Browsing by Author "Myatra, Sheila N."

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    Association between red blood cell transfusion and adverse clinical outcomes is Independent of cardiac history: a multicenter observational InPUT study analysis
    (2025) Kimmoun, Antoine; Girerd, Nicolas; Duarte, Kevin; Bruno, Jolie; Schenk, Jimmy; Levy, Bruno; Baudry, Guillaume; Raasveld, Senta J.; de Bruin, Sanne; Reuland, Merijn C.; van den Oord, Claudia; Schaap, Caroline M.; Bakker, Jan; Cecconi, Maurizio; Feldheiser, Aarne; Meier, Jens; McQuilten, Zoe; Müller, Marcella C. A.; Scheeren, Thomas W. L.; Aubron, Cécile; Flint, Andrew W. J.; Hamid, Tarikul; Piagnerelli, Michaël; Mahečić, Tina T.; Benes, Jan; Russell, Lene; Aguirre-Bermeo, Hernan; Triantafyllopoulou, Konstantina; Chantziara, Vasiliki; Gurjar, Mohan; Myatra, Sheila N.; Pota, Vincenzo; Elhadi, Muhammed; Gawda, Ryszard; Mourisco, Mafalda; Lance, Marcus; Neskovic, Vojislava; Podbregar, Matej; Llau, Juan V.; Quintana-Diaz, Manual; Cronhjort, Maria; Pfortmueller, Carmen A.; Yapici, Nihan; Nielsen, Nathan; Shah, Akshay; de Grooth, Harm-Jan; Vlaar, Alexander P. J.; Mebazaa, Alexandre
    Purpose Red-blood-cell (RBC) transfusion is one of the most frequent interventions in critical care patients. While patients with acute cardiac conditions are more likely to receive transfusions at higher haemoglobin thresholds than other critically ill patients, data on RBC transfusion practice for critically ill patients with pre-existing cardiac conditions are scarce. Methods Using the International Point-Prevalence Study of Intensive-Care Unit Transfusion Practices cohort, weighted logistic regression investigated the association between the RBC units transfused and the primary composite outcome of 28-day mortality, new-onset acute kidney injury or ventilatory weaning failure. Interactions with cardiac history (acute coronary syndrome and/or heart failure) were tested. Results Cardiac history was present in 746 of 3643 patients (20%) and 894 of 3643 (25%) received at least one RBC unit. Transfusion rates were similar in patients with and without cardiac history (25% vs. 24%; p = 0.51). Among transfused patients, median nadir haemoglobin during ICU stay was slightly higher in those with cardiac history (7.6 g/dL vs. 7.4 g/dL respectively; p = 0.007), whereas stated haemoglobin transfusion threshold did not statistically differ (8.5 g/dL vs. 8.0 g/dL; p = 0.11). Each additional RBC unit increased the odds of the composite outcome in the whole cohort (2.18, 95% CI 1.85–2.56, p < 0.0001), without interaction with cardiac history (p = 0.44). Conclusions RBC transfusion was commonly and similarly prescribed in critically ill patients with or without cardiac history. Each additional unit was associated with a worse outcome with no evidence of differential effect due to cardiac history. Trial registration NL9049 (Dutch Trial Register), registered on 16 November 2020. Graphical Abstract
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    Pathophysiology of fuid administration in critically ill patients
    (2022) Messina, Antonio; Bakker, Jan; Chew, Michelle; De Backer, Daniel; Hamzaoui, Olfa; Hernández P., Glenn; Myatra, Sheila N.; Monnet, Xavier; Ostermann, Marlies; Pinsky, Michael; Teboul, Jean-Louis; Cecconi, Maurizio
    Fluid administration is a cornerstone of treatment of critically ill patients. The aim of this review is to reappraise the pathophysiology of fluid therapy, considering the mechanisms related to the interplay of flow and pressure variables, the systemic response to the shock syndrome, the effects of different types of fluids administered and the concept of preload dependency responsiveness. In this context, the relationship between preload, stroke volume (SV) and fluid administration is that the volume infused has to be large enough to increase the driving pressure for venous return, and that the resulting increase in end-diastolic volume produces an increase in SV only if both ventricles are operating on the steep part of the curve. As a consequence, fluids should be given as drugs and, accordingly, the dose and the rate of administration impact on the final outcome. Titrating fluid therapy in terms of overall volume infused but also considering the type of fluid used is a key component of fluid resuscitation. A single, reliable, and feasible physiological or biochemical parameter to define the balance between the changes in SV and oxygen delivery (i.e., coupling “macro” and “micro” circulation) is still not available, making the diagnosis of acute circulatory dysfunction primarily clinical.
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    The Sequential Organ Failure Assessment (SOFA) Score: has the time come for an update?
    (2023) Moreno, Rui; Rhodes, Andrew; Piquilloud, Lise; Hernández P., Glenn; Takala, Jukka; Gershengorn, Hayley B.; Tavares, Miguel; Coopersmith, Craig M.; Myatra, Sheila N.; Singer, Mervyn; Rezende, Ederlon; Prescott, Hallie C.; Soares, Márcio; Timsit, Jean-François; de Lange, Dylan W.; Jung, Christian; De Waele, Jan J.; Martin, Greg S.; Summers, Charlotte; Azoulay, Elie; Fujii, Tomoko; McLean, Anthony S.; Vincent, Jean-Louis; Pontificia Universidad Católica de Chile. Departamento de Medicina Intensiva, Facultad de Medicina
    The Sequential Organ Failure Assessment (SOFA) score was developed more than 25 years ago to provide a simple method of assessing and monitoring organ dysfunction in critically ill patients. Changes in clinical practice over the last few decades, with new interventions and a greater focus on non-invasive monitoring systems, mean it is time to update the SOFA score. As a first step in this process, we propose some possible new variables that could be included in a SOFA 2.0. By so doing, we hope to stimulate debate and discussion to move toward a new, properly validated score that will be fit for modern practice.