The MINUTES bundle for the initial 30 min management of undifferentiated circulatory shock: an expert opinion.

Acute circulatory shock is a life-threatening emergency requiring an efficient and timely management plan, which varies according to shock etiology and pathophysiology. Specific guidelines have been developed for each type of shock; however, there is a need for a clear timeline to promptly implement initial life-saving interventions during the early phase of shock recognition and management. A simple, easily memorable bundle of interventions could facilitate standardized management with clear targets and specified timeline.

Continuous Detection of Stimulus Brightness Differences Using Visual Evoked Potentials in Healthy Volunteers with Closed Eyes.

We defined the value of a machine learning algorithm to distinguish between the EEG response to no light or any light stimulations, and between light stimulations with different brightnesses in awake volunteers with closed eyelids. This new method utilizing EEG analysis is visionary in the understanding of visual signal processing and will facilitate the deepening of our knowledge concerning anesthetic research. : X-gradient boosting models were used to classify the cortical response to visual stimulation (no light vs.

Emergency critical care: closing the gap between onset of critical illness and intensive care unit admission.

Critical illness is an exquisitely time-sensitive condition and follows a disease continuum, which always starts before admission to the intensive care unit (ICU), in the majority of cases even before hospital admission. Reflecting the common practice in many healthcare systems that critical care is mainly provided in the confined areas of an ICU, any delay in ICU admission of critically ill patients is associated with increased morbidity and mortality. However, if appropriate critical care interventions are provided before ICU admission, this association is not observed.

Treatment of Refractory Cardiac Arrest by Controlled Reperfusion of the Whole Body: A Multicenter, Prospective Observational Study.

Survival following cardiac arrest (CA) remains poor after conventional cardiopulmonary resuscitation (CCPR) (6-26%), and the outcomes after extracorporeal cardiopulmonary resuscitation (ECPR) are often inconsistent. Poor survival is a consequence of CA, low-flow states during CCPR, multi-organ injury, insufficient monitoring, and delayed treatment of the causative condition. We developed a new strategy to address these issues.

Out-of-hospital deaths in Mongolia: a nationwide cohort study on the proportion, causes, and potential impact of emergency and critical care services.

Background: Little is known about the proportion and causes of out-of-hospital deaths in Mongolia. In this study, we aimed to determine the proportion and causes of out-of-hospital deaths in Mongolia during a six-month observation period before the COVID-19 pandemic.

Methods: In a retrospective study, the Mongolian National Death Registry was screened for all deaths occurring from 01 to 06/2020.

Near-Infrared Spectroscopy-Guided, Individualized Arterial Blood Pressure Management for Carotid Endarterectomy under General Anesthesia: A Randomized, Controlled Trial.

: Differences in blood pressure can influence the risk of brain ischemia, perioperative complications, and postoperative neurocognitive function in patients undergoing carotid endarterectomy (CEA). : In this single-center trial, patients scheduled for CEA under general anesthesia were randomized into an intervention group receiving near-infrared spectroscopy (NIRS)-guided blood pressure management during carotid cross-clamping and a control group receiving standard care. The primary endpoint was postoperative neurocognitive function assessed before surgery, on postoperative days 1 and 7, and eight weeks after surgery.

Acquired Factor XIII Deficiency Is Common during ECMO Therapy and Associated with Major Bleeding Events and Transfusion Requirements.

Background: Bleeding events are frequent complications during extracorporeal membrane oxygenation therapy (ECMO).

Objective: To determine the rate of acquired factor XIII deficiency and its association with major bleeding events and transfusion requirements in adults undergoing ECMO therapy.

Materials And Methods: A retrospective single centre cohort study.

The value of a machine learning algorithm to predict adverse short-term outcome during resuscitation of patients with in-hospital cardiac arrest: a retrospective study.

Background and importance Guidelines recommend that hospital emergency teams locally validate criteria for termination of cardiopulmonary resuscitation in patients with in-hospital cardiac arrest (IHCA). Objective To determine the value of a machine learning algorithm to predict failure to achieve return of spontaneous circulation (ROSC) and unfavourable functional outcome from IHCA using only data readily available at emergency team arrival. Design Retrospective cohort study.

Respiratory Support Techniques for COVID-19-Related ARDS in a Sub-Saharan African Country: A Multicenter Observational Study.

Background: Limited data from low-income countries report on respiratory support techniques in COVID-19-associated ARDS.

Research Question: Which respiratory support techniques are used in patients with COVID-19-associated ARDS in Uganda?

Study Design And Methods: A multicenter, prospective, observational study was conducted at 13 Ugandan hospitals during the pandemic and included adults with COVID-19-associated ARDS. Patient characteristics, clinical and laboratory data, initial and most advanced respiratory support techniques, and 28-day mortality were recorded.

The Value of the First Clinical Impression as Assessed by 18 Observations in Patients Presenting to the Emergency Department.

The first clinical impression of emergency patients conveys a myriad of information that has been incompletely elucidated. In this prospective, observational study, the value of the first clinical impression, assessed by 18 observations, to predict the need for timely medical attention, the need for hospital admission, and in-hospital mortality in 1506 adult patients presenting to the triage desk of an emergency department was determined. Machine learning models were used for statistical analysis.

The course of adrenomedullin and endothelin levels in patients with vasodilatory shock after cardiac surgery compared to patients after uncomplicated elective cardiac surgery.

Purpose: The aim of this study was to analyse the course of adrenomedullin (ADM) and endothelin-1 (ET-1) levels in patients with vasodilatory shock after cardiac surgery and to explore differences compared to patients after uncomplicated coronary artery bypass graft (CABG) surgery. ADM and ET-1 are involved in the vasomotor response during vasodilatory shock.

Materials And Methods: We included 32 patients with vasodilatory shock (study group) and 10 patients after uncomplicated CABG surgery (control group).

The Austrian ICU survey : A questionnaire-based evaluation of intensive care medicine in Austria.

Background: While structures of intensive care medicine in Austria are well defined, data on organisational and medical practice in intensive care units (ICUs) have not been systematically evaluated.

Methods: In this explorative survey, organisational and medical details of ICUs in Austria were collected using an online questionnaire consisting of 147 questions.

Results: Out of 249 registered ICUs 73 (29.

[The role of the microcirculation in the pathogenesis of organ dysfunction].

The microcirculation includes all blood and lymph vessels with a diameter < 100 µm. Microcirculatory dysfunction is common in critically ill patients and is closely associated with both the severity of (multi-)organ dysfunction and mortality. The nature and extent of microcirculatory dysfunction differ depending on the underlying disease and are most pronounced in patients with systemic inflammation (e.

Epidemiology and Outcome of Sepsis in Adults and Children in a Rural, Sub-Sahara African Setting.

Objectives: To identify the epidemiology and outcome of adults and children with and without sepsis in a rural sub-Sahara African setting.

Design: A priori planned substudy of a prospective, before-and-after trial.

Setting: Rural, sub-Sahara African hospital.

Vasopressors in Trauma: A Never Event?

Vasopressor use in severely injured trauma patients is discouraged due to concerns that vasoconstriction will worsen organ perfusion and result in increased mortality and organ failure in hypotensive trauma patients. Hypotensive resuscitation is advocated based on limited data that lower systolic blood pressure and mean arterial pressure will result in improved mortality. It is classically taught that hypotension and hypovolemia in trauma are associated with peripheral vasoconstriction.

Current use of inotropes in circulatory shock.

Background: Treatment decisions on critically ill patients with circulatory shock lack consensus. In an international survey, we aimed to evaluate the indications, current practice, and therapeutic goals of inotrope therapy in the treatment of patients with circulatory shock.

Methods: From November 2016 to April 2017, an anonymous web-based survey on the use of cardiovascular drugs was accessible to members of the European Society of Intensive Care Medicine (ESICM).

Machine Learning Prediction of SARS-CoV-2 Polymerase Chain Reaction Results with Routine Blood Tests.

Objective: The diagnosis of COVID-19 is based on the detection of SARS-CoV-2 in respiratory secretions, blood, or stool. Currently, reverse transcription polymerase chain reaction (RT-PCR) is the most commonly used method to test for SARS-CoV-2.

Methods: In this retrospective cohort analysis, we evaluated whether machine learning could exclude SARS-CoV-2 infection using routinely available laboratory values.

RBC Transfusion Triggers: Is There Anything New?

For many years, in daily clinical practice, the traditional 10/30 rule (hemoglobin 10 g/dL - hematocrit 30%) has been the most commonly used trigger for blood transfusions. Over the years, this approach is believed to have contributed to a countless number of unnecessary transfusions and an unknown number of overtransfusion-related deaths. Recent studies have shown that lower hemoglobin levels can safely be accepted, even in critically ill patients.