Suboptimal plasma concentrations with posaconazole suspension as prophylaxis in critically ill COVID-19 patients at risk of Covid-associated pulmonary aspergillosis.

What Is Known And Objective: The safety and efficacy of different antifungal agents in the prophylaxis of invasive fungal infection in patients with haematological disorders are known. We comment on the poor bioavailability of posaconazole suspension to suggest that it is not useful in critically ill COVID patients.

Comment: The increased mortality and high incidence of COVID-associated pulmonary aspergillosis (CAPA) might justify administration of off-label posaconazole for preventing CAPA, being the only drug officially registered for prophylaxis of fungal infections.

Electroencephalogram predicts outcome in patients with postanoxic coma during mild therapeutic hypothermia.

Objective: To assess the value of electroencephalogram for prediction of outcome of comatose patients after cardiac arrest treated with mild therapeutic hypothermia.

Design: Prospective cohort study.

Setting: Medical ICU.

Pulmonary leucostasis syndrome presented by unilateral pulmonary infiltrates.

A 48-year-old woman presented with suspected acute myelogenous leukaemia with a leucocyte count of 80×10(9)/L. On admission, she had high fever and shortness of breath. Chest X-ray demonstrated unilateral consolidations of right lung suggestive for pneumonia and broad spectrum antibiotics were started.

Mixed venous O2 saturation and fluid responsiveness after cardiac or major vascular surgery.

Background: It is unclear if and how SvO2 can serve as an indicator of fluid responsiveness in patients after cardiac or major vascular surgery.

Methods: This was a substudy of a randomized single-blinded clinical trial reported earlier on critically ill patients with clinical hypovolemia after cardiac or major vascular surgery. Colloid fluid loading was done for 90 min, guided by changes in pulmonary artery occlusion pressure (PAOP) or central venous pressure (CVP).

Global end-diastolic volume increases to maintain fluid responsiveness in sepsis-induced systolic dysfunction.

Background: Sepsis-induced cardiac dysfunction may limit fluid responsiveness and the mechanism thereof remains unclear. Since cardiac function may affect the relative value of cardiac filling pressures, such as the recommended central venous pressure (CVP), versus filling volumes in guiding fluid loading, we studied these parameters as determinants of fluid responsiveness, according to cardiac function.

Methods: A delta CVP-guided, 90 min colloid fluid loading protocol was performed in 16 mechanically ventilated patients with sepsis-induced hypotension and three 30 min consecutive fluid loading steps of about 450 mL per patient were evaluated.

Volume-limited versus pressure-limited hemodynamic management in septic and nonseptic shock.

Objectives: To evaluate the effect of hemodynamic management guided by upper limits of cardiac filling volumes or pressures on durations of mechanical ventilation and lengths of stay in critically ill patients with shock.

Design: Prospective, randomized, clinical trial.

Setting: Mixed intensive care unit of a large teaching hospital and mixed intensive care unit of a tertiary care, academic medical center.

Cardiac filling volumes versus pressures for predicting fluid responsiveness after cardiovascular surgery: the role of systolic cardiac function.

Introduction: Static cardiac filling volumes have been suggested to better predict fluid responsiveness than filling pressures, but this may not apply to hearts with systolic dysfunction and dilatation. We evaluated the relative value of cardiac filling volume and pressures for predicting and monitoring fluid responsiveness, according to systolic cardiac function, estimated by global ejection fraction (GEF, normal 25 to 35%) from transpulmonary thermodilution.

Methods: We studied hypovolemic, mechanically ventilated patients after coronary (n = 18) or major vascular (n = 14) surgery in the intensive care unit.

Greater cardiac response of colloid than saline fluid loading in septic and non-septic critically ill patients with clinical hypovolaemia.

Background And Objective: The haemodynamics of crystalloid and colloid fluid loading may depend on underlying disease, i.e. sepsis versus non-sepsis.

Hepatosplanchnic ischemia/reperfusion is a major determinant of lung vascular injury after aortic surgery.

Objectives: To study risk factors, including the level of cross-clamping and ischemia/reperfusion, for lung vascular injury after aortic surgery.

Design: Single-center prospective observational study.

Patients And Methods: Twenty-seven consecutive and mechanically ventilated patients were included within 3 h after elective aortic surgery, i.

Relative value of pressures and volumes in assessing fluid responsiveness after valvular and coronary artery surgery.

Background And Aims: Cardiac function may differ after valvular (VS) and coronary artery (CAS) surgery and this may affect assessment of fluid responsiveness. The aim of the study was to compare VS and CAS in the value of cardiac filling pressures and volumes herein.

Methods: There were eight consecutive patients after VS and eight after CAS, with femoral and pulmonary artery catheters in place.

Transpulmonary dilution-derived extravascular lung water as a measure of lung edema.

Purpose Of Review: This review highlights current insights concerning the (measurement of) extravascular lung water as an index of pulmonary edema, by transpulmonary dilution techniques. The focus is on the applicability of the technique at the bedside in monitoring critically ill patients.

Recent Findings: Several (animal) studies have been performed to validate the technique by postmortem gravimetry in different conditions.

Biomarkers of acute renal injury and renal failure.

Acute renal failure (ARF) is a frequent problem in the intensive care unit and is associated with a high mortality. Early recognition could help clinical management, but current indices lack sufficient predictive value for ARF. Therefore, there might be a need for biomarkers in detecting renal tubular injury and/or dysfunction at an early stage before a decline in glomerular filtration rate is noted by an increased serum creatinine.