‌Review the Latest in Critical Care News

Exclusively for SCCM Select and Professional members, Critical Pulse contains late-breaking and important information to help your practice.

New Drugs Are on the Horizon for AKI

A review in Current Opinion in Critical Care highlights recently published developments on pharmacologic treatments that aim to prevent or alleviate the severity of AKI in critically ill patients. Several new compounds are being investigated for their effects on renal end points and several show potential to prevent or alleviate AKI. Many studies aim to improve hemodynamics and renal function, mediate inflammatory-related renal damage, and reduce oxidative stress. Identification of different underlying pathologic processes is important in the selection of appropriate patients and the type and timing of treatment. Current challenges include the timely detection and recognition of the underlying mechanism of AKI.

‌AI and Machine Learning Can Assist in Clinical Decision-Making for Patients With Disorders of Consciousness

A review in Current Opinion in Neurology examined the use of AI and machine learning (ML) to assist in clinical decision-making for the diagnosis, prognosis, and therapy for patients with disorders of consciousness. Most studies used AI to analyze functional neuroimaging and EEG data to differentiate between unresponsive wakefulness syndrome and minimally conscious state. Conventional ML was often proposed rather than deep learning algorithms. ML has also been used to predict the effects of different therapeutic interventions. It was proposed that performance should significantly improve with the use of deep learning techniques.

‌Probiotic Therapy May Improve Clinical Outcomes in Patients With TBI

A systematic review and meta-analysis in BMC Infectious Diseases evaluated the efficacy of probiotic supplementation on outcomes of patients with TBI. The authors analyzed data from 6 studies, including 391 patients with TBI. The results showed increased Glasgow Coma Scale score with the use of probiotic therapy in patients > age 50 years. Probiotic therapy also reduced the risk of infection and mortality (OR 0.53; 95% CI, 0.3-0.8 and OR 0.41; 95% CI, 0.2-0.7, respectively). Probiotic supplementation is a promising therapy for the treatment of CNS disorders. Additional studies are needed to strengthen the results of the analysis.

‌Albumin Levels Not Associated With Delirium Duration and Severity in Critically Ill Patients

A retrospective study in American Journal of Critical Care from an RCT involving ICU patients investigated the relationship between albumin levels and delirium duration and severity. The study included 237 critically ill patients with delirium who were admitted to 3 hospitals from 2009 to 2015. Serum albumin levels within 72 hours of ICU admission were collected from electronic medical records. No significant associations were found between albumin levels and delirium duration or severity. However, patients with normal albumin levels (≥3 g/dL) had shorter stays than did patients with hypoalbuminemia.

‌Early Increases in TNF Expression Are Associated With Improved Outcomes in Patients With Sepsis

A prospective observational study in Frontiers in Immunology evaluated whether tumor necrosis factor (TNF) expression could be used to model clinical outcomes in patients with sepsis. The study included 46 healthy controls, 68 ICU patients without sepsis, and 107 ICU patients with sepsis. Whole blood samples were collected to quantify TNF expression. Early increases in total TNF expression were associated with favorable discharge disposition and lower in-hospital mortality. Additionally, the early immunocompetent endotype was associated with favorable discharge and improved in-hospital and 180-day survival. The stratification of septic patients based on TNF expression may allow for identification of future immune-modulating therapies.

‌Functional Magnetic Stimulation Prevents ICU-Acquired Muscle Loss in Critically Ill Patients

An RCT in Medicina (Kaunas) investigated the effect of neuromuscular functional magnetic stimulation (FMS) on quadriceps muscle thickness in critically ill patients. ICU patients were randomized to FMS or routine physiotherapy. Quadriceps thickness was measured by ultrasound in transversal and longitudinal planes at enrollment, days 3-5, and days 9-12. The study found that quadriceps thickness in transversal and longitudinal planes decreased in the nonstimulated legs, but it did not change in FMS legs (‒4.1 mm [95% CI, ‒9.4 to ‒0.6] vs. ‒0.7 mm [95% CI, ‒4.1 to ‒0.7; P = 0.03] and ‒4.4 mm [95% CI, ‒8.9 to ‒1.1] vs. ‒1.5 mm [95% CI, ‒2.6 to ‒2.2; P = 0.02], respectively). Neuromuscular FMS is feasible and decreases the loss of quadriceps muscle thickness in critically ill patients.

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