Abstract:
:Venous thromboembolism (VTE) is a major health concern associated with significant morbidity and mortality. Critically ill patients are at an increased risk of VTE compared to general medical patients due to unique risk factors: prolonged immobilization, invasive lines and devices, certain medications, and acquired thrombophilia. Furthermore, VTE in the critically ill is associated with increased duration of mechanical ventilation, increased length of intensive care unit and hospital stay, and a trend toward increased mortality. Clinical practice guidelines therefore recommend VTE prophylaxis with either subcutaneous heparin or low-molecular-weight heparin for all critically ill patients without contraindication. Yet, many patients will develop VTE despite appropriate pharmacologic prophylaxis, which has led to interest in risk-stratifying critically ill patients for more aggressive prophylaxis strategies. Recent research identified patients at highest risk of failure of thromboprophylaxis and provided insight into the pathophysiologic mechanisms. Obesity and the receipt of vasopressors are 2 risk factors consistently identified in observational studies; further clinical data support decreased absorption of anticoagulant administered via the subcutaneous route as the likely mechanism behind thromboprophylaxis failure in these patient populations. Several studies have investigated novel thromboprophylaxis strategies to circumvent pharmacokinetic limitations in patients who are obese or on vasopressors: increased fixed-dose, weight-based subcutaneous, or continuous intravenous infusion of a prophylactic dose of anticoagulant has shown promise in limited studies; however, the results have yet to demonstrate superiority compared to current standard-of-care. This review discusses observational studies identifying patients at risk of thromboprophylaxis failure and critiques clinical studies evaluating novel thromboprophylaxis strategies in high-risk, critically ill patients with a focus on their limitations. Future studies are currently being conducted that will provide further guidance into the appropriate use of individualized thromboprophylaxis.
journal_name
J Intensive Care Medjournal_title
Journal of intensive care medicineauthors
Lewis TC,Cortes J,Altshuler D,Papadopoulos Jdoi
10.1177/0885066618796486subject
Has Abstractpub_date
2019-11-01 00:00:00pages
877-888issue
11-12eissn
0885-0666issn
1525-1489journal_volume
34pub_type
杂志文章,评审abstract::Cardiomyopathy secondary to toxic shock syndrome (TSS) is an uncommon but potentially life-threatening problem. We report the case of a 51-year-old male who presented with profound cardiogenic shock and multiorgan failure that could not be managed by conventional therapy with intravenous fluids, vasopressors and inotr...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066613517069
更新日期:2015-02-01 00:00:00
abstract:BACKGROUND:Pharmacogenomic (PGx) testing has the potential to provide information on specific drug-metabolizing enzymes that may lead to an absence, reduction, or increase in medication effect in patients. There is a paucity of prospective studies examining PGx testing in the intensive care unit (ICU) setting. RESEARC...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066620946303
更新日期:2020-07-31 00:00:00
abstract::Neurologic complications of cancer are common and are frequently life-threatening events. Certain neurologic emergencies occur more frequently in the cancer population, specifically elevated intracranial pressure, epidural cord compression, status epilepticus, ischemic and hemorrhagic stroke, central nervous system in...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
doi:10.1177/0885066615619582
更新日期:2017-02-01 00:00:00
abstract:BACKGROUND:Admission to an intensive care unit (ICU) specialized for brain and spine injury patients is associated with improved outcome. We investigated the effects of the first dedicated, combined neurological and neurosurgical ICU (NeuroICU) in Korea on patient outcomes. METHODS:The first dedicated NeuroICU in Kore...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066617706675
更新日期:2019-02-01 00:00:00
abstract::Left ventricular assist devices (LVADs) and total artificial hearts (TAHs) are surgically implanted as permanent treatment of unrecoverable heart failure. Both LVADs and TAHs are durable mechanical circulatory support (MCS) devices that can prolong patient survival but also alter end-of-life trajectory. The permissibi...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
doi:10.1177/0885066611432415
更新日期:2014-01-01 00:00:00
abstract:OBJECTIVES:We report the case of a 28-year-old patient with systemic lupus erythematosus (SLE) with rapid onset of dyspnea and hemoptysis found to have diffuse alveolar hemorrhage (DAH) with refractory hypoxemia successfully treated with venovenous extracorporeal membrane oxygenation (ECMO). The discussion includes cli...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
doi:10.1177/0885066612464335
更新日期:2014-03-01 00:00:00
abstract:OBJECTIVE:Fluid responsiveness is the ability to increase the cardiac output in response to a fluid challenge. Only about 50% of patients receiving fluid resuscitation for acute circulatory failure increase their stroke volume, but the other 50% may worsen their outcome. Therefore, predicting fluid responsiveness is ne...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,meta分析
doi:10.1177/0885066617752308
更新日期:2020-04-01 00:00:00
abstract::Bronchopulmonary dysplasia is the most common morbidity among surviving premature infants. Injury to the developing lung is the result of the interaction between a susceptible host and a number of contributing factors such as mechanical ventilation and infection. The resulting persistent impairment of pulmonary functi...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
doi:10.1177/0885066604273494
更新日期:2005-03-01 00:00:00
abstract:BACKGROUND:At this time, there are no studies evaluating the risk of delirium or coma with the use of ketamine in mechanically ventilated adult patients, compared to conventional therapies such as propofol or dexmedetomidine. OBJECTIVE:The objective of this study was to evaluate the number of days alive without deliri...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066618767619
更新日期:2020-06-01 00:00:00
abstract::Sepsis is a major cause of morbidity and mortality worldwide. With the advance of medical care, the mortality of sepsis has decreased in the past decades. Many treatments and diagnostic tools still lack supporting evidence. We conducted a retrospective population-based cohort study with propensity score matched subcoh...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066619827270
更新日期:2020-12-01 00:00:00
abstract::The objective of this retrospective study was to determine the optimal initial antibiotic regimen for hospital-acquired pneumonia using the frequency and sensitivity of Gram negative microorganisms found in sputum cultures. An antibiogram was constructed and compared with the hospital intensive care unit (ICU) antibio...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066605278650
更新日期:2005-09-01 00:00:00
abstract::Primary and acquired abdominal pathology accounts for a significant proportion of sepsis and SIRS in the ICU population. Abdominal processes often present a difficult diagnostic dilemma in the truly critically ill patient who, due to hemodynamic instability or severe acute respiratory distress syndrome (ARDS) requirin...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066613492102
更新日期:2015-07-01 00:00:00
abstract:OBJECTIVE:In the intensive care unit (ICU), prolonged inactivity is common, increasing patients' risk for adverse outcomes, including ICU-acquired weakness. Hence, interventions to minimize inactivity are gaining popularity, highlighting actigraphy, a measure of activity involving a wristwatch-like accelerometer, as a ...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066619863654
更新日期:2020-11-01 00:00:00
abstract::Acute adrenocortical insufficiency is a critical care emergency characterized by hemodynamic instability, lethargy, and cardiovascular collapse. Acute adrenal insufficiency has many etiologies, from rapid withdrawal of exogenous glucocorticoids to adrenocortical destruction to poor adrenal reserve after administration...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
doi:10.1177/0885066606298140
更新日期:2007-03-01 00:00:00
abstract::Acute brain injury (ABI) increases morbidity and mortality in patients with veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Optimal neurologic monitoring methods have not been well-explicated. We studied the use of Near-infrared Spectroscopy (NIRS) to monitor cerebral regional oxygenation tissue saturatio...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066620966962
更新日期:2020-10-15 00:00:00
abstract:PURPOSE:The aim of this study was to check if serum lactate was independently associated with mortality among critically ill patients. MATERIALS AND METHODS:This was a single-center, retrospective cohort study. All adult patients (>18 years of age) who had at least 1 measurement of lactate within 24 hours of admission...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066619854355
更新日期:2020-11-01 00:00:00
abstract:INTRODUCTION:A 25-hydroxyvitamin D, 25(OH)D, deficiency is common among critically ill patients and correlated with increased mortality. Furthermore, deficiency is associated with advanced liver disease. However, there are no studies available comparing the dimensions and consequences of a 25(OH)D deficiency between pa...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066618803844
更新日期:2020-10-01 00:00:00
abstract::The brain reacts to injury or disease by cascades of cellular and molecular responses. Evidence suggests that immune-inflammatory processes are key elements in the physiopathological processes associated with brain injury or damage. Cytokines are among major mediators implicated in these processes. Cytokine responses ...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
doi:10.1177/0885066608318458
更新日期:2008-07-01 00:00:00
abstract:BACKGROUND:The efficacy of low-dose hydrocortisone therapy in the management of septic shock remains controversial in critical care for many years. Hence, we performed this meta-analysis of randomized controlled trials (RCTs) with trial sequential analysis (TSA) to evaluate its effect on clinical outcome among adult pa...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066618803062
更新日期:2020-10-01 00:00:00
abstract::Objectives: Standard management strategies for lowering intracranial pressure (ICP) in traumatic brain injury has been well-studied, but the use of lesser known interventions for ICP in subarachnoid hemorrhage (SAH) remains elusive. Searches were performed in PubMed and EBSCO Host to identify best available evidence f...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
doi:10.1177/0885066618813073
更新日期:2020-03-01 00:00:00
abstract:BACKGROUND:Changes in white blood cell (WBC) counts and/or temperature could have important implications in patients on ventilators, but the frequency of these events is uncertain. METHODS:We reviewed the medical records from 281 ventilation episodes in our medical intensive care unit to determine patient characterist...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066615605036
更新日期:2017-05-01 00:00:00
abstract:AIMS:To investigate the occurrence and etiology of fever at anytime during pediatric intensive care unit (PICU) admission, and to study its possible effects on clinical outcome in a heterogeneous population of critically ill children. METHODS:Retrospective, observational single center study, comprising 202 patients ag...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066609340631
更新日期:2009-09-01 00:00:00
abstract:INTRODUCTION:Although magnesium plays an important role in aerobic metabolism and magnesium deficiency is a common phenomenon in critical illness, the association between magnesium deficiency and lactic acidosis in the intensive care unit (ICU) has not been defined. METHODS:This was a retrospective, cross-sectional st...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066614530659
更新日期:2016-03-01 00:00:00
abstract::Cirrhotic patients admitted to the medical intensive care unit (ICU) are associated with high mortality rates. The prognosis of critically ill cirrhotic patients is determined by the extent of hepatic and extrahepatic organ dysfunction. This study was conducted to assess and compare the accuracy of the Child-Pugh clas...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066603261991
更新日期:2004-03-01 00:00:00
abstract::Early predictors of prognosis in comatose patients post cardiac arrest help inform decisions surrounding continuation or withdrawal of treatment and provide a framework on which to better inform relatives of the likely outcome. Markers defined prior to the widespread use of therapeutic hypothermia post arrest may no l...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
doi:10.1177/0885066613511045
更新日期:2018-04-01 00:00:00
abstract:BACKGROUND:SARS-CoV2 can cause pulmonary failure requiring prolonged invasive mechanical ventilation (MV). Lung protective ventilation strategies are recommended in order to minimize ventilator induced lung injury. Whether patients with COVID-19 have the same risk for complications including barotrauma is still unknown...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066620954364
更新日期:2020-09-22 00:00:00
abstract::Echodynamics refers to the use of echocardiography as hemodynamic tool mostly in intensive and acute care settings. It implies a smooth drift from the classic cardiology use to a more critical care adjusted use. A more personalized approach is advocated in critical care, and echo is one way to reach such goal. Correct...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
doi:10.1177/0885066617734151
更新日期:2018-08-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Impaired physical functioning is common and long lasting after an intensive care unit (ICU) admission. The 6-minute walk test (6MWT) is a validated and widely used test of functional capacity. This systematic review synthesizes existing data in order to: (1) evaluate 6-minute walk distance (6M...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066619885838
更新日期:2019-11-05 00:00:00
abstract:PURPOSE:To characterize physicians' stated practices in the treatment of patients with severe acute alcohol withdrawal syndrome (sAAWS) and to use intravenous (IV) phenobarbital as an adjuvant treatment for sAAWS. METHODS:A multidisciplinary, cross-sectional, self-administered survey at 2 large academic centers specia...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066619847119
更新日期:2020-11-01 00:00:00
abstract::The authors retrospectively review their experience with low immunoglobulin G (IgG) levels in a pediatric ICU population over a 12-month period. The total IgG level was below the normal for age in 14 of the 20 patients. The 14 patients with a low IgG level were younger and weighed less when compared with the 6 patient...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066603255905
更新日期:2003-09-01 00:00:00