Neurally adjusted ventilatory assist in critical care patients with and without obesity: a prospective randomized crossover study.

Background: Neurally Adjusted Ventilatory Assist (NAVA) compared to Pressure Support Ventilation (PSV) improves patient-ventilator interactions in intensive care unit. No study has evaluated NAVA in patients with obesity. We aimed to assess the feasibility and safety of NAVA in patients with obesity, and to compare NAVA in patients with versus without obesity.

Factors associated with women authorship over 25 years in high-impact critical care randomized controlled trials: the pipeline is still leaking.

Background: Studies have shown an underrepresentation of women in clinical research, but little is known about trends over time and factors associated with this underrepresentation. This study aimed to investigate the evolution and the independent factors associated with the proportion of women in the authorship of high-impact critical care randomized controlled trials (RCTs) over 25 years.

Methods: This meta-epidemiological study screened adult critical care RCTs published between 1999 and 2023 in the six highest-impact general and critical care journals.

Norepinephrine use at extubation in critically ill patients with obesity: a cohort study with multicenter validation.

Purpose: The aim of this study was to assess whether norepinephrine at the time of extubation increases reintubation rates in critically ill patients with obesity.

Methods: The initial step was to analyze data that had been collected prospectively, using a retrospective approach-defined as the main cohort. Then, we validated our findings using data from a multicenter randomized-controlled trial (validation cohort).

Comparison of tolerance of 4 interfaces for preventive non invasive ventilation after abdominal surgery in intensive care units assessed by patients and caregivers: A prospective randomized cross-over study.

Introduction: Interface selection is one of the major determinants of success for noninvasive ventilation (NIV). The aim of this study was to compare the tolerance of 4 interfaces (auto and hetero-evaluation) used during preventive NIV in Intensive Care Units (ICU).

Methods: ICU patients receiving preventive NIV post-extubation after abdominal surgery were included in a prospective, single-center, randomized, crossover study.

Short- and long-term outcomes and 15-year time trends of kidney replacement therapy in critically ill patients with obesity: an observational cohort.

Purpose: Obesity is a public health challenge and a risk factor for chronic and acute kidney injury (AKI). The impact of kidney replacement therapy (KRT) on mortality in this specific population remains unclear. The objectives of this study were to evaluate the association between KRT and short- and long-term outcomes in patients with obesity, and to analyze trends over time in mortality as well as AKI and KRT incidence.

Anticoagulation management and outcomes in critically ill patients with acute mesenteric ischemia: an international study.

Background: Acute mesenteric ischemia (AMI) is associated with low survival rates. It is recommended to start early a full dose of anticoagulation therapy in patients with AMI, regardless of etiology, surgical or procedural perspective, or coagulation status. However, there are no international studies addressing the impact of timing and dose of anticoagulation therapy on outcome in AMI patients hospitalized in the intensive care unit (ICU).

Impact of Underassisted Ventilation on Diaphragm Function and Structure in a Porcine Model.

Background: Long-term controlled mechanical ventilation in the intensive care unit induces ventilator-induced diaphragm dysfunction (VIDD). The transition from controlled mechanical ventilation to assisted mechanical ventilation is a challenge that requires clinicians to balance overassistance and underassistance. While the effects of overassistance on the diaphragm are well known, the authors aimed to assess the impact of underassistance on diaphragm function and structure in a piglet model with preexisting VIDD (after long-term controlled mechanical ventilation) or without VIDD (short-term controlled mechanical ventilation).

Noninvasive respiratory support following extubation in critically ill adults with obesity: a systematic review and network meta-analysis.

Background: Patients with obesity are at high-risk of extubation failure. Discrepancies were found in the results of recent randomized controlled trials (RCTs) regarding the roles of noninvasive ventilation (NIV), high flow nasal cannula (HFNC) and conventional oxygen therapy (COT) to prevent extubation failure in critically ill patients with obesity.

Methods: In this systematic review and network meta-analysis, we searched MEDLINE, Cochrane Center Register of Controlled Trials and Web of Science from 1 January 1998 to 1 July 2024 for RCTs evaluating noninvasive respiratory support therapies (NIV, HFNC, COT, NIV + HFNC) after extubation in critically ill adults with obesity.

Feasibility and safety of ultra-low volume ventilation (≤ 3 ml/kg) combined with extra corporeal carbon dioxide removal (ECCOR) in acute respiratory failure patients.

Background: Ultra-protective ventilation is the combination of low airway pressures and tidal volume (Vt) combined with extra corporeal carbon dioxide removal (ECCOR). A recent large study showed no benefit of ultra-protective ventilation compared to standard ventilation in ARDS (Acute Respiratory Distress Syndrome) patients. However, the reduction in Vt failed to achieve the objective of less than or equal to 3 ml/kg predicted body weight (PBW).

Ultrasound-guided Transcutaneous Phrenic Nerve Stimulation in Critically Ill Patients: A New Method to Evaluate Diaphragmatic Function.

Background: Diaphragm dysfunction is common in intensive care unit and associated with weaning failure and mortality. The diagnosis gold standard is the transdiaphragmatic or tracheal pressure induced by magnetic phrenic nerve stimulation. However, the equipment is not commonly available and requires specific technical skills.

Incidence, Risk Factors, and Long-Term Outcomes for Extubation Failure in ICU in Patients With Obesity: A Retrospective Analysis of a Multicenter Prospective Observational Study.

Background: To our knowledge, no large observational study has compared the incidence and risk factors for extubation failure within 48 h and during ICU stay in the same cohort of unselected critically ill patients with and without obesity.

Research Question: What are the incidence and risk factors of extubation failure in patients with and without obesity?

Study Design And Methods: In the prospective multicenter observational Practices and Risk Factors for Weaning and Extubation Airway Failure in Adult Intensive Care Unit: A Multicenter Trial (FREEREA) study in 26 ICUs, the primary objective was to compare the incidence of extubation failure within 48 h in patients with and without obesity. Secondary objectives were to describe and to identify the independent specific risk factors for extubation failure using first a logistic regression model and second a decision tree analysis.

Management and outcomes of COVID-19 patients admitted in a newly created ICU and an expert ICU, a retrospective observational study.

Background: The COVID-19 pandemic abruptly increased the inflow of patients requiring intensive care units (ICU). French health institutions responded by a twofold capacity increase with temporary upgraded beds, supplemental beds in pre-existing ICUs, or newly created units (New-ICU). We aimed to compare outcomes according to admission in expert pre-existing ICUs or in New-ICU.

Hydroxyethyl Starch for Fluid Management in Patients Undergoing Major Abdominal Surgery: A Systematic Review With Meta-analysis and Trial Sequential Analysis.

Background: In critically ill patients, warnings about a risk of death and acute kidney injury (AKI) with hydroxyethyl starch (HES) solutions have been raised. However, HES solutions may yet have a role to play in major abdominal surgery. This meta-analysis and trial sequential analysis (TSA) aimed to investigate the effect of HES intravascular volume replacement on the risk of AKI, intraoperative blood transfusion, and postoperative intra-abdominal complications compared to crystalloid intravascular volume replacement.

Shear Wave Elastography, a New Tool for Diaphragmatic Qualitative Assessment: A Translational Study.

Prolonged mechanical ventilation is often associated with either a decrease (known atrophy) or an increase (supposed injury) in diaphragmatic thickness. Shear wave elastography is a noninvasive technique that measures shear modulus, a surrogate of tissue stiffness and mechanical properties. To describe changes in shear modulus (SM) during the ICU stay and the relationship with alterations in muscle thickness.

Injection pressure monitoring during peripheral nerve blocks: from bench to operating theatre.

Background: Nerve damage can occur after ultrasound-guided peripheral nerve block (PNB). Injection pressure monitoring could improve the safety of PNB. The aim was to analyse parameters affecting pressure measurements during PNB.

Real-time continuous monitoring of injection pressure during peripheral nerve blocks in fresh cadavers.

Background: The incidence of unintentional intraneural injection while performing peripheral nerve block has been estimated to be 15% under real-time ultrasound guidance. Injection pressure increase may detect an intraneural injection. Real-time injection pressure changes throughout an entire nerve block procedure in relationship with needle tip location have never been reported.