Critical Care Medicine最新文献

{"title":"Efficacy of Virtual Visitation in ICU During COVID-19 Pandemic.","authors":"Guanyu Yang","doi":"10.1097/CCM.0000000000006500","DOIUrl":"10.1097/CCM.0000000000006500","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 3","pages":"e759"},"PeriodicalIF":7.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540477","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":"Solving the Mystery of the Obesity Paradox: A Call for Better Data?","authors":"Nicole Siparsky","doi":"10.1097/CCM.0000000000006569","DOIUrl":"10.1097/CCM.0000000000006569","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e730-e732"},"PeriodicalIF":7.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969947","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":"Dexmedetomidine to Reduce Vasopressor Resistance in Refractory Septic Shock: α2 Agonist Dexmedetomidine for REfractory Septic Shock (ADRESS): A Double-Blind Randomized Controlled Pilot Trial.","authors":"Auguste Dargent, Abderrahmane Bourredjem, Marine Jacquier, Julien Bohe, Laurent Argaud, Bruno Levy, Isabelle Fournel, Amelie Cransac, Julio Badie, Luc Quintin, Jean-Pierre Quenot","doi":"10.1097/CCM.0000000000006608","DOIUrl":"10.1097/CCM.0000000000006608","url":null,"abstract":"<p><strong>Objectives: </strong>Increasing evidence has suggested the benefits of dexmedetomidine in patients with sepsis. Dexmedetomidine may increase vasopressor sensitivity, which may be of interest in the setting of refractory septic shock. The α2 Agonist Dexmedetomidine for REfractory Septic Shock (ADRESS) pilot study aimed to evaluate the effect of dexmedetomidine on the vasopressor response in patients with refractory septic shock.</p><p><strong>Design: </strong>This study was a multicenter, randomized, placebo-controlled, double-blind pilot trial.</p><p><strong>Setting: </strong>The study was conducted in 5 ICUs in France.</p><p><strong>Patients: </strong>Inclusion criteria were septic shock (Sepsis-3 definition) and norepinephrine requirement greater than or equal to 0.25 µg/kg/min (0.5 µg/kg/min of norepinephrine tartrate) with persistent circulatory failure (defined by lactate > 2 mmol/L, oliguria, or skin mottling) and invasive mechanical ventilation.</p><p><strong>Interventions: </strong>The arterial pressure response to phenylephrine was measured before starting the treatment (0 hr), at 6 hours (primary outcome), and 12 hours. In the treatment arm, dexmedetomidine was given at a fixed dose of 1 µg/kg/hr.</p><p><strong>Measurements and main results: </strong>Inclusions were stopped early because of higher mortality in the dexmedetomidine arm. Thirty-two patients of the 36 planned were included. Response to phenylephrine at 6 hours was lower in the dexmedetomidine group than in the placebo group (1.26 ± 0.23 vs. 1.45 ± 0.26; p = 0.048), although this difference was also observed at baseline (p = 0.029). There were no significant differences between the groups in terms of cumulative norepinephrine dose, lactatemia, Sequential Organ Failure Assessment score, fluid balance, ventilation-free days, or occurrence of bradycardia. Mortality on day 3 was higher in the dexmedetomidine group than in the placebo group, with a difference that diminished and was no longer significant on 30 and 90 days.</p><p><strong>Conclusions: </strong>Patients in the dexmedetomidine arm had a significantly lower response to phenylephrine at all study times including baseline, which might have contributed to higher early mortality in the dexmedetomidine arm and preclude to conclude on dexmedetomidine efficacy in refractory septic shock. However, heart rate was not decreased in the dexmedetomidine arm.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11952692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cystatin C-Guided Dosing Nomogram Improves Target Attainment for Cefepime in the Critically Ill.","authors":"Erin F Barreto, Marc H Scheetz, Jack Chang, Kristin C Cole, Lindsay A Fogelson, Johar Paul, Paul J Jannetto, Ognjen Gajic, Andrew D Rule","doi":"10.1097/CCM.0000000000006622","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006622","url":null,"abstract":"<p><strong>Objectives: </strong>Estimated glomerular filtration rate is more accurate with combined creatinine and cystatin C equations (eGFRcr-cys) than creatinine alone. This study created and evaluated a cefepime dosing nomogram based on eGFRcr-cys for initial dosing in the critically ill.</p><p><strong>Design: </strong>Pharmacokinetic modeling and simulation study.</p><p><strong>Setting: </strong>Academic medical center.</p><p><strong>Patients: </strong>Critically ill adults treated with cefepime.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Data from 120 patients with baseline cystatin C and follow-up cefepime levels were used to develop a nomogram based on eGFRcr-cys and weight for initial cefepime dosing. The predicted proportion of patients who achieved a free cefepime concentration above the minimum inhibitory concentration of the organism for 100% of the dosing interval in the first 24 hours (100% ƒT > MIC at 24 hr) was compared between administered doses and those predicted by the nomogram doses. Overall drug exposure was estimated with the free area under the concentration time curve from 0 to 24 hours (ƒAUC0-24) and compared between administered and nomogram doses. Achievement of 100% ƒT > MIC at 24 hours was predicted to be significantly better with the nomogram compared with the administered dose (76% vs. 38%; p < 0.001). The median ƒAUC0-24 as predicted by the nomogram (666 mg·hr/L) was slightly higher than the actual ƒAUC0-24 with administered doses (612 mg·hr/L; p = 0.01), but the nomogram led to fewer ƒAUC0-24 values which were either too high (> 900) or too low (< 300) (7% vs. 20%; p = 0.004).</p><p><strong>Conclusions: </strong>Use of a cystatin C-inclusive dosing nomogram for cefepime could improve target attainment without increasing the risk of potentially toxic levels in the critically ill.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514761","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":"One-Year Mortality and Hospital Readmission in Survivors of COVID-19 Critical Illness-A Population-Based Cohort Study.","authors":"Shannon M Fernando, Danial Qureshi, Zharmaine Ante, Robert Talarico, Daniel I McIsaac, Martin Urner, Laveena Munshi, Bram Rochwerg, Dale M Needham, Carol L Hodgson, Daniel Brodie, Robert A Fowler, Arthur S Slutsky, Damon C Scales, Margaret S Herridge, Peter Tanuseputro, Eddy Fan","doi":"10.1097/CCM.0000000000006603","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006603","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate 1-year outcomes (mortality, and recurrent hospital and ICU readmission) in adult survivors of COVID-19 critical illness compared with survivors of critical illness from non-COVID-19 pneumonia.</p><p><strong>Design: </strong>Population-based retrospective observational cohort study.</p><p><strong>Setting: </strong>Province of Ontario, Canada.</p><p><strong>Patients: </strong>Six thousand ninety-eight consecutive adult patients (≥ 18 yr old) from 102 centers, admitted to ICU with COVID-19 (from January 1, 2020, to March 31, 2022), and surviving to hospital discharge.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The primary outcome was 1-year mortality. We also evaluated the number of emergency department (ED) visits, hospital readmissions, and ICU readmissions over this same time period. We compared patients using overlap propensity score-weighted, cause-specific proportional hazard models. Mean age was 59.6 years and 38.5% were female. Of these patients, 1610 (26.4%) and 375 (6.1%) were readmitted to hospital and ICU, respectively, and 917 (15.0%) died within 1 year. Compared with survivors of critical illness from non-COVID-19 pneumonia (n = 2568), those who survived COVID-19 critical illness had a lower risk of ED visit (hazard ratio [HR], 0.65 [95% CI, 0.60-0.71]), hospital readmission (HR, 0.56 [95% CI, 0.51-0.62]), ICU readmission (HR, 0.44 [95% CI, 0.37-0.53]), and mortality (HR, 0.67 [95% CI, 0.58-0.78]) within 1 year.</p><p><strong>Conclusions: </strong>Risk of ED visit, hospital readmission, ICU readmission, and mortality within 1 year of discharge among survivors of COVID-19 critical illness was lower than survivors of critical illness from non-COVID-19 pneumonia.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514733","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 Hypocalcemia and Mean Arterial Pressure With Patient Outcome in ICU.","authors":"Fang-Yuan Li, Yan Chen, Xiang Zhou, Long-Xiang Su, Yun Long, Li Weng, Bin Du","doi":"10.1097/CCM.0000000000006602","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006602","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to verify the relationship between hypocalcemia in the first 24 hours of ICU admission and mortality, we also hypothesized that blood pressure and blood pressure reactivity are associated with ionized calcium (iCa) and might have mediation effects in the iCa-mortality association.</p><p><strong>Design: </strong>Retrospective, observational study.</p><p><strong>Setting: </strong>ICUs in a general hospital.</p><p><strong>Patients: </strong>Nonhypercalcemia adult patients were divided into two groups based on mean iCa within the first 24 hours after ICU admission using a cutoff of 1.1 mmol/L.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>A total of 4947 patients from Peking Union Medical College Hospital between January 2013 and December 2022 were included in the study, with 2160 (43.7%) suffering from hypocalcemia. Overall, the median (interquartile range) age was 61 years (49-71 yr), with 2824 (57.1%) being female. Time-weighted average mean arterial pressure (TWA-MAP) above 0 and 65 mm Hg, respectively, during the first 24 hours were used to analyze the MAP of each patient and TWA-MAP/norepinephrine (TWA-MAP/NE) dose was calculated to examine blood pressure reactivity. Among 4091 patients eligible for multivariate analysis, iCa was independently associated with ICU mortality (odds ratio, 0.17; 95% CI, 0.04-0.79; p < 0.05). Both the blood pressure parameter (TWA-MAP above 0 mm Hg [TWA-MAP-0]) and pressure reactivity parameter (TWA-MAP-0/weight-adjusted dose of norepinephrine infusion in the first 24 hr after ICU admission [TWA-MAP-0/NE]) mediated the outcome of ICU mortality with a proportion of 4.55% (95% CI, 0.16-17%; p < 0.05) and 2.6% (95% CI, 0.02-11%; p < 0.05), respectively. TWA-MAP-0 correlated positively with iCa (Spearman rank test, ρ = 0.17; p < 0.01) while no significant association was found between iCa and TWA-MAP-0/NE (Spearman rank test, ρ = -0.07; p < 0.01).</p><p><strong>Conclusions: </strong>In this retrospective study on nonhypercalcemia patients, iCa of the first 24 hours after admission was independently associated with ICU mortality, which was potentially mediated by TWA-MAP and blood pressure reactivity (TWA-MAP/NE). iCa was also positively associated with TWA-MAP, while no general relationship was found between iCa and TWA-MAP/NE.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514758","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":"Tackling Ableism After Critical Illness Is Overdue.","authors":"Katrina E Hauschildt, Susanne Muehlschlegel","doi":"10.1097/CCM.0000000000006625","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006625","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143499569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ICU Patient-to-Pharmacist Ratios: A Prospective, Multicenter Time-Motion Study.","authors":"Mitchell S Buckley, Susan E Smith, Barbara Birriel, John J Radosevich, Amy L Dzierba, Russel J Roberts, Jeffrey F Barletta, Hayley B Gershengorn, Andrea Sikora, Lars-Kristofer Peterson, Ryan Bodkin, David Kaufman, Thomas Ardiles, Suresh Uppalapu, Allison J Tompeck, Paul Dabrowski, Letitia Close, Heidi Brewer, Ashlee Jontz, Brenda Downs, Lori A Cox, Sheila A Alexander, Katherine Harrison, Robert MacLaren","doi":"10.1097/CCM.0000000000006605","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006605","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the relationship among ICU patient-to-pharmacist ratio, perceived quality of patient care, and pharmacist burnout.</p><p><strong>Design: </strong>A prospective, multicenter, time-motion study conducted over a 10-month period (from May 1, 2022, to February 28, 2023).</p><p><strong>Setting: </strong>Adult ICU, PICU, or neonatal ICU.</p><p><strong>Subjects: </strong>ICU clinical pharmacists.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Overall, 128 ICU pharmacists completed 703 unique time-motion observation days and recorded their time associated with direct/indirect patient care activities, Maslach Burnout Inventor survey scores, and perceived quality of patient care provided (5-point Likert scale). Total pharmacist time on direct and indirect patient care activities were 5.9 ± 1.9 and 3.3 ± 1.7 hours per shift, respectively. The number of assigned patients in the ICU and overall (ICU and non-ICU) per shift was 19.3 ± 12.9 and 23.4 ± 17.9, respectively. The overall frequency of pharmacist burnout was 38.1%. Burnout was associated with incremental increases in the number of assigned total patients (odds ratio [OR], 1.03; 95% CI, 1.01-1.05) and overtime worked (OR, 1.18; 95% CI, 1.03-1.35). Higher compared with lower perceived quality of patient care was associated with significantly smaller assigned ICU patients (17.0 ± 7.4 vs. 30.6 ± 23.8, respectively; p < 0.001). Additional direct patient care time allocated per patient was predictive of a high quality of care perception (OR, 1.53; 95% CI, 1.03-2.05). Burnout was inversely associated with high quality of care (OR, 0.59; 95% CI, 0.36-0.96). The ICU patient-to-pharmacist ratio between 16:1 and 19:1 was associated with the highest perceived quality of patient care and comprehensive patient assessment completion rates.</p><p><strong>Conclusions: </strong>Critical care pharmacist practice models across healthcare institutions are inconsistent regarding patient assignments and time allocated toward direct and indirect patient care activities. The ICU patient-to-pharmacist ratio range between 16:1 and 19:1 may optimize quality of care and burnout risk at large academic institutions.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143499602","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":"Sometimes It Is Better to Be Liberal.","authors":"Verity J Ford, Harvey G Klein, Charles Natanson","doi":"10.1097/CCM.0000000000006624","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006624","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143499566","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":"Rethinking Transfusion Thresholds in Traumatic Brain Injury: More Blood, Better Outcomes.","authors":"François Lauzier, Alexis F Turgeon","doi":"10.1097/CCM.0000000000006627","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006627","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143499618","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}