Critical Care Medicine最新文献

{"title":"Infections Acquired in the ICU Among Cancer and Other Immunosuppressed Patients: A Nationwide Cohort Study.","authors":"Renato Daltro-Oliveira, Silvana Soares Dos Santos, Luciana Coelho Sanches, Bianca Ramos Ferronatto, Thiago Gomes Romano, Thiago Costa Lisboa, Adriano José Pereira, Alexandre Biasi Cavalcanti, Bruno Martins Tomazini, Viviane Cordeiro Veiga, Bruno Adler Maccagnan Pinheiro Besen, Antonio Paulo Nassar","doi":"10.1097/CCM.0000000000007388","DOIUrl":"https://doi.org/10.1097/CCM.0000000000007388","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the cumulative incidence of ICU-acquired infections (ICU-AIs) across distinct immunosuppression diagnostic categories (solid cancer, hematological cancer, other immunosuppression) and nonimmunosuppressed patients, accounting for competing risks of death and discharge.</p><p><strong>Design: </strong>Retrospective cohort study using prospectively collected data.</p><p><strong>Setting: </strong>A total of 50 participating ICUs in Brazil.</p><p><strong>Patients: </strong>A total of 38,126 adult patients admitted between October 2019 and December 2021 with an ICU stay exceeding 48 hours and no infections diagnosed within the first 48 hours.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The primary outcome was the incidence of the first ICU-AI during the ICU stay, evaluated using Fine-Gray subdistribution hazard ratios (sHR). In the multivariable competing-risk analysis, patients with hematological malignancies (sHR, 1.64; 95% CI, 1.01-2.65) and other immunosuppressive conditions (sHR, 1.61; 95% CI, 1.02-2.54) were associated with an increased cumulative incidence of ICU-AI, while solid malignancy was not significantly different from non-immunosuppressed patients (sHR, 0.88; 95% CI, 0.68-1.14).</p><p><strong>Conclusions: </strong>Patients with hematological malignancies and other immunosuppressive conditions face a significantly higher risk of ICU-AIs.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Quality Improvement Initiative to Achieve Provincial Implementation of a Web-Based Family Satisfaction in ICU (FS-ICU) Survey to Inform Patient-Centered Care.","authors":"David T Neilipovitz, Andrew Wincen, Bernard Lawless, Jonathan Neilipovitz, Daniel I McIsaac","doi":"10.1097/CCM.0000000000007377","DOIUrl":"https://doi.org/10.1097/CCM.0000000000007377","url":null,"abstract":"<p><strong>Objectives: </strong>To review the web-based Family Satisfaction in ICU (FS-ICU) survey across all adult level 3 Ontario ICUs to capture patient and family experiences with critical care, and to evaluate feasibility, participation, and satisfaction scores.</p><p><strong>Design: </strong>A province-wide, multisite quality improvement study using an electronic, key-based FS-ICU survey with prospectively collected anonymous data linked to encounters through a centralized database.</p><p><strong>Setting: </strong>All 83 adult level 3 ICUs (52 community, 31 academic) in ON, Canada, from July 1, 2019, to May 31, 2024.</p><p><strong>Patients: </strong>The population comprised adult ICU patients, family members, or substitute decision-makers, with one survey per ICU encounter regardless of length of stay or number of family members.</p><p><strong>Interventions: </strong>ICUs implemented a web-based FS-ICU using a unique seven-digit key in three formats (Staff-Provided, Quick Response-Driven, Website-Code), supported by training, resources, and tablets, with no clinical care interventions beyond routine practice.</p><p><strong>Measurements and main results: </strong>Feasibility metrics included onboarding (keys generated per ICU admission), opening, participation, and completion rates, calculated for different centers using provincial data. Over the study period, 24,679 unique keys were generated for 353,400 ICU admissions (onboarding rate, 7.0%), 13,596 keys were opened (opening rate, 55.1%), and 7,542 surveys met the greater than or equal to 70% completion threshold (completion rate, 57.6% among opened surveys; reflection rate, 2.1% of ICU encounters). Survey initiation was highest with the Staff-Provided format (88.4% of keys initiated), and overall satisfaction was high, with mean FS with Care, 87.8; FS with Decision-Making, 84.4; and FS-TOTAL 86.5 on a 0-100 scale, with nursing care rated highest and adequacy of time for questions rated lowest.</p><p><strong>Conclusions: </strong>A provincial, web-based FS-ICU was implemented across all adult level 3 Ontario ICUs, producing a large dataset with high satisfaction scores. A small proportion completed the survey, highlighting feasibility and workflow barriers. Future efforts should improve activation and completion rates and integrate FS-ICU data into routine quality improvement to enhance patient- and family-centered care.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ICU Physical Environments Used for Family Conferences: A Multimodal Qualitative Evaluation with ICU Team Members.","authors":"Cemre Orhan, David A Deemer, William J Hercules, Oystein Tronstad, Anna K Sanders, Ella Christoph, Diana C Anderson, Justin T Clapp, Jacqueline M Kruser","doi":"10.1097/CCM.0000000000007406","DOIUrl":"https://doi.org/10.1097/CCM.0000000000007406","url":null,"abstract":"<p><strong>Objectives: </strong>Family-clinician communication is central to high-quality care for critically ill patients. Although previous work has focused on improving how and what is communicated, little is known about where this high-stakes communication takes place and how it is shaped by the physical environment. Our objectives were to characterize ICU spaces typically used for family conferences and identify modifiable environmental features that influence communication.</p><p><strong>Design: </strong>We conducted a multimodal qualitative study of 17 spaces typically used for family conferences across four adult ICUs in a U.S. academic medical center. Healthcare design and architecture experts independently assessed architectural plans and photographs to characterize spatial features. Then, we conducted semi-structured interviews with 23 ICU team members (nurses, social workers, case managers) to elicit perspectives on and experiences within these spaces. We conducted qualitative content analysis using a combined inductive and deductive approach.</p><p><strong>Setting: </strong>A total of 17 family conference spaces across four adult ICUs in a U.S. academic medical center.</p><p><strong>Participants: </strong>A total of 23 ICU team members.</p><p><strong>Interventions: </strong>None.</p><p><strong>Results: </strong>The 17 analyzed spaces included designated family-communication rooms (n = 2), multipurpose rooms (n = 6), visitor lounges (n = 4), and public areas (n = 5; lobbies/hallways). Study participants preferred designated spaces, as they provide privacy, prevent interruption, and facilitate emotional support. Conversely, multipurpose and public areas are prone to distractions and interruptions from conflicting uses. We identified key environmental features that support communication: proximity to patients, flexible furniture layout, and nonclinical ambiance.</p><p><strong>Conclusions: </strong>Family conferences occur in a variety of physical environments in and around adult ICUs, ranging from intentionally designed rooms to elevator lobbies. ICU team members perceive that physical environments have an important influence on communication quality, and we identified pragmatic opportunities to improve existing spaces.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing Models for Complicated Outcomes in Acutely Intoxicated ICU Patients With and Without Toxicity Information.","authors":"Samanta M Zwaag, Nick van Sabben, Irma S van den Hengel-Koot, Stuart Baker, Patrick Druwé, Muhammed Elhadi, Ana Ferrer Dufol, Sune Forsberg, Burcin Halacli, Christian Jung, Gabija Laubner Sakalauskienė, Elin Lindqvist, Rui Moreno, Christian Rabe, Nanna Reiter, Richard Rezar, Radu Țincu, Arzu Topeli, David M Wood, Dylan W de Lange, Claudine C Hunault","doi":"10.1097/CCM.0000000000007376","DOIUrl":"https://doi.org/10.1097/CCM.0000000000007376","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the prognostic value of the mean Lethality Risk Score (LRS), reflecting the toxicity of substances involved in an exposure, and to develop prediction models for complicated outcomes in ICU patients with acute intoxication.</p><p><strong>Design: </strong>Multicenter prospective cohort study.</p><p><strong>Setting: </strong>Seventy-eight ICUs in Europe, Australia, and the Eastern Mediterranean (2020-2023).</p><p><strong>Patients: </strong>A total of 2265 adult patients were admitted to the ICU with acute intoxication as the main reason for admission for at least 4 hours.</p><p><strong>Intervention: </strong>None.</p><p><strong>Measurements and main results: </strong>The primary outcome was defined as ICU complications or death (22.5%). Clinical data were collected in an electronic capture system. We developed two prediction models: one incorporating laboratory variables (\"Laboratory Model\"), and one including the mean LRS (\"Expo Model\"). The mean LRS was calculated as the average of the individual LRS values assigned to the toxicants involved in the exposure. Key predictors were age, severity at presentation, systolic blood pressure, Glasgow Coma Scale score, and hospital type. The mean LRS remained significant only when laboratory variables were not considered. Model performance was assessed using the area under the receiver operating characteristic (AUROC), calibration plots, likelihood ratio tests, and decision curve analysis. Internal validation demonstrated good performance for both models (AUROCs of 0.79 and 0.77; calibration slopes of 0.94 and 0.95; intercepts of -0.06 and -0.06), with minimal overfitting. Decision curve analysis revealed clinically relevant threshold probability ranges of 0-50% for the Laboratory Model and 0-40% for the Expo Model.</p><p><strong>Conclusions: </strong>The mean LRS had prognostic value only in the absence of laboratory test results. Both models may aid decision-making regarding the management of acutely intoxicated patients in the ICU.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ventilatory Management in Neurocritical Versus Non-Neurocritical Care Patients: A Pooled Analysis From the PRIME Database.","authors":"Simon Corrado Serafini, Raphael Cinotti, Karim Asehnoune, Denise Battaglini, Lorenzo Ball, Nicolò Patroniti, Ary Serpa Neto, Luigi Pisani, Guido Mazzinari, Edda M Tschernko, Marcus J Schultz, Chiara Robba","doi":"10.1097/CCM.0000000000007385","DOIUrl":"https://doi.org/10.1097/CCM.0000000000007385","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To describe ventilatory management in neurocritical care and non-neurocritical care patients and determine whether specific ventilator settings are associated with development of acute respiratory distress syndrome (ARDS) and mortality in neurocritical care patients. The primary endpoint was a diagnosis of ARDS after initiation of invasive ventilation; one secondary endpoint was ICU mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data sources: &lt;/strong&gt;Post hoc pooled analysis of harmonized individual patient data from three recent prospective observational studies combined into the PRIME database.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study selection: &lt;/strong&gt;PRIME is a harmonized pooled database comprising individual patient data from three recent prospective observational studies on ventilatory management in critically ill patients: \"PRactice of VENTilation in critically ill patients without ARDS\" (PRoVENT), \"PRactice of VENTilation in critically ill patients in Middle-income Countries\" (PRoVENT-iMiC), and \"Extubation strategies in Neuro-ICU patients and associations with Outcomes\" (ENIO). We excluded patients with ARDS at the start of ventilation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data extraction: &lt;/strong&gt;Demographic and clinical characteristics, ventilator settings, respiratory variables, arterial blood gas values, and clinical outcomes were extracted from the harmonized PRIME database. Derived ventilation parameters included tidal volume normalized to predicted body weight, driving pressure, respiratory system compliance, mechanical power, ventilatory ratio, and Pao2/Fio2 ratio.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data synthesis: &lt;/strong&gt;This analysis included 3848 patients, including 1702 neurocritical care and 1920 non-neurocritical care patients. Based on recorded ventilatory variables, neurocritical care patients received lower median tidal volumes (Vts), positive end-expiratory pressure, and Fio2. They had lower median driving pressure (ΔP), mechanical power (MP) of ventilation, and ventilatory ratio, as well as higher respiratory system compliance compared with non-neurocritical care patients. These differences were consistently observed at both assessed time points. ARDS was diagnosed more frequently in neurocritical care patients than in non-neurocritical care patients (8.7% vs. 3.9%; p &lt; 0.001), while ICU mortality was lower (14.3% vs. 22.8%; p &lt; 0.001). Among neurocritical care patients, those who developed ARDS were ventilated with lower median Vt and higher Fio2 and had higher median ΔP and MP. Vt normalized for predicted body weight in neurocritical care patients was independently associated with the development of ARDS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this cohort, ventilatory management at the initial and 48-hour assessments differed between neurocritical care and non-neurocritical care patients, particularly with respect to key ventilator settings like Vt, positive end-expiratory pressure, and Fio2. In neurocritical care patients, ARDS was more often diagnosed than in non","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Open Visiting Policy and Delirium in Adult Patients in ICUs: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.","authors":"Nicolò Sella, Tommaso Pettenuzzo, Andrea Bruni, Alessandro De Cassai, Sabrina Congedi, Francesco Monteleone, Nicole Zanardi, Sara Frasson, Diana Braganca Winther, Giulia Mormando, Alessia Antonello, Honoria Ocagli, John Laffey, Paolo Navalesi, Annalisa Boscolo","doi":"10.1097/CCM.0000000000007393","DOIUrl":"https://doi.org/10.1097/CCM.0000000000007393","url":null,"abstract":"<p><strong>Objectives: </strong>To critically evaluate the comparative effects of open or flexible family presence policies vs. restricted or traditional family presence policies on the occurrence of delirium and other major outcomes among adult patients admitted to ICUs.</p><p><strong>Data sources: </strong>We conducted a comprehensive electronic search of MEDLINE, Embase, Scopus, Web of Science, CINAHL, and the Cochrane Central Register of Controlled Trials from inception to November 21, 2025.</p><p><strong>Study selection: </strong>We included randomized controlled trials (RCTs) comparing open or flexible vs. restricted ICU visiting policies in adult patients.</p><p><strong>Data extraction: </strong>The primary outcome extracted was delirium occurrence. Secondary outcomes included the duration of invasive mechanical ventilation (IMV), ICU length of stay, hospital-acquired infections, and ICU mortality.</p><p><strong>Data synthesis: </strong>Thirteen RCTs comprising 3861 patients were included. Random-effects models showed that compared with restricted policies, open/flexible family presence reduced delirium occurrence (risk ratio [RR], 0.48; 95% CI, 0.29-0.81; low certainty) and IMV duration (mean difference [MD], -0.36 d; 95% CI, -0.46 to -0.26 d; low certainty). The intervention did not affect the ICU length of stay (MD, 4.21 d; 95% CI, -4.65 to 13.07 d; very low certainty), the rates of hospital-acquired infections (RR, 1.00; 95% CI, 0.81-1.23; low certainty), or ICU mortality (RR, 0.88; 95% CI, 0.72-1.08; very low certainty).</p><p><strong>Conclusions: </strong>Open/flexible ICU family presence may reduce delirium and shorten the duration of IMV slightly, without increasing infections or ICU mortality, although the certainty of evidence is low and heterogeneity remains substantial.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Tele-Critical Care Capability With Interhospital Transfers and Potentially Low-Value Transfers Among Critically Ill Medicare Beneficiaries.","authors":"Karan Rai, Anuj B Mehta, James F Burke, Nathan E Brummel","doi":"10.1097/CCM.0000000000007389","DOIUrl":"https://doi.org/10.1097/CCM.0000000000007389","url":null,"abstract":"<p><strong>Objectives: </strong>Interhospital transfer is essential for accessing specialized critical care services, yet it poses clinical risk and substantial burden for patients and the healthcare system. Tele-critical care (TCC) programs extend expertise to resource-limited hospitals and may influence transfer decisions by identifying patients requiring escalation or supporting local management. We examined the association between TCC capability at index ICU hospitalizations, interhospital transfer, and post-transfer outcomes.</p><p><strong>Design: </strong>Nationwide retrospective cohort study using 2021-2023 Medicare claims linked to the American Hospital Association Annual Survey Database (AHAASD).</p><p><strong>Setting: </strong>U.S. acute care hospitals.</p><p><strong>Patients: </strong>Medicare fee-for-service beneficiaries with ICU hospitalizations between 2022 and 2023.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>TCC capability was identified by AHAASD reporting and/or the presence of five or more TCC claims annually. The primary outcome was interhospital ICU transfer. Exploratory post-transfer outcomes included receipt of specialty procedures, death or hospice discharge within 1 day of transfer, in-hospital and 30-day mortality, and discharge disposition. Hierarchical logistic regression adjusted for patient demographics, comorbidities, acute organ failures, and transferring/accepting hospital characteristics, with transferring hospitals as random intercepts. Among 2,140,919 ICU hospitalizations, 33.4% occurred at 1,066 TCC-capable hospitals. Absolute transfer rates were similar (2.5% vs. 3.0%), but TCC capability was associated with higher adjusted odds of transfer (adjusted odds ratio [aOR], 1.08; 95% CI, 1.01-1.14). In exploratory post-transfer analyses, transferred patients from TCC hospitals had greater illness severity yet were less likely to die or be discharged to hospice within 1 day of transfer (4.6% vs. 6.6%; aOR, 0.86; 95% CI, 0.76-0.97) and more likely to be discharged home within 2 days (4.7% vs. 3.7%; aOR, 1.17; 95% CI, 1.03-1.33).</p><p><strong>Conclusions: </strong>TCC capability was associated with modestly increased transfer rates, fewer potentially low-value transfers, and improved post-transfer outcomes, suggesting improved transfer selection.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Weaning Strategies for High-Flow Nasal Cannula in Critically Ill Adults: A Randomized Clinical Trial.","authors":"Taewoo Kim, Won Gun Kwack, Sunghoon Park, Seyoung Jung, Myung Jin Song, Eun Sun Kim, Sung Yoon Lim","doi":"10.1097/CCM.0000000000007379","DOIUrl":"https://doi.org/10.1097/CCM.0000000000007379","url":null,"abstract":"<p><strong>Objectives: </strong>This study evaluated the efficacy of different high-flow nasal cannula (HFNC) weaning protocols in critically ill adults.</p><p><strong>Design: </strong>This multicenter, randomized controlled trial was conducted from December 1, 2022, to August 31, 2024, based on the suggested protocol (SLOWH trial). Experts reviewed the trial between October 2, 2024, and April 15, 2025.</p><p><strong>Setting: </strong>Randomization was performed by a research coordinator using a sequence of random numbers generated by an independent statistician blinded to both researchers and participants.</p><p><strong>Patients: </strong>Adults (≥ 18 yr old) in the ICU who met the weaning criteria after receiving HFNC were included. Among 102 patients from three tertiary care hospitals, 15 were excluded.</p><p><strong>Interventions: </strong>The remaining patients were randomized into three intervention groups: flow reduction (FR) first, Fio2 reduction (OR) first, or simultaneous reduction (SR). The primary outcome was the HFNC weaning success rate, defined as successful transition to conventional oxygen therapy without the need for HFNC reapplication, noninvasive ventilation, or endotracheal intubation within 24 hours.</p><p><strong>Measurements and main results: </strong>A total of 87 adults completed the trial (FR, n = 31 [male, 52%]; OR, n = 26 [male, 77%]; SR, n = 30 [male, 53%]). The weaning success rates in the FR, OR, and SR groups were 94%, 81%, and 77%, respectively (p = 0.15). The median [interquartile range] weaning duration was 31.0 hours (29.0-45.8 hr), 29.5 hours (28.0-60.4 hr), and 29.5 hours (26.5-45.0 hr) in the FR, OR, and SR groups, respectively, with no statistically significant difference among groups (p = 0.87).</p><p><strong>Conclusions: </strong>In this randomized trial, no statistically significant differences were observed among the three HFNC weaning strategies in terms of weaning success or duration.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tools Measuring Health Literacy in Critically Ill Patients and Their Caregivers: A Scoping Review.","authors":"Thérèse G Poulin, Karla D Krewulak, Nina M Carcamo Arakawa, Anmol Shahid, Henry T Stelfox, Kirsten M Fiest","doi":"10.1097/CCM.0000000000007382","DOIUrl":"https://doi.org/10.1097/CCM.0000000000007382","url":null,"abstract":"<p><strong>Objectives: </strong>Health literacy, the ability to understand and use health information, is important for critically ill patients and their caregivers in the neonatal ICU (NICU), PICU, and adult ICU to make informed decisions and navigate complex care. This review aimed to identify and summarize tools used to assess health literacy in critically ill patients or their caregivers.</p><p><strong>Data sources: </strong>We searched MEDLINE, Embase, CINAHL, and PsycINFO through July 24, 2025.</p><p><strong>Study selection: </strong>Included articles reported on tools to assess health literacy in critically ill patients or their caregivers. Two reviewers independently performed screening and data extraction.</p><p><strong>Data extraction: </strong>Two independent reviewers extracted data in Covidence. Data items included study characteristics (country in which the study was conducted, study funding, study setting) and health literacy tool characteristics (tool user, types of questions in the tool, method of tool administration, if the tool was created by the study team, and if a full version was available in the publication).</p><p><strong>Data synthesis: </strong>We included 92 articles describing 84 health literacy tools. Tools measured: 1) topic-specific clinical knowledge (e.g., organ donation, cardiopulmonary resuscitation; n = 24/84, 29%; NICU: n = 9; PICU: n = 1; ICU: n = 14); 2) ICU prognosis, diagnosis, and treatment (n = 23/84, 27%; NICU: 6; PICU: 3; ICU: n = 15); 3) neonatal and parenting (n = 13/84, 15%; all NICU); 4) general health literacy abilities (n = 11/84, 13%; NICU: n = 6; PICU: n = 2; ICU: n = 7); 5) information needs (n = 4/84, 5%; NICU: n = 1; PICU: n = 0; ICU: n = 3); 6) readiness for discharge (n = 3/84, 4%; all NICU); 7) decision-making (n = 3/84, 4%; all NICU); 8) health-related behaviors (n = 2/84, 2%; NICU: n = 1; ICU: n = 1); and 9) research participation (n = 1/84, 1%; NICU).</p><p><strong>Conclusions: </strong>Although several health literacy tools exist, they often focus on individual knowledge of specific aspects of ICU care, with less attention to how understanding is produced within the clinical context through interactions among patients, caregivers, and healthcare providers. This may limit their ability to reflect how health literacy functions in critical illness. Assessment of health literacy requires pairing the appropriate tools with interaction-focused approaches to guide communication and support informed decision-making in ICU settings.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Oliguria With Acute Kidney Injury, Chronic Kidney Disease, and Mortality: Determining the Optimal Threshold in Critically Ill Patients.","authors":"Rasmus Mossberg, Miklós Lipcsey, Michael Marks-Hultström, Mikael Eriksson","doi":"10.1097/CCM.0000000000007370","DOIUrl":"https://doi.org/10.1097/CCM.0000000000007370","url":null,"abstract":"<p><strong>Objectives: </strong>Oliguria is a key prognostic indicator of acute kidney injury (AKI), yet the consensus definition (< 0.5 mL/kg/hr) is increasingly questioned. We aimed to determine thresholds of lowest mean diuresis (LMD) associated with AKI, chronic kidney disease (CKD), and mortality.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Setting: </strong>Uppsala University Hospital ICU, Sweden.</p><p><strong>Patients: </strong>A total of 4999 adults (≥ 18 yr) without preexisting CKD admitted to the ICU between 2017 and 2024.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>LMD was calculated over 3, 6, 12, and 24 hours (LMD3h-LMD24h). Generalized additive models were used, adjusting for Simplified Acute Physiology Score 3 estimated mortality ratio and gender. Outcomes were AKI within 7 days of LMD (Kidney Disease Improving Global Outcomes creatinine criteria), incident CKD after ICU discharge, and 90-day mortality. All LMD time frames were significantly associated with AKI, CKD, and death (p < 0.0001). Thresholds for AKI were 0.43, 0.41, 0.42, and 0.53 mL/kg/hr; for CKD, 0.21, 0.21, 0.31, and 0.43 mL/kg/hr; and for mortality 0.16, 0.18, 0.24, and 0.39 across LMD3h-LMD24h.</p><p><strong>Conclusions: </strong>The risk of mortality or persistent kidney injury, reflected by incident CKD, increases at a lower urine output threshold than the current AKI definition. These findings support the idea of filtration deficit, urine output, and tissue injury as different dimensions of AKI and should influence future AKI definitions.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}