestations, and treatment of sepsis-related liver injury. Liver injury, pathophysiological mechanism, sepsis, sepsis-related liver injury
  1,509 147 -