Atrial fibrillation (AF) is the most common arrhythmia experienced by critically ill patients. It has been associated with adverse short-and long-term outcomes, including an increased risk of thromboembolic events, heart failure, and death. Due to complex and multifactorial pathophysiology, a heterogenous patient population, and a lack of clinical tools for risk stratification validated in this population, AF in critical illness is challenging to predict, prevent, and manage. Personalized management strategies that consider patient factors such as underlying cardiac structure and function, potentially reversible arrhythmogenic triggers, and risk for complications of AF are needed. Furthermore, evaluation of the effects of these interventions on long-term outcomes is warranted. Critical illness survivors who have had AF represent a unique population who require systematic follow-up after discharge. However, the frequency, type, and intensity of follow-up is unknown. This state-of-the-art review aims to summarize the evidence, contextualize the current guidelines within the setting of critical illness, and highlight gaps in knowledge and research opportunities to further our understanding of this arrhythmia and improve patient outcomes.

• Klíčová slova
• Atrial fibrillation, Critical illness,
• MeSH
• fibrilace síní * terapie   patofyziologie   komplikace   MeSH
• hodnocení rizik MeSH
• kritický stav * terapie   MeSH
• lidé MeSH
• rizikové faktory MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

PURPOSE: The aim of this study was to examine the effects of intravenous (IV) fluid restriction on time to resolution of hyperlactatemia in septic shock. Hyperlactatemia in sepsis is associated with worse outcome. Sepsis guidelines suggest targeting lactate clearance to guide fluid therapy despite the complexity of hyperlactatemia and the potential harm of fluid overload. METHODS: We conducted a post hoc analysis of serial plasma lactate concentrations in a sub-cohort of 777 patients from the international multicenter clinical CLASSIC trial (restriction of intravenous fluids in intensive care unit (ICU) patients with septic shock). Adult ICU patients with septic shock had been randomized to restrictive (n = 385) or standard (n = 392) intravenous fluid therapy. The primary outcome, time to resolution of hyperlactatemia, was analyzed with a competing-risks regression model. Death and discharge were competing outcomes, and administrative censoring was imposed 72 h after randomization if hyperlactatemia persisted. The regression analysis was adjusted for the same stratification variables and covariates as in the original CLASSIC trial analysis. RESULTS: The hazard ratios (HRs) for the cumulative probability of resolution of hyperlactatemia, in the restrictive vs the standard group, in the unadjusted analysis, with time split, were 0.94 (confidence interval (CI) 0.78-1.14) at day 1 and 1.21 (0.89-1.65) at day 2-3. The adjusted analyses were consistent with the unadjusted results. CONCLUSION: In this post hoc retrospective analysis of a multicenter randomized controlled trial (RCT), a restrictive intravenous fluid strategy did not seem to affect the time to resolution of hyperlactatemia in adult ICU patients with septic shock.

• Klíčová slova
• Fluid therapy, Hyperlactatemia, Lactate, Sepsis, Septic shock,
• MeSH
• časové faktory MeSH
• hyperlaktatemie * etiologie   MeSH
• jednotky intenzivní péče * statistika a číselné údaje   MeSH
• kyselina mléčná krev   MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• septický šok * terapie   komplikace   krev   mortalita   MeSH
• tekutinová terapie * metody   normy   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH
• Názvy látek
• kyselina mléčná MeSH

PURPOSE: To assess long-term outcomes of restrictive versus standard intravenous (IV) fluid therapy in adult intensive care unit (ICU) patients with septic shock included in the European Conservative versus Liberal Approach to Fluid Therapy in Septic Shock in Intensive Care (CLASSIC) trial. METHODS: We conducted the pre-planned analyses of mortality, health-related quality of life (HRQoL) using EuroQol (EQ)-5D-5L index values and EQ visual analogue scale (VAS), and cognitive function using Mini Montreal Cognitive Assessment (Mini MoCA) test at 1 year. Deceased patients were assigned numerical zero for HRQoL as a state equal to death and zero for cognitive function outcomes as worst possible score, and we used multiple imputation for missing data on HRQoL and cognitive function. RESULTS: Among 1554 randomized patients, we obtained 1-year data on mortality in 97.9% of patients, HRQoL in 91.3%, and cognitive function in 86.3%. One-year mortality was 385/746 (51.3%) in the restrictive-fluid group versus 383/767 (49.9%) in the standard-fluid group, absolute risk difference 1.5%-points [99% confidence interval (CI) - 4.8 to 7.8]. Mean differences were 0.00 (99% CI - 0.06 to 0.05) for EQ-5D-5L index values, - 0.65 for EQ VAS (- 5.40 to 4.08), and - 0.14 for Mini MoCA (- 1.59 to 1.14) for the restrictive-fluid group versus the standard-fluid group. The results for survivors only were similar in both groups. CONCLUSIONS: Among adult ICU patients with septic shock, restrictive versus standard IV fluid therapy resulted in similar survival, HRQoL, and cognitive function at 1 year, but clinically important differences could not be ruled out.

• Klíčová slova
• Cognitive function, Critical illness, Intravenous fluid, Long-term outcomes, Quality of life, Sepsis, Septic shock,
• MeSH
• dospělí MeSH
• jednotky intenzivní péče MeSH
• kvalita života MeSH
• lidé MeSH
• péče o pacienty v kritickém stavu MeSH
• přežívající MeSH
• septický šok * terapie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• komentáře MeSH