Critical Care Medicine最新文献

{"title":"The Search for Sepsis Biomarkers: A Tale of Promises, Pitfalls, and Potential.","authors":"Tobias Zimmermann, David Brealey, Mervyn Singer","doi":"10.1097/CCM.0000000000006560","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006560","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846004","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":"Toward Precision in Nutrition Therapy.","authors":"Christian Stoppe, Aileen Hill, Kenneth B Christopher, Arnold S Kristof","doi":"10.1097/CCM.0000000000006537","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006537","url":null,"abstract":"<p><p>Precision in critical care nutrition is paramount, as it focuses nutrition interventions on those patients most likely to benefit, or those who might potentially be harmed. Critical care nutrition must therefore be tailored to individual metabolic needs as determined by factors that control the capacity for tissue homeostasis and anabolic responses. This ideally involves the accurate and timely assessment of macronutrient and micronutrient requirements, a careful evaluation of metabolic response mechanisms and the identification of circumstances that might interfere with the productive utilization of dietary substrates. Specific surrogate markers of metabolic response, such as blood glucose levels, urea levels, or nitrogen balance, might be used to evaluate the metabolic readiness for nutrition and to establish the timing, nature, and clinical effectiveness of nutrition interventions. Despite the pressing need to further develop more targeted approaches in critically ill patients, indices of immediate metabolic responses that correlate with favorable clinical outcomes are lacking. In addition, the development of precision approaches might address timely adjustments in protein, energy, or micronutrient supplementation based on evolving clinical conditions. Here, we review why precision tools are needed in critical care nutrition, our progress thus far, as well as promising approaches and technologies by which multidisciplinary healthcare teams can improve quality of care and clinical outcomes by individualizing nutrition interventions.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834535","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":"Obesity Is Associated With Increased Mortality in Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation.","authors":"Colin G McCloskey, Kevin W Hatton, David Furfaro, Milo Engoren","doi":"10.1097/CCM.0000000000006547","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006547","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the relationship between all-cause hospital mortality and morbidity in patients treated with venoarterial extracorporeal membrane oxygenation (ECMO) and to assess whether this relationship is mediated via body mass index (BMI).</p><p><strong>Design: </strong>Using the Extracorporeal Life Support Organization (ELSO) registry, venoarterial ECMO runs from 2015 to 2021 were retrospectively analyzed. Patient demographics, ECMO indications, and complications for survivors and decedents were univariately compared. Logistic regression with fractional polynomials was used to estimate the relationship between BMI and both mortality and complications in venoarterial ECMO patients.</p><p><strong>Setting: </strong>Contributing centers to the ELSO ECMO registry.</p><p><strong>Patients: </strong>Patients that underwent venoarterial ECMO at an ELSO contributing ECMO center.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Twenty-two thousand eight hundred twenty-five venoarterial ECMO runs met inclusion criteria for analysis. The mean BMI for survivors was 28.4 ± 6.5 vs. 29.5 ± 6.9 kg/m2 for decedents. BMI was significantly associated with mortality (p < 0.001), with the proportion of patients dying increasing with increasing BMI: 47% of underweight patients died, increasing to 50% for the normal range, to 53%, 56%, 58%, and 65% for preobese, class 1, class 2, and class 3 obese patients, respectively. Relative to a BMI of 25, a BMI of 35 had an odds ratio (OR) of death of 1.15 (1.09-1.18), and a BMI of 45 an OR of 1.46 (1.25-1.57). BMI was significantly associated with increased mechanical and renal complications, but decreased pulmonary complications.</p><p><strong>Conclusions: </strong>In patients undergoing venoarterial ECMO, increasing BMI was associated with increasing all-cause mortality and mechanical and renal complications.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834533","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":"Prognostic Factors Associated With Intracranial Hemorrhage and Ischemic Stroke During Venovenous Extracorporeal Membrane Oxygenation: A Systematic Review.","authors":"Sonny Thiara, Alexander J Willms, Alexandre Tran, Anish R Mitra, Mypinder Sekhon, Ryan Hoiland, Donald Griesdale","doi":"10.1097/CCM.0000000000006520","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006520","url":null,"abstract":"<p><strong>Objectives: </strong>Venovenous extracorporeal membrane oxygenation (ECMO) is a life-preserving intervention for patients with respiratory failure refractory to conventional mechanical ventilation. Intracranial hemorrhage (ICH) and ischemic stroke are life-threatening complications associated with venovenous ECMO. Despite this, little is known regarding the prognostic factors associated with these adverse neurologic events. We conducted a systematic review that characterizes these predictors of ICH and ischemic stroke during venovenous ECMO.</p><p><strong>Data sources: </strong>We conducted a comprehensive search of MEDLINE and Embase via the Ovid interface.</p><p><strong>Study selection: </strong>We developed and performed a literature search to identify articles that evaluated ICH and ischemic stroke in adult patients undergoing venovenous ECMO. We excluded studies based on design, target population, and outcomes.</p><p><strong>Data extraction: </strong>Data were extracted manually by one reviewer. Risk of bias assessment was completed using the Quality in Prognostic Studies approach for each included study. Prognostic factors associated with ICH and ischemic stroke that were identified in two or more included studies were evaluated through the Grading of Recommendations, Assessment, Development, and Evaluation approach.</p><p><strong>Data synthesis: </strong>Three hundred thirty-three studies met criteria for screening. Seventeen studies met final inclusion criteria. Seventeen studies addressed predictors of ICH. Five studies demonstrated an increased risk of ICH with lower pH before venovenous ECMO (moderate certainty). Five studies demonstrated an increased risk of ICH with greater decreases in Paco2 pre- to post-venovenous ECMO cannulation (moderate certainty). Four studies addressed predictors of ischemic stroke; however, there were no predictors of ischemic stroke identified in two or more of the included studies.</p><p><strong>Conclusions: </strong>This systematic review demonstrates that abnormalities and changes in blood gas parameters from pre- to post-venovenous ECMO cannulation are probably associated with increased risk of ICH. Additional high-quality studies dedicated to probable predictors of these adverse neurologic events are crucial to understanding the pathophysiology of ICH and ischemic stroke in this population and informing clinical practice to mitigate the risk of these life-threatening events.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806283","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":"Sex-Specific Obesity Paradox in Critically Ill Patients With Severe Acute Kidney Injury: A Retrospective Analysis.","authors":"Hyo Jin Jung, Yu Jin Seo, Jiyun Jung, Jangwook Lee, Jae Yoon Park, Yong Chul Kim, Sung Woo Lee, Tae Hyun Ban, Woo Yeong Park, Kipyo Kim, Hyosang Kim, Kyeongmin Kim, Hee-Yeon Jung, Ji-Young Choi, Jang-Hee Cho, Sun-Hee Park, Chan-Duck Kim, Jeong-Hoon Lim, Yong-Lim Kim","doi":"10.1097/CCM.0000000000006538","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006538","url":null,"abstract":"<p><strong>Objectives: </strong>Although obesity is typically correlated with adverse outcomes in various diseases, certain acute critical illnesses exhibit a phenomenon known as the obesity paradox. This study evaluated sex-specific differences in the prognostic implications of the body mass index (BMI) of patients with severe acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT).</p><p><strong>Design: </strong>A multicenter retrospective cohort study.</p><p><strong>Setting: </strong>Data from eight tertiary hospitals in Korea.</p><p><strong>Patients: </strong>A total of 3805 critically ill patients receiving CRRT. Patients were categorized into four BMI groups: underweight, normal weight, overweight, and obese.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>There were 2308 male and 1497 female patients. The 90-day mortality risk significantly differed among BMI groups in the overall patient population and the male subpopulation but not the female subpopulation. Following adjustment for confounding variables, the 90-day mortality risk was higher in the underweight group than in the obese group (hazard ratio [HR], 1.20; 95% CI, 1.05-1.36; p = 0.006). Among male patients, the 90-day mortality risk was higher in both the underweight and normal weight groups than in the obese group (underweight: HR, 1.30; 95% CI, 1.10-1.53; p = 0.002 and normal weight: HR, 1.18; 95% CI, 1.04-1.35; p = 0.010); however, no such association was observed among female patients. Subgroup analysis demonstrated the obesity paradox in male patients of old age, with septic AKI, or with low albumin levels.</p><p><strong>Conclusions: </strong>There were sex differences in the association between BMI and mortality in critically ill patients with severe AKI. Although the precise distribution of fat mass and muscle mass was not identified, obese male patients had a more favorable prognosis, which was not evident among female patients. These findings highlight the importance of considering sex-specific factors in understanding the complex relationship between obesity and mortality in critically ill patients with AKI.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799668","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":"Adjunctive Midodrine Therapy for Vasopressor-Dependent Shock in the ICU: A Systematic Review and Meta-Analysis.","authors":"Sebastian J Kilcommons, Fadi Hammal, Mostafa Kamaleldin, Dawn L Opgenorth, Kirsten M Fiest, Constantine J Karvellas, Demetrios J Kutsogiannis, Vincent I Lau, Erika J MacIntyre, Bram Rochwerg, Janek M Senaratne, Jocelyn M Slemko, Wendy I Sligl, Xiaoming X M Wang, Sean M Bagshaw, Oleksa G Rewa","doi":"10.1097/CCM.0000000000006519","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006519","url":null,"abstract":"<p><strong>Objectives: </strong>To summarize the efficacy of midodrine as an adjunctive therapy in critically ill patients. Safety of midodrine was assessed as a secondary outcome.</p><p><strong>Data sources: </strong>We performed a systematic review and meta-analysis using a peer-reviewed search strategy combining the themes of vasopressor-dependent shock, critical care, and midodrine and including MEDLINE, Ovid Embase, CINAHL, and Cochrane library databases until September 14, 2023.</p><p><strong>Study selection: </strong>We included studies if they: 1) included patients with vasopressor-dependent shock, 2) were performed in the ICU, 3) evaluated oral midodrine therapy compared with placebo or usual care, and 4) evaluated one of the outcomes of interest.</p><p><strong>Data extraction: </strong>We extracted data independently in duplicate using standardized data abstraction forms, which included the following specific variables: patient characteristics, age, sex, type of ICU, etiology of shock, number of patients, study inclusion and exclusion criteria, and geographical location. We also captured the type, dose, and duration of IV vasopressors, any cointervention used, and outcome data.</p><p><strong>Data synthesis: </strong>We identified seven randomized controlled trials (six included in the pooled analysis) and ten observational studies (four included in the pooled analysis) that met eligibility criteria. Adjunctive midodrine may decrease ICU length of stay (LOS) and there is low certainty of effect on hospital LOS. Midodrine may decrease IV vasopressor support duration, ICU mortality, and hospital mortality. Pooled observational data was based on very low certainty data for all outcomes of interest. The trial sequential analysis-informed required sample size was not met for ICU LOS or IV vasopressor duration and this contributed to Grading of Recommendations, Assessment, Development, and Evaluations assessments of imprecision for both outcomes.</p><p><strong>Conclusions: </strong>Adjunctive midodrine may decrease ICU LOS, duration of IV vasopressor therapy, and mortality in critically ill patients. However, required sample sizes was not met to determine our outcomes of interest. Midodrine may increase risk of bradycardia. While midodrine may provide benefit for patient-centered outcomes, due to increased risk of adverse events, further large-scale studies are needed to inform and guide its routine use in the ICU.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779481","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 Ongoing Pursuit to Reduce the Burden of IV Vasopressor Infusions.","authors":"Patrick M Wieruszewski, Amos Lal","doi":"10.1097/CCM.0000000000006531","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006531","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799670","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":"Mastering the Sequential Organ Failure Assessment Score: Critical Choices of Score Statistic, Timing, Imputations, and Competing Risk Handling in Major Trials-A Systematic Review.","authors":"Marilena Marmiere, Filippo D'Amico, Giacomo Monti, Giovanni Landoni","doi":"10.1097/CCM.0000000000006532","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006532","url":null,"abstract":"<p><strong>Objectives: </strong>The Sequential Organ Failure Assessment (SOFA) score originated as a tool for assessing organ dysfunction in critical illness but has expanded to become an outcome measure in clinical trials. We aimed to assess how the SOFA score was used as the primary or secondary endpoint of major randomized controlled trials (RCTs).</p><p><strong>Data sources: </strong>Independent reviewers searched MEDLINE/PubMed, Scopus, and Embase databases.</p><p><strong>Study selection: </strong>Articles were selected when they fulfilled: 1) RCT; 2) SOFA score was primary or secondary endpoint; and 3) published in the Lancet, New England Journal of Medicine, or Journal of the American Medical Association.</p><p><strong>Data extraction: </strong>Data collection included study details, outcomes, statistical differences in SOFA score, choice of score statistics, timepoints of SOFA reporting, and how missing data and competing risks analysis were managed.</p><p><strong>Data synthesis: </strong>Twenty-three RCTs had SOFA score as outcome measure, eight used it as primary endpoint. Daily maximum SOFA was the key statistic in 11 RCTs, delta SOFA was used in eight, and mean SOFA in four. Mean SOFA was most frequently chosen as primary endpoint (4/8, 50%). There were 18 different outcome assessment timepoints, ranging from 1 to 28 days. Three RCTs reported statistically significant difference in SOFA between groups. Handling of missing SOFA scores was not described in ten of 23 RCTs. When described, it varied from study to study with variable imputation methods and variable accounting for the competing risk of mortality and ICU discharge.</p><p><strong>Conclusions: </strong>There is major variability in the choice of summary statistic for SOFA score analysis and assessment timepoints, when using it as outcome measure in RCTs. There was either no information or great variability in the handling of missing values, use of imputation, and accounting for competing risk. The current use of SOFA scores in RCTs lacks sufficient reproducibility and statistical and methodological robustness.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779521","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":"Can Machine Learning Raise Early Goal-Directed Therapy From the Grave?","authors":"Alexandra B Spicer, Matthew M Churpek","doi":"10.1097/CCM.0000000000006493","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006493","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779484","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":"From Syndrome to Subphenotypes: Electrical Impedance Tomography As a Severity Stratification Tool in the Acute Respiratory Distress Syndrome.","authors":"Spencer Keil, Kelly Fiorino, Robert C Hyzy","doi":"10.1097/CCM.0000000000006487","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006487","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784372","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}