Background: Guidelines for diabetic ketoacidosis (DKA) management are limited, resulting in varied practices. This study assessed Intensive Care Unit (ICU) admission criteria, fluid resuscitation, insulin therapy, and metabolic management in adult patients with DKA.
Methods: An international survey of ICU clinicians consisted of 39 items that focused on management of DKA and was endorsed by the European Society of the Intensive Care Medicine. An experienced ICU was defined as a unit admitting > 20 patients with DKA per year.
Results: A total of 522 respondents from 57 different countries participated: 295(57%) worked in Europe, 86(16%) in North America, 25(5%) in South America, 52(10%) in Africa, 52(10%) in Asia and 12(2%) in Oceania. Among respondents, 377(72%) worked in teaching hospitals, 355(68%) in medical-surgical ICUs, and 204(39%) in experienced ICUs. The pH value (< 7.20), arterial or venous bicarbonate concentration (< 15 mmol/L), and the need for continuous intravenous insulin (regardless of the dose) were considered criteria for ICU admission by 362(69%), 240(46%) and 264(51%) respondents, respectively. A protocol for fluid resuscitation was available for 290(63%) respondents, 135(29%) administered isotonic saline only, 173(38%) administered balanced solutions only, and 153(33%) administered both. A protocol for insulin therapy was available for 355(77%) respondents. An initial bolus of intravenous insulin was administered by 228(49%) respondents, 221(48%) used an initial continuous intravenous insulin dose of 0.1 UI/kg/h, 42(9%) used an initial predefined fixed dose, 159(35%) based the initial dose on blood glucose and 39(8%) on blood and/or urine ketones. Fluid choice and modalities of intravenous insulin administration did not differ between experienced and non-experienced ICUs. Intravenous insulin administration was more likely to be initiated upon ICU admission (57%vs.45%, p = 0.04) and less likely after initial fluid resuscitation (27%vs.35%, p = 0.04) in experienced ICUs. Arterial or venous pH was monitored by 408(90%) respondents. Arterial blood gases were favored by 236(52%) respondents and venous blood gases were more likely to be performed in experienced ICUs (30%vs.18%,p < 0.01).
Conclusions: The management of patients with DKA remains heterogeneous worldwide. Future randomized trials are needed, especially regarding fluid resuscitation and insulin therapy. Trial registrationNot applicable.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11654269 | PMC |
J Echocardiogr
December 2024
Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Shimokasuya 143, Isehara-shi, Kanagawa, 259-1193, Japan.
Purpose: Few investigational reports have evaluated the status of cardiovascular manifestations of coronavirus disease 2019 (COVID-19) during the Omicron dominance period. In this study, we aimed to investigate the cardiac function parameters and clinical outcomes of patients with COVID-19 before and after the Omicron variant (OV) propagation.
Methods: We retrospectively analyzed the data of 88 adult patients with COVID-19 who underwent clinically indicated standard transthoracic echocardiography (TTE) in intensive care wards.
J Anesth
December 2024
Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
Otolaryngol Head Neck Surg
December 2024
Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA.
Objective: Accurately measuring the cost of a clinical process is critical to identifying ways to increase the value of a healthcare process. The objective of this study was to review time-driven activity-based costing (TDABC) in otolaryngology and to illustrate areas where value may be increased.
Data Sources: PubMed, Web of Science, Embase, CINAHL Complete, and Business Source Complete from database inception to August 2024.
Pediatr Rheumatol Online J
December 2024
Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Background: This study aims to develop Z-Score models to normalize measurements of three coronary arteries and enhance the diagnosis of Kawasaki disease (KD) in children from newborns to 10 years old. Developing a reliable Z-Score model is challenging, as some existing models fail the normality test. Overcoming these challenges is crucial for improving KD diagnosis.
View Article and Find Full Text PDFCrit Care
December 2024
Division of Anesthesia, Critical Care, Pain and Emergency Medicine, UR‑UM103 IMAGINE, University of Montpellier, Nimes University Hospital, Nîmes, France.
Background: In septic shock, the classic fluid resuscitation strategy can lead to a potentially harmful positive fluid balance. This multicenter, randomized, single-blind, parallel, controlled pilot study assessed the effectiveness of a restrictive fluid strategy aiming to limit daily volume.
Methods: Patients 18-85 years' old admitted to the ICU department of three French hospitals were eligible for inclusion if they had septic shock and were in the first 24 h of vasopressor infusion.
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