Critical Care Medicine最新文献

{"title":"Lateral Versus Midline: A Retrospective Review of Paracentesis Site Location and Risk of Hemorrhagic Complication.","authors":"Josef Miller, Tracy Dinh, Cole Pieroni, Agostina Velo, Anne Pohlman, Gaurav Ajmani, Krysta Wolfe, Bhakti Patel, John P Kress","doi":"10.1097/CCM.0000000000006883","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006883","url":null,"abstract":"<p><strong>Objectives: </strong>Patients who have cirrhosis, malignancy, or heart failure frequently accumulate ascitic fluid in their peritoneal cavity. Percutaneous drainage of ascites is a common procedure to provide diagnostic and/or therapeutic benefit to the patient; however, this procedure is associated with a small but life-threatening risk of hemorrhage. Given the avascular nature of the linea alba, it was hypothesized that a midline approach would reduce the risk of hemorrhage.</p><p><strong>Data sources: </strong>Data were collected from the electronic medical record. This review was authorized by the University of Chicago, Institutional Review Board 20-0083.</p><p><strong>Study selection: </strong>Using the electronic medical record, 1798 patients were identified using International Classification of Diseases, 9th revision and International Classification of Diseases, 10th revision codes between January 1, 2011, and January 1, 2020.</p><p><strong>Data extraction: </strong>We conducted a retrospective chart review of 1798 patients who underwent 4563 percutaneous abdominal paracentesis events with ultrasound guidance. Four thousand five hundred thirteen of those procedures had information about procedure location. The location of catheter placement, lateral vs. midline, was recorded in conjunction with occurence rate of post-paracentesis clinically significant hemorrhage, defined as CT imaging with evidence of hemorrhage at the procedural site within 7 days of paracentesis that required either blood transfusion, angiographic intervention, or resulted in death. Baseline characteristics were also collected, including age, sex, body mass index, volume of ascites drained, baseline hemoglobin, platelet count, international normalized ratio, serum sodium, creatinine, bilirubin, albumin, and etiology of ascites. Among paracentesis events for patients with a diagnosis of cirrhosis (n = 2497), 2206 has sufficient data to calculate a Model for End-Stage Liver Disease (MELD) 3.0 score and 2202 had sufficient data to determine Child-Pugh Classification.</p><p><strong>Data synthesis: </strong>Among patients receiving paracentesis, the overall occurence rate of hemorrhage was 1.3% (60/4563). There was a statistically significant reduction in the occurence rate of hemorrhage among patients who underwent midline percutaneous catheter placement (0/230) compared with lateral percutaneous catheter placement (60/4283; p = 0.03). Among patients with cirrhosis, patients undergoing lateral paracentesis (n = 2086) had a mean MELD 3.0 score of 22 (sd, 8.46) and patients undergoing midline paracentesis (n = 118) had a mean MELD 3.0 score of 25 (sd, 8.13). These groups had a statistically significant difference by Mann-Whitney U test (p ≤ 0.001) with a standardized effect size of 0.071. Logistic regression was performed to identify patient variables that correlated with hemorrhage. Among these, only serum bilirubin nearly approached significance (p = 0.07). No ba","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145184799","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":"Platelet Transfusion Practices in the ICU: A Prospective Multicenter Cohort Study.","authors":"Stefan F van Wonderen, Senta Jorinde Raasveld, Andrew W J Flint, Jimmy Schenk, Claudia van den Oord, Merijn C Reuland, Sanne de Bruin, Jan Bakker, Maurizio Cecconi, Aarne Feldheiser, Jens Meier, Marcella C A Müller, Thomas W L Scheeren, Tarikul Hamid, Michaël Piagnerelli, Tina Tomić Mahečić, Jan Benes, Lene Russell, Hernan Aguirre-Bermeo, Konstantina Triantafyllopoulou, Vasiliki Chantziara, Mohan Gurjar, Sheila Nainan Myatra, Vincenzo Pota, Muhammed Elhadi, Ryszard Gawda, Mafalda Mourisco, Marcus Lance, Vojislava Neskovic, Matej Podbregar, Juan V Llau, Manual Quintana-Diaz, Maria Cronhjort, Carmen A Pfortmueller, Nihan Yapici, Nathan D Nielsen, Akshay Shah, Harm-Jan de Grooth, Zoe McQuilten, Alexander P J Vlaar, Cécile Aubron","doi":"10.1097/CCM.0000000000006880","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006880","url":null,"abstract":"<p><strong>Objective: </strong>There is a lack of comprehensive international data regarding platelet transfusion practices in the ICU. This study aimed to evaluate the current occurrence rate of platelet transfusion in the ICU and provide an overview of platelet transfusion practices including indications for a platelet transfusion, thresholds, (non-)adherence and geo-economic region variations.</p><p><strong>Design: </strong>International prospective cohort study.</p><p><strong>Setting: </strong>Two hundred thirty-three centers in 30 countries worldwide.</p><p><strong>Patients: </strong>All patients 18 years old and older, admitted to the ICU during a single study week, selected by each site from one of the 16 predefined weeks (March 2019 to October 2022), were included.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Of the 3643 patients, 208 (6%) received a platelet transfusion during their ICU stay and main indications consisted of active bleeding (42%, n = 187/443), prophylaxis (33%, n = 144/443) or an upcoming procedure (12%, n = 51/443). The median platelet count before transfusion was 44 × 109/L (interquartile range [IQR], 20-78) with variation by indication, including a higher median of 60 × 109/L (IQR 31-93) during active bleeding. A threshold for transfusion was stated in 51% (n = 224/443) of the events, with a median threshold platelet count of 50 × 109/L (IQR, 40-100). The advised threshold was not adhered to in 16% (n = 36/224) of cases, with the majority having active bleeding as indication. Contrasts in transfusion practices were observed across different geo-economic regions. Platelet transfusions were administered to 6% (n = 156/2520) of patients in high-income countries, 5% (n = 52/1069) of patients in upper-middle-income countries and in none from lower-middle-income countries (n = 0/54). Non-adherence was higher in the high-income countries (23%, n = 34/149) than upper-middle-income countries (3%, n = 2/75).</p><p><strong>Conclusions: </strong>Platelet transfusions were administered to a small proportion of critically ill patients, and were given to treat active bleeding or as prophylaxis in the majority of cases. Occurence rate, indication and threshold adherence for platelet transfusion widely varied between geo-economic regions.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145148151","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":"Prolonged Grief Disorder, Posttraumatic Stress Disorder, Depression, and Anxiety Symptom States Over ICU Family Members' First Two Bereavement Years.","authors":"Fur-Hsing Wen, Paul A Boelen, Wen-Chi Chou, Tsung-Hui Hu, Chung-Chi Huang, Siew Tzuh Tang","doi":"10.1097/CCM.0000000000006894","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006894","url":null,"abstract":"<p><strong>Objective: </strong>Co-occurrence of prolonged grief disorder (PGD) with psychologic distress like posttraumatic stress disorder (PTSD) and depression is widely studied. However, only two non-ICU studies from Western countries have cross-sectionally examined co-occurring PGD, PTSD, depression, and anxiety symptoms among individuals who experienced traumatic bereavement, yielding inconsistent findings. Despite this, PGD symptoms frequently co-occur with anxiety symptoms, which strongly predicts PTSD-depression trajectories and PGD-PTSD-depression symptom states. To identify and examine transitions through distinct states of co-occurring PGD, PTSD, depression, and anxiety symptoms over the first two bereavement years among Taiwanese ICU bereaved who lost a family member to diseases.</p><p><strong>Design: </strong>Prospective cohort study.</p><p><strong>Setting: </strong>MICUs of two Taiwanese medical centers.</p><p><strong>Subjects: </strong>Three hundred three family members.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Participants were surveyed at 6, 13, 18, and 24 months of post-bereavement with 11 items from the PG-13, the Impact of Event Scale-Revised, and depression and anxiety subscales of the Hospital Anxiety and Depression Scale. Latent transition analysis was used to examine the PGD-PTSD-depression-anxiety symptom states and their prevalence over time. At 6 months of post-bereavement, we identified four distinct PGD-PTSD-depression-anxiety symptom states (prevalence): resilient (62.7%), subthreshold PGD-depression (21.2%), PGD-dominant (11.2%), and co-occurring PGD-PTSD-depression-anxiety (4.9%). Symptom states were mostly stable over time; however, when participants transitioned between states, they typically moved toward lower distress states. At 24 months of post-bereavement, the prevalence rankings remained unchanged: resilient (81.1%), subthreshold PGD-depression (10.9%), PGD-dominant (5.5%), and co-occurring PGD-PTSD-depression-anxiety (2.5%).</p><p><strong>Conclusions: </strong>We consistently observed four distinct PGD-PTSD-depression-anxiety-symptom states during the first two bereavement years of ICU family members. Persistently elevated PGD symptoms, alone or with PTSD, depression, and anxiety, can already be detected within 6 months of bereavement, underscoring the need for early screening to provide timely psychologic support or treatments for those at risk of chronic PGD or co-occurring symptom states.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145148182","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":"Reporting of Hospital-Free Days As an Outcome Measure in Critical Care Trials: A Systematic Review.","authors":"Ralph Shackleton, Sarah Vollam, Stephen Gerry, Akshay Shah, David M Griffith","doi":"10.1097/CCM.0000000000006858","DOIUrl":"10.1097/CCM.0000000000006858","url":null,"abstract":"<p><strong>Objectives: </strong>To synthesize the existing use, definitions, and variation in the application of hospital-free days (HFDs) as an outcome measure in randomized controlled trials (RCTs) of critically ill adults.</p><p><strong>Data sources: </strong>Trial registries (ISRCTN, ClinicalTrials.gov) and electronic databases (CENTRAL, MEDLINE, Embase, and CINAHL PLUS).</p><p><strong>Study selection: </strong>We included trial registrations, protocols, or articles reporting RCTs that included patients admitted to an adult ICU and had any variation of HFD as a primary or secondary outcome.</p><p><strong>Data extraction: </strong>Data collected included definition of HFD, statistical analysis, minimal clinically important difference, method of data collection, and loss to follow-up. Risk of bias in the included studies was assessed using the relevant domains of the Cochrane Risk of Bias 2 tool (blinding of outcome assessment, incomplete outcome data, and selective reporting). Data were synthesized quantitatively using frequencies and percentages.</p><p><strong>Data synthesis: </strong>We identified 110 eligible studies. We found considerable variability in how HFD was defined and reported. Incomplete reporting was common, with 69 studies (62.7%) not reporting all three individual components of HFD. Length of stay was omitted most frequently. Risk of bias related to outcome assessment and measurement was considered low. Fifty-two studies (47.3%) collected HFD data from routine healthcare records. The most common follow-up time points were 28 and 90 days. Over half of all studies (56 [50.9%]) did not report the number of HFD counted if a patient died during follow-up.</p><p><strong>Conclusions: </strong>This systematic review highlights the heterogeneity in the definition, reporting, and analysis of HFD. We propose guidance for the use of HFD and highlight areas for future research to allow standardization in the use and reporting of HFD in critical care research.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039498","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":"Institutional Risk Factors Associated With Healthcare-Associated Infections in Brazilian ICUs: A Nested Cohort Within the IMPACTO-MR Platform.","authors":"Bruno Adler Maccagnan Pinheiro Besen, Camila Dietrich, Carla Cristina Gomes Pinheiro, Débora Patrício Silva, Renata Rodrigues de Mattos, Clayse Carla da Silva Spadoni, Luiz Fernando Lima Reis, Pedro Aniceto Nunes Neto, Luis Eduardo Miranda Paciência, Eliana Bernadete Caser, Caio Cesar Ferreira Fernandes, Vanildes de Fátima Fernandes, Bianca Ramos Ferronato, Hugo Corrêa de Andrade Urbano, Cintia Magalhães Carvalho Grion, Elisangela Maria de Lima Medeiros, Antônio Carlos da Silva, Nicole Alberti Golin, Valéria Paes Lima, Emerson Boschi, André Sant'Ana Machado, Rafael Botelho Foernges, Lúcio Couto de Oliveira Junior, Everton Macêdo Silva, Francielle Constantino Pereira, Thiago Costa Lisboa, Antônio Paulo Nassar, Adriano José Pereira, Viviane Cordeiro Veiga, Beatriz Arns, Giovanna Marsola, Flávia Ribeiro Machado, Alexandre Biasi Cavalcanti, Luciano César Pontes Azevedo, Bruno Martins Tomazini","doi":"10.1097/CCM.0000000000006881","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006881","url":null,"abstract":"<p><strong>Objectives: </strong>Healthcare-associated infections are common and potentially preventable, especially in low- and middle-income countries (LMICs), due to substandard staffing, structure, and process-of-care. We evaluated institutional risk factors associated with ventilator-associated pneumonia (VAP) and central line-associated bloodstream infection (CLABSI) rates.</p><p><strong>Design: </strong>Multicenter cohort study.</p><p><strong>Setting: </strong>Fifty Brazilian ICUs.</p><p><strong>Patients: </strong>All patients admitted from September 2019 to December 2021 to the participating ICUs, exposed to at least 2 days of invasive mechanical ventilation (MV) or central venous catheter (CVC).</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Individual patient data were prospectively collected, and cross-sectional hospital-level data were collected at baseline. VAP and CLABSI were reported in accordance with Brazilian regulatory agency guidance. Negative binomial or Poisson multiple regression were used to model risk factors, adjusted for individual-level covariates. Of 75,164 ICU admissions, there were 19,108 at-risk (≥ 48 hr of MV) patients with a total of 244,059 MV-days for a VAP incidence rate of 6.03 (95% CI, 5.73-6.35) per 1,000 MV-days. There were 26,560 patients with a total of 375,078 CVC-days for a CLABSI incidence rate of 1.63 per 1,000 CVC-days (95% CI, 1.51-1.77 per 1,000 CVC-days). The median rate ratios of hospital random-effects were 4.39 (95% CI, 2.72-6.06) for VAP and 3.53 (95% CI, 2.30-4.76) for CLABSI. Hospital-level fixed effects explained 39.9% (95% CI, 33.6-46.1%) of the between-hospital variability for VAP and 44.7% (95% CI, 35.0-54.5%) for CLABSI. Prevention protocols, flexible family visitation policies, and hand hygiene training were associated with reduced rates of VAP and CLABSI. Nursing staffing ratios, single-use gowns, and alcohol availability were associated with a lower CLABSI rate. Sedation titration by nurses, weaning by respiratory therapists, and dentist availability were associated with a lower rate of VAP.</p><p><strong>Conclusions: </strong>Processes-of-care and ICU structure measures are associated with the burden of VAP and CLABSI in LMICs.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130440","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":"Digital Twins to Evaluate the Risk of Ventilator-Induced Lung Injury During Airway Pressure Release Ventilation Compared With Pressure-Controlled Ventilation.","authors":"William Joy, Beatrice Albanese, Diallo Oakley, Sonal Mistry, Kateryna Nikulina, Andreas Schuppert, Gernot Marx, Bindi S Brook, Jonathan G Hardman, John G Laffey, Louise Rose, Luigi Camporota, Timothy E Scott, Declan G Bates, Sina Saffaran","doi":"10.1097/CCM.0000000000006885","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006885","url":null,"abstract":"<p><strong>Objective: </strong>To use digital twins constructed based on data from patients with acute respiratory distress syndrome (ARDS) to calculate all key indices of ventilator-induced lung injury (VILI) during airway pressure release ventilation (APRV), and to compare them with corresponding values obtained during pressure-controlled ventilation (PCV).</p><p><strong>Design: </strong>Digital twins were created by matching a high-fidelity cardiopulmonary simulation model to each patient's data.</p><p><strong>Setting: </strong>Interdisciplinary Collaboration in Systems Medicine Research Network.</p><p><strong>Subjects: </strong>A dataset consisting of pairs of ventilator settings and arterial blood gases for 98 patients with ARDS receiving PCV.</p><p><strong>Interventions: </strong>VILI indices were calculated for each recorded PCV datapoint, and for typical APRV settings in fixed and time-controlled adaptive modes, in the same digital twins. Global optimization algorithms evaluated greater than 4.8 million changes to these settings to identify the lowest values of VILI indices that could be achieved in both modes while preserving adequate gas-exchange.</p><p><strong>Measurements and mains results: </strong>In digital twins, APRV settings of inspiratory pressure equals to 25 cm H2O, low-pressure setting equals to 0 cm H2O, inspiration time equals to 5 s, and expiration time set to achieve 75% of peak expiratory flow rate (mean 0.5 s), reduced mean mechanical power (MP) by 32% and mean tidal alveolar recruitment/de-recruitment by 34% compared with documented PCV settings, at the cost of moderate hypercapnia (mean PaCO2 58.5 mm Hg, pHa 7.32 vs. PaCO2 45.6 mm Hg, pHa 7.37). Mean driving pressure, tidal volume, and lung stress/strain were similar in both modes. Computational optimization showed that these settings were close to optimal in terms of minimizing both mean MP and mean levels of tidal recruitment/de-recruitment during APRV.</p><p><strong>Conclusions: </strong>Using digital twins we found possible lung-protective conditions and beneficial effects of APRV which need further evaluation in randomized clinical trials.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130402","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 Conservative Vs. Liberal Extracorporeal Oxygen Target During Venoarterial Extracorporeal Membrane Oxygenation Support for Cardiogenic Shock: A Pilot Randomized Control Trial.","authors":"Hadrien Winiszewski, Marc Puyraveau, Antoine Kimmoun, Gael Piton, Karena Moretto Riedweg, Mélanie Moltenis, Pierre-André Pinel, Guillaume Besch, Pierre-Grégoire Guinot, Gilles Capellier","doi":"10.1097/CCM.0000000000006882","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006882","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate if titration of sweep gas oxygen fraction (FDO2) targeting post oxygenator conservative oxygen strategy might decrease organ dysfunction compared with a liberal extracorporeal oxygenation strategy.</p><p><strong>Design: </strong>Pilot multicenter randomized controlled trial.</p><p><strong>Setting: </strong>Four ICUs in three teaching hospitals of the eastern France.</p><p><strong>Patients: </strong>Cardiogenic shock supported by venoarterial extracorporeal membrane oxygenation (VA ECMO).</p><p><strong>Interventions: </strong>FDO2 titration targeting postoxygenator oxygen partial pressure (PPOSTO2) 100-150 mm Hg in the conservative arm, and FDO2 maintained at 100% in the liberal arm.</p><p><strong>Measurements and main results: </strong>Primary outcome was mean plasmatic intestinal fatty acid binding protein (IFABP) level at day 2, a marker of gut damage. Secondary outcome were feasibility criteria, biomarkers of hepatic and renal dysfunction, biomarkers of inflammation and antioxidant system. Among the 55 patients analyzed, 29 were assigned to the conservative arm and 26 to the liberal arm. The two arms were well separated over the first 7 days: FDO2 61 (± 7) % vs. 98 (± 5) %, and PPOSTO2 139 (± 40) mm Hg vs. 420 (± 50) mm Hg, in the conservative and liberal arms, respectively. However, in the conservative arm, the mean proportion of time within the targeted window was only 33 (± 20) %. IFABP on day 2 did not differ between conservative and liberal arms (407 [206-549] pg/mL vs. 569 [247-708] pg/mL, p = 0.25). Lactate, vasoactive inotropic score, aspartate aminotransferase, prothrombin time, serum creatinine, need for renal replacement therapy, tumor necrosis factor-α, IL-6 and IL-8 did not differ between the two arms at day 0, 2, and 6 after randomization.</p><p><strong>Conclusions: </strong>In patients supported by VA ECMO for cardiogenic shock, a conservative oxygen target strategy was not easily feasible, as PPOSTO2 could be maintained within the targeted window only 33% of time. However, the conservative and liberal arms were well separated regarding PPOSTO2, and we did not find any difference in biomarkers of organ dysfunction.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130376","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":"Data-Driven Quality of Care in the ICU: A Concise Review.","authors":"Giulliana M Moralez, Filipe Amado, Vincent X Liu, Sing Chee Tan, Geert Meyfroidt, Robert D Stevens, David Pilcher, Jorge I F Salluh","doi":"10.1097/CCM.0000000000006862","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006862","url":null,"abstract":"<p><strong>Objectives: </strong>Artificial intelligence (AI) and machine learning (ML) are emerging as transformative tools in intensive care medicine. Nevertheless, despite the development of numerous AI/ML models, their integration into routine ICU practice remains limited. This concise review examines the role of AI and data science in critical care, with a focus on their contributions to safety and quality assurance, clinical processes improvements, and ICU management. By synthesizing current evidence, this review aims to highlight the opportunities and challenges associated with implementing AI-driven solutions in critical care settings.</p><p><strong>Data sources: </strong>English-language articles were identified in PubMed using keywords related to AI, ML, ICU management, clinical decision support, and predictive analytics.</p><p><strong>Study selection: </strong>Original research articles, reviews, letters, and commentaries relevant to AI/ML applications in ICU quality and performance assessment were included.</p><p><strong>Data extraction: </strong>Relevant literature was identified, key findings were synthesized into a structured narrative review.</p><p><strong>Data synthesis: </strong>The integration of AI and ML into ICU management leverages vast clinical data to evaluate ICU performance, measure risk factors, optimize workflows, and predict adverse events. ML-driven models can improve clinical decision-making and ICU management. Despite the promising results, real-world implementation requires rigorous validation and clinician adoption. AI-driven successful implementation in ICU comes with significant challenges.</p><p><strong>Conclusions: </strong>AI and ML have the potential to transform ICU management. However, their success depends on validated methodologies, interoperable data frameworks, and interpretable models that clinicians can trust. Advancing AI use in the ICU demands a multidisciplinary effort to create adaptive, transparent, and clinically meaningful solutions that enhance patient care and improve workflow, while ensuring safety and efficiency.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085233","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":"Optimizing Agreement Between Bedside Nurse-Documented and Trained Researcher Delirium Assessments in the ICU.","authors":"Kelly M Toth, Zahra Aghababa, Jason N Kennedy, Chukwudi Onyemekwu, Niall T Prendergast, Christopher A Franz, Michael E Reznik, Brian Jiang, Brett Curtis, Faraaz Shah, Georgios D Kitsios, Bryan J McVerry, Timothy D Girard","doi":"10.1097/CCM.0000000000006879","DOIUrl":"10.1097/CCM.0000000000006879","url":null,"abstract":"<p><strong>Objectives: </strong>Delirium is common and harmful in the ICU. The Intensive Care Delirium Screening Checklist (ICDSC) and Confusion Assessment Method for the ICU (CAM-ICU) are validated tools recommended for delirium identification. However, the accuracy of bedside nurse-documented delirium assessments in the ICU is inconsistent, limiting utility in clinical research. We sought to evaluate and optimize agreement between bedside nurse-documented and trained researcher delirium assessments.</p><p><strong>Design, setting, and patients: </strong>Critically ill adults with acute respiratory failure or sepsis in ICUs in large academic hospitals in a southwestern Pennsylvania health system were assessed daily for delirium by bedside nurses (using the ICDSC) and trained researchers (using the CAM-ICU). Using matched nurse-to-researcher delirium assessments, we categorized delirium status using validated cutoffs and evaluated agreement using Cohen's kappa. We derived and compared logistic regression models that used ICDSC documentation, mechanical ventilation status, and admission Sequential Organ Failure Assessment to predict delirium in noncomatose patients, using researcher CAM-ICU assessments as the reference standard. We internally validated models using ten-fold cross-validation.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>From a sample of 1535 matched assessments of 279 patients, there was moderate agreement between bedside nurse assessments using the established ICDSC delirium/normal cutoff (ICDSC ≥ 4) and trained researcher assessments using the CAM-ICU (Cohen's kappa = 0.42). A logistic regression model informed by individual ICDSC components and clinical data predicted a positive research CAM-ICU with good discrimination (area under the curve = 0.87) and performed well in cross-validation (F1 score = 0.72). In sensitivity analyses, models with more limited ICDSC information demonstrated fair to good discriminatory ability (F1 = 0.60-0.70), with the validated cutoff model having the lowest performance.</p><p><strong>Conclusions: </strong>A delirium model informed by bedside nurse ICDSC findings and clinical variables improves accuracy of delirium detected in the ICU and can be used in future pragmatic research that leverages large clinical datasets to advance understanding of delirium mechanisms, trajectories, and outcomes.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085351","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":"Multidisciplinary Approach to Early Mobility at an Academic Medical Center.","authors":"Dimpi A Patel, Shannon M Stillwell, Sara E Booth, Meredith A Schofield, Anna E Silverstein, Alyse M Reichheld, Roberto J Gonzalez, Brian J McDonnell, Susy L Carnevale, Jacqueline L Joy, Adrienne Cronin, Ashley L O'Donoghue, James R Devanney, Ryan M Gould, Elaine M Klatt, Stephanie Li, Margaret M Hayes, Jennifer P Stevens, David M Furfaro","doi":"10.1097/CCM.0000000000006890","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006890","url":null,"abstract":"<p><strong>Objectives: </strong>ICU-acquired weakness affects 50% of critically ill patients. Early mobility programs have been shown to improve functional status at hospital discharge, shorten duration of mechanical ventilation, prevent delirium, and reduce length of stay. Despite these benefits, early mobility is one of the most difficult parts of the ABCDEF bundle to incorporate into practice. This project sought to use a multidisciplinary intervention to improve mobility in the ICU.</p><p><strong>Design: </strong>Randomized, pragmatic design quality improvement study.</p><p><strong>Setting: </strong>Two ICUs at a large academic medical center between July 2023 and February 2024.</p><p><strong>Patients: </strong>Five hundred seventy-four ICU patients with 271 in the intervention ICU and 276 in the control ICU.</p><p><strong>Interventions: </strong>A multidisciplinary quality improvement initiative focused on increasing education, raising awareness, and addressing barriers.</p><p><strong>Measurements and main results: </strong>Our primary outcome was achievement of an intensity-specific mobility goal with nursing staff on a patient-day level. A difference-in-differences model was used to evaluate the association between the mobility intervention and mobility goal achievement. The percentage of daily mobility goals met increased from 48.6% pre-intervention to 65.4% post-intervention in the intervention ICU (p < 0.001). There was no significant difference in daily mobility goal adherence between the intervention and control ICU pre-intervention, but post-intervention, the intervention ICUs adherence was significantly higher (65.4% vs. 43.0%; p < 0.001). After controlling for demographic, clinical, and ICU characteristics, the intervention ICU was 1.96 times more likely to reach the daily mobility goal on a patient-day level (p = 0.017). There was no significant change in ICU length of stay, inpatient length of stay, discharge to home, or in-hospital mortality between patients treated in the intervention vs. control ICU.</p><p><strong>Conclusions: </strong>A multidisciplinary quality improvement initiative can improve adherence to daily mobility goals.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085217","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}