Critical Care Medicine最新文献

{"title":"Experiencing Sepsis: A Meta-Ethnography.","authors":"Marie W Sim Johnston, Amy J Lorimer, Kimberley J Haines, Edward Litton","doi":"10.1097/CCM.0000000000006913","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006913","url":null,"abstract":"<p><strong>Objective: </strong>To explore and synthesize the adverse and transformative experiences of sepsis survivors and their caregivers, to generate novel, experience-based insights that inform recovery support and future care strategies.</p><p><strong>Data sources: </strong>Five databases (MEDLINE, Embase, CINAHL, PsycINFO, Web of Science) were searched from 2000 to 2025.</p><p><strong>Study selection: </strong>Eligible studies included qualitative or mixed-methods research reporting experiences of adult sepsis survivors and/or caregivers. Studies focusing solely on healthcare providers or published in languages other than English were excluded. Nine studies met inclusion criteria.</p><p><strong>Data extraction: </strong>First- and second-order constructs were extracted. Study quality was assessed using the Critical Appraisal Skills program. Confidence in findings was evaluated using GRADE-Confidence in Evidence from Reviews of Qualitative Research, which assesses methodological limitations, coherence, adequacy, and relevance.</p><p><strong>Data synthesis: </strong>A meta-ethnographic approach guided synthesis, using Noblit and Hare's seven-phase methodology. Five third-order themes emerged for survivors:1. Increased dependency (moderate confidence)2. ICU fog (high confidence)3. Psychological adjustment (moderate confidence)4. Gratitude and guilt in relationships (moderate confidence)5. Post-discharge challenges (moderate confidence)Three themes emerged for caregivers:1. Adapting to caregiving (moderate confidence)2. Uncertainty about the future (moderate confidence)3. Communication challenges (low confidence)Experiences were shaped by both adversity and transformation. Dependency emerged as a central theme influencing autonomy, identity, and engagement with healthcare. Caregivers experienced emotional and logistical strain, often unsupported.</p><p><strong>Conclusions: </strong>Although deeply personal, sepsis survivorship is marked by consistent themes. Survivor experiences reveal critical insights and generate directions for research and intervention. Findings underscore the need to strengthen survivorship care by prioritizing psychological support, effective communication, and responsive post-discharge services.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145344033","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":"Phenylephrine Vs. Norepinephrine on the Renin-Angiotensin-Aldosterone System and Postoperative Complications in Acute Abdomen Emergency Surgery: A Randomized Controlled Trial.","authors":"Junda Chen, Xinghe Wang, Tianyu Yin, Jie Guo, Xiaoyi Chen, Yangyang Chen, Yucheng Liu, Zhengxiu Sun, Keqin Wang, Yuqi Zhang, Ziqian Zhang, Lei Shen, Linlin Zhao, Yan Wu, Su Liu","doi":"10.1097/CCM.0000000000006912","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006912","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to explore how phenylephrine (PE) and norepinephrine (NE) affect renin-angiotensin-aldosterone system (RAAS) components and postoperative complications in patients undergoing acute abdomen emergency surgery.</p><p><strong>Design: </strong>A randomized controlled trial.</p><p><strong>Setting: </strong>The Anesthesiology Department at the Affiliated Hospital of Xuzhou Medical University.</p><p><strong>Patients: </strong>We enrolled 156 patients 18 years older who were undergoing emergency acute abdominal surgery under general anesthesia.</p><p><strong>Interventions: </strong>Patients were randomized to receive PE (PE group) or NE (NE group) to maintain their mean arterial pressure at 70-80 mm Hg during operation.</p><p><strong>Measurements and main results: </strong>The plasma renin level increased in the immediate postoperative period in the NE group (median difference [MD]: 21 μIU/mL (interquartile range [IQR]: 5-51], p = 0.020), but not in the PE group (MD: 7 μIU/mL [IQR: -1 to 33], p = 0.336). However, the plasma renin levels were significantly decreased in both groups at 24 hours postoperation. Furthermore, in both groups, the levels of angiotensin II and aldosterone were reduced at 24 hours postoperation. The upper quartile of the plasma renin level before surgery was associated with higher vasopressor requirements and higher acute kidney injury (AKI) incidence. Furthermore, the groups showed no significant difference in AKI incidence (relative risk [RR]: 1.50 [95% CI, 0.65-3.47], p = 0.569), myocardial injury (RR: 1.11 [95% CI, 0.64-1.93], p = 0.497), and 30-day mortality rate (RR: 1.00 [95% CI, 0.44-2.27], p = 1.000).</p><p><strong>Conclusions: </strong>PE and NE exert similar effects on RAAS components and postoperative complications. A higher plasma renin level before surgery is associated with greater vasopressor requirement and a higher incidence of postoperative complications.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145344034","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":"The Association Between Frailty, Pao2/Fio2 Ratio, and Hospital Mortality: A Retrospective Registry-Based Cohort Study.","authors":"Ashwin Subramaniam, Ryan Ruiyang Ling, Aidan Burrell, Benjamin Moran, Mahesh Ramanan, Kollengode Ramanathan, Mallikarjuna Ponnapa Reddy, David Pilcher, Kiran Shekar","doi":"10.1097/CCM.0000000000006917","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006917","url":null,"abstract":"<p><strong>Objectives: </strong>While research into critically ill patients with acute hypoxemic respiratory failure (AHRF) is growing, how this interacts with frailty is currently unknown.</p><p><strong>Design: </strong>A retrospective multicentric registry-based observational study using the Australia New Zealand Intensive Care Society Adult Patient Database.</p><p><strong>Setting and patients: </strong>All adult (≥ 16 yr) patients admitted to 191 ICUs from January 1, 2017, to March 31, 2023, with an arterial blood gas sample within the first 24 hours were included. We categorized patients as having no AHRF (Pao2/Fio2 ≥ 300), mild AHRF (Pao2/Fio2 200-300), moderate AHRF (Pao2/Fio2 100-200), and severe AHRF (Pao2/Fio2 < 100). We defined frailty as a Clinical Frailty Scale (CFS) greater than or equal to 5.</p><p><strong>Interventions: </strong>None.</p><p><strong>Main outcomes: </strong>The primary outcome was in-hospital mortality.</p><p><strong>Measurements and main results: </strong>We evaluated the association between Pao2/Fio2 ratio and risk-adjusted mortality using restricted cubic splines with four knots. We conducted predefined subgroup analyses based on age (< 65 vs. ≥ 65 yr), mechanical ventilation status, and patients who survived ICU discharge. We included 497,185 patients; 97,317 had frailty (19.6%). AHRF was more common in patients with frailty compared with those without frailty (58.3% vs. 49.0%). Overall, 7.4% of patients died in hospital (36,791/497,185); a higher proportion were frail (16.4% vs. 5.2%). Mortality rates in patients with frailty with AHRF rose alongside worsening AHRF showing increasing absolute differences in in-hospital mortality as AHRF severity increased. Additionally, within each CFS category, increasing CFS scores also correlated with higher absolute differences in mortality. After adjusting for confounders, there was a nonlinear relationship between frailty, Pao2/Fio2, and in-hospital mortality, with a clear separation between each of the CFS categories.</p><p><strong>Conclusions: </strong>This multicenter, retrospective study that investigated the association between frailty, AHRF, and in-hospital mortality found that AHRF was highly prevalent in patients with frailty. Increasing frailty was associated with higher in-hospital mortality in AHRF and its increasing severity, with a nonlinear relationship.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145344035","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":"Say It Is Not So!-Should We Be Studying the Efficacy of Rapid Response Teams Differently?","authors":"Michael L Cheatham","doi":"10.1097/CCM.0000000000006905","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006905","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145328527","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":"Perspectives on Deceased Donor Intervention Research-Opportunities and the Imperative for Continued Progress.","authors":"Michael Kueht, Madhukar S Patel, Ali Zarrinpar","doi":"10.1097/CCM.0000000000006898","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006898","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145328501","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":"Impact of Left Ventricular Venting on Acute Brain Injury in Patients With Cardiogenic Shock: An Extracorporeal Life Support Organization Registry Analysis.","authors":"Shi Nan Feng, Winnie L Liu, Jin Kook Kang, Andrew Kalra, Jiah Kim, Akram Zaqooq, Melissa A Vogelsong, Bo Soo Kim, Daniel Brodie, Patricia Brown, Glenn J R Whitman, Steven Keller, Sung-Min Cho","doi":"10.1097/CCM.0000000000006897","DOIUrl":"10.1097/CCM.0000000000006897","url":null,"abstract":"<p><strong>Objectives: </strong>While left ventricular (LV) venting reduces LV distension in cardiogenic shock patients on venoarterial extracorporeal membrane oxygenation (ECMO), it may also amplify risk of acute brain injury (ABI). We investigated the hypothesis that LV venting is associated with increased risk of ABI. We also compared ABI risk of the two most common LV venting strategies, percutaneous microaxial flow pump (mAFP) and intra-aortic balloon pump (IABP).</p><p><strong>Design: </strong>Retrospective observational cohort study.</p><p><strong>Setting: </strong>The Extracorporeal Life Support Organization registry.</p><p><strong>Patients: </strong>Adult patients on peripheral venoarterial ECMO for cardiogenic shock (2013-2024).</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>ABI was defined as hypoxic-ischemic brain injury, ischemic stroke, or intracranial hemorrhage. Secondary outcome was hospital mortality. We compared no LV venting with: 1) LV venting, 2) mAFP, and 3) IABP using multivariable logistic regression. To compare ABI risk of mAFP vs. IABP, propensity-score matching was performed. Of 13,276 patients (median age = 58.2, 69.9% male), 1,456 (11.0%) received LV venting (65.5% mAFP and 29.9% IABP), and 525 (4.0%) had ABI. After multivariable regression, LV-vented patients had increased odds of ABI (adjusted odds ratio [aOR], 1.67; 95% CI, 1.22-2.26; p = 0.001) but no difference in mortality (aOR, 1.07; 95% CI, 0.90-1.27; p = 0.45) compared with non-LV-vented patients. In the propensity-matched cohort of IABP (n = 231) vs. mAFP (n = 231) patients, there was no significant difference in odds of ABI (aOR, 1.35; 95% CI, 0.69-2.71; p = 0.39) or mortality (aOR, 0.88; 95% CI, 0.58-1.31; p = 0.52).</p><p><strong>Conclusions: </strong>LV venting was associated with increased odds of ABI but not mortality in patients receiving peripheral venoarterial ECMO for cardiogenic shock. There was no difference in odds of ABI or mortality for IABP vs. mAFP patients.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145307107","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":"Patient Backgrounds and Outcomes of Mechanically Ventilated Children Treated in ICUs Versus General Wards in Japan: A Retrospective Cohort Study Using a National Inpatient Database.","authors":"Yoshio Sakurai, Nobuaki Michihata, Kohei Osada, Shingo Kobayashi, Wataru Sakamoto, Yuta Uchida, Kuniya Ishii, Hiroya Yokohari, Hiroshi Kurosawa, Toshiaki Isogai, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga","doi":"10.1097/CCM.0000000000006901","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006901","url":null,"abstract":"<p><strong>Objectives: </strong>In western countries, adult and pediatric patients requiring mechanical ventilation are treated in ICUs. However, in Japan, there is concern that many children on mechanical ventilation are being treated in general wards. This study aimed to compare patient characteristics and treatment outcomes between mechanically ventilated children in general wards and ICUs using a national inpatient database in Japan.</p><p><strong>Design: </strong>A retrospective cohort study using a national inpatient database.</p><p><strong>Setting: </strong>The study was carried out using a national inpatient database in Japan between July 2010 and March 2022, which includes data from multiple hospitals across the country. Patient characteristics were compared between patients in general wards and ICUs. We performed a 1:1 propensity score matching to compare in-hospital mortality between the groups.</p><p><strong>Patients: </strong>A total of 129,375 mechanically ventilated children 14 years old or younger who were hospitalized in general wards or ICUs were included in the study.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>During the study period, we identified 129,375 eligible patients. Of these, 63% of all patients, 78% of nonoperative patients, and 17% of postoperative patients were treated in general wards. Overall, 56% of the 48,137 ICU patients were postoperative and 70% of them underwent cardiac surgery. The one-to-one propensity score matching created 15,760 pairs, and in-hospital mortality was significantly higher in general ward patients than in ICU patients (6.4% vs. 4.1%; odds ratio, 1.49; 95% CI, 1.35-1.65; p < 0.001).</p><p><strong>Conclusions: </strong>Most of the children on mechanical ventilation in Japan were treated in general wards. The treatment of patients in general wards was associated with higher mortality than in ICUs, suggesting the need to centralize the care for mechanically ventilated pediatric patients in ICUs.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145307053","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":"Extracorporeal Membrane Oxygenation Complications Are Not Causal for Mortality in Patients With Infarct-Related Cardiogenic Shock: A Mediation Analysis of the Extracorporeal Life Support in Infarct-Related Cardiogenic Shock (ECLS-SHOCK) Trial.","authors":"Tharusan Thevathasan, Mohamad Alyahoud, Anne Freund, Ibrahim Akin, Stephan Fichtlscherer, Uwe Zeymer, Hans-Josef Feistritzer, Janine Pöss, Alexander Jobs, Michelle Roßberg, Christian Jung, Carsten Skurk, Tienush Rassaf, Taoufik Ouarrak, Steffen Schneider, Holger Thiele, Steffen Desch","doi":"10.1097/CCM.0000000000006893","DOIUrl":"10.1097/CCM.0000000000006893","url":null,"abstract":"<p><strong>Objective: </strong>Recently published randomized controlled trials and an individual patient data meta-analysis showed that the routine use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) did not reduce mortality compared with medical therapy alone in patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS). The objective of this study was to investigate whether possible VA-ECMO-related medical complications are associated with increased mortality risk, which might explain the observed equipoise among mortality outcomes between VA-ECMO and usual care.</p><p><strong>Design: </strong>Sub-analysis of the randomized Extracorporeal Life Support in Infarct-Related Cardiogenic Shock (ECLS-SHOCK) trial.</p><p><strong>Setting: </strong>Multicenter, international randomized controlled trial across 44 centers specialized in treating AMI-CS.</p><p><strong>Patients: </strong>Adults patients with AMI-CS.</p><p><strong>Interventions: </strong>Patients received either routine VA-ECMO support or medical therapy.</p><p><strong>Measurements and main results: </strong>The rate of complications and mortality as well as causes of death within 30 days. In total, 417 patients were included in this analysis. Moderate and severe bleeding as well as peripheral vascular complications requiring intervention were classified as possible VA-ECMO-related complications. A total of 88 patients (21.1%) developed possible VA-ECMO-related complications, which mostly occurred within five days after randomization and more frequently in the VA-ECMO group than in the control group: 49 (23.4%) vs. 20 (9.6%) patients, p < 0.001 for bleeding and 23 (11.0%) vs. 8 (3.8%) patients, p equals to 0.008 for peripheral vascular complications, respectively. Only four patients died from bleeding as the primary cause of death. Causal mediation analyses revealed no significant mediation effect of possible VA-ECMO-related complications on 30-day mortality. Logistic regression analyses of possible VA-ECMO-related complications confirmed no significant associations between the frequency of VA-ECMO-related complications and mortality.</p><p><strong>Conclusions: </strong>VA-ECMO use in patients with AMI-CS was associated with increased frequencies of moderate to severe bleeding as well as vascular complications warranting intervention. However, these possible VA-ECMO-related complications did not mediate an increased mortality risk.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov, protocol: NCT03637205; August 2018.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145328437","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":"Targeted Tissue Perfusion Versus Macrocirculatory-Guided Standard Care in Patients With Septic Shock: A Randomized Clinical Trial-The TARTARE-2S Trial.","authors":"Ville Pettilä, Carmen A Pfortmüller, Anders Perner, Tobias M Merz, Erika Wilkman, Johanna Hästbacka, Matthias F Lang, Paolo Lombardo, Tuomas Selander, Stephan M Jakob, Jukka Takala","doi":"10.1097/CCM.0000000000006899","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006899","url":null,"abstract":"<p><strong>Objectives: </strong>To determine whether treatment targeting improving tissue perfusion while allowing lower than recommended blood pressure (targeted tissue perfusion [TTP]) improves outcome compared with mean arterial pressure (MAP)-guided standard care (SC).</p><p><strong>Design: </strong>A randomized, parallel-group, open-label clinical trial with 30-day follow-up. Allocation was stratified according to trial site and presence of chronic arterial hypertension.</p><p><strong>Setting: </strong>Three European university hospital ICUs with enrollment from 2016 to 2022.</p><p><strong>Patients: </strong>Two hundred nineteen patients with septic shock and blood lactate greater than 3 mmol/L allocated to TTP (n = 111) vs. SC (n = 108).</p><p><strong>Interventions: </strong>The TTP protocol comprised capillary refill time, peripheral skin temperature, arterial lactate concentrations, and MAP 50-65 mm Hg. The SC protocol comprised the hemodynamic targets of 2012 Surviving Sepsis Campaign.</p><p><strong>Measurements and main results: </strong>Ninety-seven (87.4%) in TTP and 97 (89.8%) in SC group (total n = 194) were analyzed for the primary outcome. The median (interquartile range) of days alive in 30 days with normal lactate and without vasopressor/inotropic drugs (primary outcome) was 23 (10-27) in TTP group and 22 (1-27) in SC group (difference in medians, 0.59; 95% CI, -3 to 4). Secondary outcomes (single components of the primary outcome, days alive without organ support and mortality, all at 30 d) and serious adverse reactions were not significantly different between intervention groups. At day 30, 24 patients (24.7%) in TTP group vs. 27 patients (27.8%) in SC group had died. MAP levels were lower in the TTP group vs. the SC group.</p><p><strong>Conclusions: </strong>In ICU patients with septic shock and lactate greater than 3 mmol/L, targeting tissue perfusion and allowing lower than recommended MAP did not increase the number of days alive with normal lactate and without vasopressor/inotropic drugs at 30 days. No additional safety concerns with the TTP strategy were detected compared with SC.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145307122","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":"RBC Transfusion Practices in Critically Ill Patients With Sepsis.","authors":"Myung Jin Song, Woo-In Seo, Yeonhoon Jang, Sunghoon Park, RyoungEun Ko, Gee Young Suh, Dong Kyu Oh, Su Yeon Lee, Mi Hyeon Park, Chae-Man Lim, Se Young Jung, Sung Yoon Lim","doi":"10.1097/CCM.0000000000006892","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006892","url":null,"abstract":"<p><strong>Objective: </strong>To assess real-world RBC transfusion practices during early resuscitation in sepsis and evaluate their association with 60-day mortality.</p><p><strong>Design: </strong>Secondary analysis of a prospective, multicenter observational cohort (the Korean Sepsis Alliance cohort) from September 2019 to December 2022.</p><p><strong>Setting: </strong>Thirteen ICUs across South Korea.</p><p><strong>Patients: </strong>Adults (19 yr old or older) admitted to the ICU with sepsis were categorized into transfused and non-transfused groups based on whether they received RBC transfusions during ICU days 1-3.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Among 2613 patients (mean age 71.9 ± 13.3 yr old), 45.3% received RBC transfusions during the early resuscitation phase. The mean lowest hemoglobin level on the day of transfusion was 8.8 ± ;1.7 g/dL. RBC transfusion was associated with clinical factors beyond hemoglobin levels, including higher Simplified Acute Physiology Score 3 and Sepsis-Induced Coagulopathy scores, septic shock, surgical source control, elevated lactate and bilirubin levels, low platelet counts, the use of two or more vasopressors, and continuous renal replacement therapy. In the propensity score-matched cohort, there was no overall difference in 60-day mortality between groups. However, a significant qualitative interaction was observed when stratifying by an ICU day 1 hemoglobin threshold of 10 g/dL (p for interaction = 0.0124). RBC transfusion was linked to higher mortality at hemoglobin greater than or equal to 10 g/dL, but showed a trend toward decreased mortality below this threshold.</p><p><strong>Conclusions: </strong>RBC transfusions are common in critically ill patients with sepsis, highlighting a gap between clinical practice and guideline recommendations. Although not associated with overall mortality, a qualitative interaction was observed at a hemoglobin threshold of 10 g/dL. Transfusion decisions may be guided by physiologic markers up to 9-10 g/dL, but should be avoided when hemoglobin levels exceed 10 g/dL due to the potential for harm.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145291484","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}