Yuki Kotani, MD

💧Early diuretics after cardiac surgery?
No gain, potential pain

In this post-hoc analysis of the #BROTHERstudy early IV diuresis didn’t prevent #AKI and prolonged hospitalization

🔗 www.signavitae.com/articles/10.22514/sv.2023.112

#Anesthesia #CardiacSurgery #ICU #MedEd
@yukikotani.bsky.social

🧠 Sedation in the ICU: are volatile anesthetics better than IV anesthetics?

Our meta-analysis of 21 RCTs (n=2,367): volatile sedation ↑ mortality (RR 1.17 [1.02–1.35]) vs. IV Sedation

⚠️ Routine use is not supported. Consider only in selected patients.

🔗 ccforum.biomedcentral.com/articles/10....

Contamination of blood cultures drawn from arterial catheters versus venipuncture or venous catheters in critically ill patients: a systematic review and meta-analysis AbstractBackground. Arterial catheter-drawn blood culture sampling may reduce patient discomfort and healthcare providers’ workload. Guidelines discourage

🩸 Our new meta-analysis on arterial line blood cultures

Contamination rate with arterial catheter–drawn cultures was comparable to venipuncture & lower vs venous catheter–drawn cultures

📌 In critically ill adults, arterial line sampling may be a reasonable alternative.
doi.org/10.1093/cid/...

Dexmedetomidine- or Clonidine-Based Sedation vs Propofol in Critically Ill Patients This randomized clinical trial compares the effects of dexmedetomidine- or clonidine-based sedation vs propofol-based sedation (usual care) on the duration of mechanical ventilation in critically ill ...

🩺 Clinical implications:
1️⃣ Routine switch from propofol-based sedation is not supported
2️⃣ In patients requiring deep sedation, Dex/Clon may be suboptimal due to agitation
3️⃣ Monitor for bradycardia when using Dex or Clon

📄 Full article:
jamanetwork.com/journals/jam...

💡 Interpretation:
Dex and Clon were expected to facilitate extubation due to lighter sedation

However, in ~25–30% of cases, deep sedation was unavoidable

High propofol co-use diluted between-group differences

No reduction in delirium with dex, contrary to prior hopes

⚠️ Safety concerns:
Bradycardia (HR < 50): Increased with both Dex and Clon
Agitation (RASS +3–4): Also increased in both groups
Delirium (via CAM-ICU): No difference

💉 Real-world sedation use:
Target RASS: –2 to +1
20–30% required deep sedation per clinician judgment
Even in Dex/Clon groups, propofol was used during ~75–77% of sedation days

🎯 Primary outcome: No difference in time to extubation success across groups

🏥 Overview:
41 ICUs, 1,404 patients

🧩 PICO (3-arm):
P: Adults expected to require ≥48h of MV
I: Sedation primarily with ① dexmedetomidine or ② clonidine
C: Sedation primarily with propofol
O: Time from randomization to 48h of sustained spontaneous breathing (i.e., extubation success)

🆕 New RCT in JAMA: Sedation in mechanically ventilated ICU patients—Dexmedetomidine vs Clonidine vs Propofol

📕 Main takeaway: In critically ill patients, neither dexmedetomidine nor clonidine shortened time to successful extubation compared to propofol.

NEXT Fellowship in General Intensive Care Ultrasound (GenIUS) - ESICM

🎓 Applications are OPEN for the 1️⃣ #ESICMNEXT 𝗚𝗲𝗻𝗜𝗨𝗦 𝗙𝗲𝗹𝗹𝗼𝘄𝘀𝗵𝗶𝗽𝘀 — a 5-day hands-on training in General Intensive Care Ultrasound!

🌍 30 young intensivists will train at 7 top centres across Europe 🗓️ 𝗢𝗰𝘁 𝟭𝟯–𝟭𝟳, 𝟮𝟬𝟮𝟱

🗓️ Apply by 𝗠𝗮𝘆 𝟮𝟬 👉 www.esicm.org/newfellowshi...

#IntensiveCare #GenIUSFellowship

📢 Your 𝗹𝗮𝘁𝗲𝘀𝘁 𝗶𝘀𝘀𝘂𝗲 of the @intenscaremed.bsky.social with the latest articles is here! 📖 𝗙𝗼𝗹𝗹𝗼𝘄 𝘂𝘀 & stay updated with the latest research, delivered straight to you.

📍 Read all the latest articles here 👉 www.esicm.org/icm-latest-i...

#ICM #ESICM #Research #MedicalJournals #IntensiveCare

2024 EACTS/EACTAIC/EBCP Guidelines on cardiopulmonary bypass in adult cardiac surgery Clinical practice guidelines consolidate and evaluate all pertinent evidence on a specific topic available at the time of their formulation. The goal is to assist physicians in determining the most ef...

Guidelines for CPB in adult cardiac surgery

The CPB can only be performed through collaboration between cardiac surgeons, anesthesiologists, and perfusionists.
This European guideline covers hot topics, such as intravenous amino acid therapy for AKI prevention.
www.bjanaesthesia.org/article/S000...

So, true.

Death by p-value: the overreliance on p-values in critical care research - Critical Care The p-value has changed from a versatile tool for scientific reasoning to a strict judge of medical information, with the usual 0.05 cutoff frequently deciding a study’s significance and subsequent cl...

Both frequentist and Bayesian approaches are important to interpret the findings of critical care research.
ccforum.biomedcentral.com/articles/10....

Serum chloride concentration and outcomes in adults receiving intravenous fluid therapy with a balanced crystalloid solution or 0.9% sodium chloride - Intensive Care Medicine Purpose To determine whether there is an interaction between baseline serum chloride concentration and pH and treatment effects in Intensive Care Unit (ICU) patients receiving intravenous fluid therap...

This secondary analysis of an RCT examined whether the risk of death changes between balanced crystalloids and saline depending on the Cl concentration.
The higher the Cl concentration, the more the point estimates of mortality risk favor balanced crystalloids.
link.springer.com/article/10.1...

Understanding the disease: euglycemic ketoacidosis with SGLT2 inhibitors - Intensive Care Medicine Intensive Care Medicine -

Pathological physiology, clinical significance, and differential diagnosis of euglycemic DKA by SGLT2 inhibitors
idp.springer.com/authorize?re...

Recently, it has been mostly accepted that ketamine does not increase intracranial pressure. Rather, thanks to its hemodynamic tolerance, ketamine can avoid hypotension and maintain cerebral perfusion pressure when used as an induction agent for intubation.
www.bjanaesthesia.org/article/S000...

Heterogeneity in the therapeutic effects of oxygen therapy in critically ill patients

Different baseline conditions, acute diseases, and concurrent interventions likely modify the optimal goals for oxygen therapy. Two large RCTs may guide future practice.
ccforum.biomedcentral.com/articles/10....

Induction Agents for Tracheal Intubation in Critically Ill... : Critical Care Medicine tracheal intubation in critically ill patients. STUDY SELECTION: We included randomized controlled trials and observational studies that reported patient outcomes. DATA EXTRACTION: Data from inc...

Thanks a lot for our paper!
journals.lww.com/ccmjournal/f...

Induction Agents for Tracheal Intubation in Critically Ill Patients

CCR Journal Watch
criticalcarereviews.com/latest-evide...

Get the latest critical care literature every weekend via the CCR Newsletter - subscribe at criticalcarereviews.com/newsletters/...

Hemodynamic improvement in ARDS patients after VV ECMO implantation Severe acute respiratory distress syndrome (ARDS) is often complicated by hemodynamic instability requiring pharmacological support. Venovenous extracorporeal membrane oxygenation (VV ECMO) is a well-...

What happens to hemodynamics in ARDS patients after VV ECMO initiation?

Improvements occurred in 61% at 2 h & 83% at 24 h.
The main causes seem to be improved respiratory parameters & acid-base balance and a reduction in ventilator support.
www.jcvaonline.com/article/S105...

Acute kidney injury Acute kidney injury (AKI) is a common, heterogeneous, multifactorial condition, which is part of the overarching syndrome of acute kidney diseases and disorders. This condition's incidence highest in ...

Review article on AKI: Lancet

This is a must-read paper that covers not only the epidemiology, pathophysiology, and management of AKI, but also crosstalk with other organs during the acute phase and long-term adverse effects on other organs.
www.thelancet.com/journals/lan...

Management of vasoplegic shock Vasoplegic shock is common, contributing up to two-thirds of cases of shock admitted to the ICU.1,2 For the two most common causes of vasoplegic shock—septic shock and vasoplegic shock after cardiopul...

Narrative review on vasoplegic shock

Regarding the dosage of norepinephrine used as a guideline for starting vasopressin therapy, there are an increasing number of publications stating "0.2 µg/kg/min" rather than "0.25 µg/kg/min."
www.bjaed.org/article/S205...

How we could use critical care echocardiography in the assessment of and management of cardiovascular phenotypes in septic shock: the good, the bad, and the ugly profiles - Intensive Care Medicine Intensive Care Medicine -

US assessment of LV function in septic shock

EF does not represent LV contractility but the relationship between LV contractility and afterload. For example, if there is too much vasopressor, the afterload will increase and EF may appear relatively low.
link.springer.com/article/10.1...

#sepsis #levophed #angiotensin ii, methylene blue, septic shock, fluid management, #vasopressin #epinephrine #neosynephrine

#emimcc #cardiosky #critcaresky

Haemodynamic management of septic shock Abstract. Septic shock is a significant challenge in the management of patients with burns and traumatic injuries when complicated by infection, necessitat

A review article on hemodynamic management in septic shock has been published in Burns & Trauma!
It covers a wide range of topics, including fluids, vasopressors, steroids, and resuscitation goals!
Open access👇
academic.oup.com/burnstrauma/...

Our SR of angiotensin II published in JCVA is now available to read with free access until March 2!
authors.elsevier.com/c/1kQEu3lSIP...

CCR Journal Watch

#NAVIGATEtrial from #CCR24 is now published in @bjajournals.bsky.social

NIV for early resp failure on general wards

@yukikotani.bsky.social et al

criticalcarereviews.com/latest-evide...

CCR Newsletter - subscribe at criticalcarereviews.com/newsletters/...

🆕Publication: RCT to assess NIV for acute respiratory failure in general wards
@bjajournals.bsky.social

Most NIV trials were conducted in ICUs. Only two small, single-center RCTs evaluated NIV in general wards. Here are the results of the first multicenter RCT👇
authors.elsevier.com/c/1kNDs1dCDu...

Last publication in 2024🍾
We assessed the effects of non-adrenergic vasopressors in three populations (sepsis, cardiac surgery, and non-cardiac surgery).
Our findings justify future RCTs comparing these agents with usual care based on noradrenaline alone.
ccforum.biomedcentral.com/articles/10....