Critical Care Medicine最新文献

{"title":"Ivermectin for Critically and Noncritically Ill Hospitalized Patients With COVID-19: Randomized, Embedded, Multifactorial Adaptive Platform Trial for Community-Acquired Pneumonia (REMAP-CAP).","authors":"Madiha Hashmi, Rashan Haniffa, Deva Jayakumar, Abigail Beane, Elizabeth Lorenzi, Lindsay R Berry, Muhammad Nasir Khoso, Quratul Ain Khan, Ashok Kumar, Aneela Altaf Kidwai, Thomas E Hills, Djillali Annane, Diptesh Aryal, Carly Au, Kenneth Baillie, Richard Beasley, Janis Best-Lane, Marc Bonten, Charlotte A Bradbury, Frank M Brunkhorst, Aidan Burrell, Meredith Buxton, Maurizio Cecconi, Allen C Cheng, Matthew E Cove, Menno de Jong, Michelle A Detry, Eamon Duffy, Lise J Estcourt, Mark Fitzgerald, Rob Fowler, Herman Goossens, Cameron Green, Leanne M C Hays, Alisa M Higgins, David T Huang, Nao Ichihara, Sabin Koirala, François Lamontagne, Patrick R Lawler, Roger J Lewis, Edward Litton, Niamh Mahon, John C Marshall, Daniel F McAuley, Anna McGlothlin, Shay McGuinness, Zoe K McQuilten, Bryan J McVerry, Paul R Mouncey, Susan Morpeth, Mihai Netea, Katrina Orr, Rachael L Parke, Jane C Parker, Asad Patanwala, Svenja Peters, Luis Felipe Reyes, Kathryn M Rowan, Hiroki Saito, Christina T Saunders, Marlene Santos, Christopher W Seymour, Manu Shankar-Hari, Vanessa Singh, Matthew Slater, Paul A Tambyah, Steven Y C Tong, Alexis F Turgeon, Anne M Turner, Frank van de Veerdonk, Sebastian Weis, Ryan Zarychanski, Colin J McArthur, Derek C Angus, Scott M Berry, Anthony C Gordon, Lennie P G Derde, Steve A Webb, Srinivas Murthy, Yaseen Arabi, Alistair D Nichol","doi":"10.1097/CCM.0000000000007134","DOIUrl":"https://doi.org/10.1097/CCM.0000000000007134","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether ivermectin improves outcomes for critically and noncritically ill hospitalized patients with COVID-19.</p><p><strong>Design: </strong>An ongoing international, multifactorial, adaptive platform, randomized, controlled trial.</p><p><strong>Setting: </strong>Hospitals in Pakistan, India, and Ireland between June 11, 2021, and September 9, 2022.</p><p><strong>Patients: </strong>Critically and noncritically ill patients.</p><p><strong>Interventions: </strong>Randomized to ivermectin or no ivermectin (control).</p><p><strong>Measurements and main results: </strong>The primary outcome was respiratory and cardiovascular organ support-free days, assessed on an ordinal scale combining in-hospital death (assigned a value of -1) and days free of organ support through day 21 in survivors. Analyses used a Bayesian cumulative logistic model. Enrollment was closed for operational futility, following external evidence suggesting no benefit with ivermectin in nonhospitalized patients with COVID-19. Among 61 critically ill patients, the median number of organ support-free days was -1, indicating death was the most common vital outcome (interquartile range [IQR], -1 to 17), for the ivermectin group and -1 (IQR, -1 to 17.25) for the control group (adjusted proportional odds ratio [OR], 0.94; 95% credible interval [CrI], 0.40-2.07) and the posterior probability of superiority to control was 44.2%. Among 89 noncritically ill patients, the median number of organ support-free days was 22 (IQR, 18.5-22) for ivermectin and 22 (IQR, 16-22) for control (adjusted proportional OR, 1.04; 95% CrI, 0.48-2.34) and the posterior probability of superiority was 53.7%. Among critically ill patients, hospital survival was 35.1% (13/37) for ivermectin and 37.5% (9/24) for control (adjusted OR, 1.00; 95% CrI, 0.39-2.32), posterior probability of superiority was 50.0%. Among noncritically ill patients, hospital survival was 84.1% (37/44) for ivermectin and 77.8% (35/45) for control (adjusted OR, 1.16; 95% CrI, 0.5-3.07), posterior probability of superiority was 63.3%.</p><p><strong>Conclusions: </strong>For critically and noncritically ill hospitalized patients with COVID-19, ivermectin was unlikely to improve the primary composite outcome of organ support-free days and hospital survival.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834684","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":"Household Income Decline and Job Loss Among Survivors of Critical Illness: A Nationwide Cohort Study.","authors":"In-Ae Song, Tak Kyu Oh","doi":"10.1097/CCM.0000000000007152","DOIUrl":"https://doi.org/10.1097/CCM.0000000000007152","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the socioeconomic consequences of critical illness by quantifying changes in household income level and unemployment among ICU survivors in a universal health coverage setting.</p><p><strong>Design, setting, and patients: </strong>This nationwide retrospective cohort study used the Korean National Health Insurance Service database. Adult ICU survivors between January 1, 2020, and December 31, 2022, were included. Patients who died within 1 year or had missing data were excluded. The final cohort consisted of 582,341 survivors.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The primary endpoint was the change in household income level (scale 0-20) between pre-ICU and post-ICU years, analyzed using generalized estimating equation models. The most salient finding was a profound financial polarization among survivors. While the overall cohort experienced a significant and progressive decline in income rank (1-yr ratio of means [RoM], 0.994; 2-yr RoM, 0.976; both p < 0.001), this average masked a severe impact on the highest income quartile (Q4), which exhibited a substantial 6.5% relative drop in mean rank (RoM, 0.935). In contrast, the lowest quartile (Q1) showed relative stability (RoM, 2.198) due to a \"floor effect\" and transitions into the social safety net. Descriptively, 160,682 survivors (27.6%) experienced income decline, 60,432 (10.4%) suffered catastrophic decline, and 12.3% of 326,125 previously employed survivors were no longer employed within 1 year.</p><p><strong>Conclusions: </strong>Critical illness is associated with progressive socioeconomic deterioration characterized primarily by financial polarization. Even with universal health coverage, the economic burden hits previously high-earning households most severely, while lower income groups face potential asset depletion before transitioning to social safety nets. Policies integrating sustained financial protection and vocational rehabilitation into post-ICU survivorship care are essential.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834649","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":"Exposure to Antipsychotic Medication Is Associated With Less Days Alive and Free From Catatonia in Critically Ill Patients.","authors":"Gloria Nashed Mina, Trey McGonigle, Jinyuan Liu, Nathan E Brummel, Mayur B Patel, Joshua R Smith, Pratik P Pandharipande, Robert S Dittus, E Wesley Ely, Jo Ellen Wilson","doi":"10.1097/CCM.0000000000007077","DOIUrl":"10.1097/CCM.0000000000007077","url":null,"abstract":"<p><strong>Objectives: </strong>Catatonia occurs in critical illness, however, underlying causal mechanisms are unknown. We aim to determine if exposure to antipsychotic medication is associated with less days alive and free from catatonia in critically ill adults.</p><p><strong>Design: </strong>The Delirium and Catatonia Prospective Cohort Investigation is a prospective cohort.</p><p><strong>Setting: </strong>Single academic medical center's medical, surgical, and trauma ICUs.</p><p><strong>Patients: </strong>Critically ill adult patients on mechanical ventilation or vasopressors without a major neurocognitive disorder, severe psychiatric disorder, or catatonia at baseline.</p><p><strong>Interventions: </strong>The primary exposure was antipsychotic administration and cumulative dosage during the first 5 and 14 days from enrollment.</p><p><strong>Measurements and main results: </strong>Catatonia was evaluated with the Bush-Francis Catatonia Rating Scale mapped to Diagnostic and Statistical Manual of Mental Disorders , Fifth Edition criteria. The primary outcome was catatonia-free days (CFDs), defined as the number of days the patient was alive and free from catatonia. Adjusted proportional odds logistic regression was used to estimate the odds ratio (OR) of outcome events. Patients ( n = 270) were enrolled with a median (interquartile range) age of 54.5 years (36.7-67.2 yr). Of patients who were exposed to antipsychotic medication ( n = 102), 27 (26%) experienced catatonia. Compared with patients who were never exposed to antipsychotics, those exposed in both the 5- and 14-day models had a 74% and 51% reduction in the odds of more CFD (OR, 0.2568; 95% CI, 0.1580-0.4173) and (OR, 0.4939; 95% CI, 0.3857-0.6325), respectively. Furthermore, those exposed to higher dosages had a 97% reduction in the odds of more CFD (OR, 0.0281; 95% CI, 0.0142-0.0556) and (OR, 0.0335; 95% CI, 0.0166-0.0673) compared with those exposed to lower dosages in both the 5- and 14-day models, respectively.</p><p><strong>Conclusions: </strong>This study may influence how intensivists approach the use of antipsychotic medications and may build upon existing evidence that dopamine blockade is an underlying biologic mechanism underlying catatonia.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"1169-1179"},"PeriodicalIF":6.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147389649","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 Without Systemic Anticoagulation-Are We There Yet?","authors":"Graeme MacLaren","doi":"10.1097/CCM.0000000000007098","DOIUrl":"10.1097/CCM.0000000000007098","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"1261-1263"},"PeriodicalIF":6.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147303265","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 Hypercapnic and Nonrespiratory Acidemia With Hospital Mortality in Mechanically Ventilated Patients With Sepsis: A Retrospective Multicenter Cohort Study.","authors":"Ravindranath Tiruvoipati, Jason Zheng, Sachin Gupta, David Pilcher, Kavi Haji, Michael Bailey, Eldho Paul","doi":"10.1097/CCM.0000000000007086","DOIUrl":"10.1097/CCM.0000000000007086","url":null,"abstract":"<p><strong>Objectives: </strong>The mortality among patients admitted with sepsis remains high and varies depending on the site of infection. The impact of hypercapnia and acidemia on clinical outcomes in mechanically ventilated patients with sepsis is not well understood.</p><p><strong>Design: </strong>Multicenter, binational, retrospective study assessed the association of compensated hypercapnia, hypercapnic acidemia, and nonrespiratory acidemia, in mechanically ventilated patients with mortality in sepsis.</p><p><strong>Setting: </strong>Data were extracted from the \"Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation adult patient\" database over a 17-year period (from January 2006 to December 2022) from 201 ICUs.</p><p><strong>Patients: </strong>Patients were classified into four mutually exclusive groups based on a combination of arterial pH and arterial C o2 recorded during the first 24 hours of ICU stay: normocapnia with normal pH, fully compensated hypercapnia, hypercapnic acidemia, and nonrespiratory acidemia. Logistic regression and Cox proportional hazards regression were used to examine the association of compensated hypercapnia, hypercapnic, and nonrespiratory academia to hospital mortality.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Fifty-two thousand four hundred five patients were included. Overall compensated hypercapnia (odds ratio [OR], 1.39; 95% CI, 1.24-1.55; p < 0.001), hypercapnic acidemia (OR, 1.68; 95% CI, 1.57-1.80; p < 0.001), and nonrespiratory acidemia (OR, 1.75; 95% CI, 1.61-1.90; p < 0.001) was associated with increased risk of hospital mortality as compared with patients with normocapnia and normal pH. The risk of increased hospital mortality associated with hypercapnic and nonrespiratory acidemia persisted in all prespecified diagnostic subgroups when compared with patients who had normal pH and normocapnia. Compensated hypercapnia was associated with increased mortality risk in neurologic and unspecified subgroups of sepsis.</p><p><strong>Conclusions: </strong>Hypercapnic acidemia and nonrespiratory acidemia within the first 24 hours of ICU admission are associated with increased risk of hospital mortality in mechanically ventilated patients with sepsis. This association remains consistent in all diagnostic subgroups of sepsis.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"1190-1201"},"PeriodicalIF":6.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147354126","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 Frame of Survival for Sepsis: A Practical Systems Framework for Time-Sensitive Critical Illness in Low-Resource Settings.","authors":"Jorge L Hidalgo, Samuel O Akech, Subhash P Acharya, Craig M Coopersmith, Shevin T Jacob, Cintia Johnston, Niranjan Kissoon, Flávia R Machado, Ryan C Maves, Elizabeth Molyneux, Brenda M Morrow, Sheila N Myatra, M Susana Pérez Cornejo, Javier Perez-Fernandez, Chairat Permpikul, Kunchit Piyavechviratana, Andrew Rhodes, Teresa B Kortz, Vishakha K Kumar, Mpoki M Ulisubisya, Vinay Nadkarni","doi":"10.1097/CCM.0000000000007093","DOIUrl":"10.1097/CCM.0000000000007093","url":null,"abstract":"<p><strong>Objectives: </strong>Sepsis is a time-sensitive cause of preventable death worldwide, with disproportionate mortality in low-resource settings (LRS). Many recommendations in international sepsis guidance presume resources unavailable in many facilities and communities. We sought to develop a practical framework that helps health systems embed feasible sepsis actions within broader emergency and essential critical care systems, while highlighting where evidence is limited and where local learning systems are needed.</p><p><strong>Data sources: </strong>A targeted scoping review of peer-reviewed and grey literature on sepsis epidemiology, emergency care systems, essential emergency and critical care, implementation strategies, and quality improvement (QI) in LRS; and key guideline and policy documents relevant to sepsis and emergency care.</p><p><strong>Study selection: </strong>We prioritized publications and guidance relevant to LRS, including observational studies, pragmatic implementation reports, consensus statements, and policies addressing emergency care organization, workforce, supply chains, diagnostics, and QI.</p><p><strong>Data extraction: </strong>Task force members abstracted actionable strategies, implementation barriers/enablers, and feasibility considerations across the care continuum (community, transport/prehospital, facility-based acute care, and referral). We also identified domains where guideline certainty is low or indirect for LRS.</p><p><strong>Data synthesis: </strong>A Society of Critical Care Medicine-convened multidisciplinary task force iteratively developed the \"Sepsis Frame of Survival\" using a structured process that included 1) scoping evidence review, 2) a Delphi-style prioritization of candidate framework elements by importance and feasibility, and 3) a structured consensus meeting (\"Utstein-style\" conference format) to finalize the model and its priority actions. We produced a concise implementation roadmap and a feasible measurement set aligned with resource constraints.</p><p><strong>Conclusions: </strong>The Sepsis Frame of Survival is a pragmatic model to organize sepsis improvement as part of emergency and essential critical care strengthening. It emphasizes high-impact actions that can be implemented with limited resources (triage and early recognition, timely antimicrobials, oxygen and basic supportive care, cautious fluid resuscitation with reassessment, source control and referral, diagnostics/microbiology where feasible, and QI). The framework explicitly distinguishes near-term, feasible changes from longer-term system investments and highlights the need for locally generated evidence to guide quality indicators and resuscitation strategies in LRS.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"1202-1208"},"PeriodicalIF":6.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147484987","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":"Clinical Criteria for the Definition of Refractory Septic Shock: A Joint Delphi Consensus from the Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM).","authors":"Marc Leone, Sheila N Myatra, Siddharth Dugar, Patrick M Wieruszewski, Lene Russell, Laura Evans, Louis Delamarre, Sameer Sharif, Michelle S Chew, Michelle Ng Gong, Glenn Hernández, Christa Schorr, Ines Lakbar, Susan E Smith, Ignacio Martin-Loeches, Djillali Annane, Martin Balik, Maurizio Cecconi, Daniel De Backer, Katia Donadello, Martin W Dünser, Sharon Einav, Ricard Ferrer, Nicole Juffermans, Olfa Hamzaoui, Giovanni Landoni, Bruno Levy, Cathrine McKenzie, Xavier Monnet, Marlies Ostermann, Claudia Spies, Mervyn Singer, Maria Theodorakopulou, Arzu Topeli, Erin Barreto, Seth R Bauer, Laurence W Busse, Craig M Coopersmith, Clifford Deutschman, Andre L Holder, Rishikesan Kamaleswaran, Matthieu Legrand, Greg S Martin, Ryan C Maves, Lama Nazer, Mark E Nunnally, Hallie C Prescott, Teresa Rincon, Gretchen L Sacha, Chris W Seymour, Yaseen M Arabi, Bruno Amp Besen, Alexandre Biasi Cavalcanti, Adam M Deane, Simon Finfer, Naomi Hammond, Miguel Ibarra-Estrada, Eduardo Kattan, Yuki Kotani, Flavia R Machado, Gustavo A Ospina-Tascón, Mervyn Mer, Paul J Young, Bram Rochwerg, Ashish K Khanna","doi":"10.1097/CCM.0000000000007124","DOIUrl":"10.1097/CCM.0000000000007124","url":null,"abstract":"<p><strong>Objective: </strong>A definition of refractory septic shock is necessary to guide diagnosis, management, prognostication, research, and future guidelines for this most severe form of the disease. We sought to achieve consensus on clinical criteria that would be used to define refractory septic shock.</p><p><strong>Design: </strong>Review of literature, expert panel position statements, and Delphi rounds with an international expert group.</p><p><strong>Setting: </strong>Consensus was defined as having at least 75% of panellists in agreement or disagreement on the three highest or lowest levels of a 7-point Likert scale or based on responses to single- or multiple-choice questions, respectively.</p><p><strong>Subjects: </strong>A panel of multinational, multiprofessional and multidisciplinary critical care experts assembled by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine (57 invitations and 56 participants).</p><p><strong>Measurements and main results: </strong>A five-round Delphi process was conducted for consensus and stability. The steering committee proposed 34 statements, and five of them were rejected by panel experts after round 2. Among 29 statements selected from eight domains, consensus was reached for 13. The panel agreed on the need for a comprehensive consensus set of clinical criteria for refractory septic shock. Markers of organ dysfunction (75%, 2 rounds), tissue perfusion (91.1%, 2 rounds) including lactate (94.6%, 2 rounds) and capillary refill time (76.8%, 2 rounds), assessment of fluid-responsiveness after initial resuscitation (92.9%, 5 rounds), and use of vasoactive drugs at norepinephrine equivalents greater than 0.5 µg/kg/min (75.0%, 3 rounds), were selected as clinical criteria of refractory septic shock. The use of critical care ultrasound (CCUS) (92.9%, 3 rounds) was the single diagnostic modality that reached a consensus-based agreement.</p><p><strong>Conclusions: </strong>A consensus for 13 criteria to frame the definition of refractory septic shock was reached. Refractory septic shock is characterised by persistently elevated lactate concentrations and or prolonged capillary refill time in patients with septic shock who are fluid unresponsive, require a norepinephrine base equivalent dose greater than 0.5 micrograms per kilogram per minute, and undergo CCUS assessment when mixed shock is suspected.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"1073-1091"},"PeriodicalIF":6.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147502964","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":"Fiberoptic Bronchoscopy Monitoring During Percutaneous Dilatational Tracheostomy: A Multicenter, Randomized, Controlled Trial. The FIBERTRACH Randomized Clinical Trial.","authors":"José Manuel Añón, Juan Carlos Figueira, Belén Civantos, Alexander Agrifoglio, Margarita Márquez, Patricia Rodríguez, Manuel Pérez-Márquez, Covadonga Rodríguez, Renata García-Gigorro, María Paz Escuela, Andoni García-Muñoz, Jorge Rodríguez-Peláez, Mónica Hernández, María Soledad Arellano, Mario Dalorzo, María Muñoz, Belén Quesada, Guillermo Jiménez, Ignacio Fernández, Claudia Díaz-Alvariño, Alba López-Fernández, Jesús Manzanares, Lucía Cachafeiro, Eva Perales, Pablo Millán, Manuel Sánchez, María José Asensio, Javier Vejo, Mariana Díaz-Almirón, Jesús Villar","doi":"10.1097/CCM.0000000000007078","DOIUrl":"10.1097/CCM.0000000000007078","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the prevalence of perioperative complications of endoscopic-guided percutaneous dilatational tracheostomy vs. nonendoscopic-guided percutaneous dilatational tracheostomy.</p><p><strong>Design: </strong>Multicenter, unblinded, randomized parallel-group trial with an intention-to-treat analysis conducted from December 2019 to December 2024. ClinicalTrials.gov Identifier: NCT04265625.</p><p><strong>Setting: </strong>Four medical-surgical ICUs in Spain.</p><p><strong>Patients: </strong>Adults undergoing tracheostomy for prolonged mechanical ventilation were enrolled.</p><p><strong>Interventions: </strong>Patients were randomized to: 1) endoscopic-guided percutaneous dilatational tracheostomy or 2) nonendoscopic-guided percutaneous dilatational tracheostomy, both performed with the single dilatation method and by experienced clinicians in patients with no risk factors.</p><p><strong>Measurements and main results: </strong>The primary endpoint was the prevalence of perioperative complications. The secondary endpoints included airway pressures during the procedure, gas exchange after the procedure and all-cause mortality at hospital discharge. We enrolled 442 patients, 221 patients assigned to each arm. Twenty-five patients (11.3%) in the endoscopic-guided percutaneous dilatational tracheostomy group and 29 (13.1%) in nonendoscopic-guided percutaneous dilatational tracheostomy group had perioperative complications (95% CI, -6.8 to 10.4; p = 0.663). Patients randomized to endoscopic-guided percutaneous dilatational tracheostomy had higher mean peak inspiratory pressure (47.4 ± 17.6 vs. 37.05 ± 10.6 cm H 2 O; 95% CI, 7.5-13.2; p < 0.001) during the procedure and higher mean Pa co2 at the end of the procedure (44.3 ± 8.9 vs. 41.5 ± 8.1 mm Hg; 95% CI, 1.1-4.4; p = 0.001) than nonendoscopic-guided percutaneous dilatational tracheostomy patients.</p><p><strong>Conclusions: </strong>In critically ill patients undergoing percutaneous dilatational tracheostomy, the routine use of endoscopic guidance did not demonstrate superiority over procedures performed without endoscopic guidance in terms of complication rates.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"1124-1135"},"PeriodicalIF":6.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147303203","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":"To Bronch or Not to Bronch? Rethinking Routine Bronchoscopic Guidance During Percutaneous Tracheostomy.","authors":"Eduardo Kattan, Sebastián Bravo","doi":"10.1097/CCM.0000000000007100","DOIUrl":"10.1097/CCM.0000000000007100","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"1266-1268"},"PeriodicalIF":6.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147324592","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":"Diagnostic Performance of Point-of-Care Immunoassay Measurements of Pancreatic Stone Protein for Sepsis Detection in ICU Patients: A Prospective, Multicenter, Biomarker-Blinded Study.","authors":"Andrew F Shorr, Marin H Kollef, Richard G Wunderink, Luis E Jauregui-Peredo, Andrew C Bernard, Hyung Kook Kim, Robert A Balk, Patricia Cristofaro, Mitchell M Levy","doi":"10.1097/CCM.0000000000007087","DOIUrl":"10.1097/CCM.0000000000007087","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the diagnostic performance of a rapid point-of-care immunoassay measuring pancreatic stone protein (PSP) for early sepsis identification within the first three days of ICU admission. Subgroup analyses (sex, age, febrile status) were conducted, and the combined diagnostic value of PSP and C-reactive protein (CRP) was assessed.</p><p><strong>Design: </strong>Multicenter, prospective, observational study.</p><p><strong>Patient: </strong>Four hundred sixty-six adults the ICU.</p><p><strong>Setting: </strong>Six ICUs in the United States who were expected to required at least 24 hours of ICU care.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We calculated the Youden Index to evaluate the clinical performance of the PSP assay, and the resulting threshold was used to identify patients with sepsis. Diagnostic performance metrics included sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-). Receiver operating characteristic analysis were performed for PSP and CRP. At the optimal PSP cutoff point of 117 ng/mL, PSP demonstrated a sensitivity of 74.2%, specificity of 67.8%, accuracy of 71.0%, PPV of 70.3%, NPV of 71.9%, and LR+ and LR- ratios of 2.30 and 0.38, respectively. Combining PSP and CRP improved diagnostic specificity to 95.2%. Subgroup analyses demonstrated consistent performance across sex, and higher specificity was observed in patients 18-60 years old. In febrile patients, PSP achieved high specificity (77.8%) but lower sensitivity (63.6%). In non-febrile patients, specificity and sensitivity sensitivity and specificity were 67.0% and 76.6%, respectively.</p><p><strong>Conclusions: </strong>PSP can serve as a biomarker for the early identification of sepsis. Diagnostic performance across diverse ages, sex, and clinical presentation supports the assay's broad applicability. The combination of PSP and CRP enhances diagnostic specificity for sepsis detection, offering a complementary approach to improve sepsis detection and lead to earlier appropriate management.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"1147-1157"},"PeriodicalIF":6.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147353693","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}