Critical Care Medicine最新文献

{"title":"Hit By a Bus: Erratum.","authors":"Uttara Koul","doi":"10.1097/CCM.0000000000006687","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006687","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 6","pages":"e1353"},"PeriodicalIF":7.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207892","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":"Induction Agents for Tracheal Intubation in Critically Ill Patients.","authors":"Carlos Chamorro-Falero, Julia Macías-Clemente, Juan J Morales-Domene","doi":"10.1097/CCM.0000000000006631","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006631","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 6","pages":"e1331-e1332"},"PeriodicalIF":7.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207893","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":"Peer Review: Present and Future for Critical Care Medicine.","authors":"Jonathan Sevransky, Sheila Alexander, Lama Nazer, Aarti Sarwal, Tamas Szakmany, Robert Tasker","doi":"10.1097/CCM.0000000000006689","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006689","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 6","pages":"e1174-e1176"},"PeriodicalIF":7.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207895","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 authors reply.","authors":"Asad E Patanwala, Xuya Xiao, Thomas E Hills, Alisa M Higgins, Colin J McArthur, G Caleb Alexander, Hemalkumar B Mehta","doi":"10.1097/CCM.0000000000006675","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006675","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 6","pages":"e1346-e1347"},"PeriodicalIF":7.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207902","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":"Beyond Functional Outcomes: Exploring Quality of Life After Critical Illness-A Qualitative Study.","authors":"Lucy L Porter, Koen Wijntjes, Koen S Simons, Mark van den Boogaard, José A E Custers, Marieke Zegers","doi":"10.1097/CCM.0000000000006665","DOIUrl":"10.1097/CCM.0000000000006665","url":null,"abstract":"<p><strong>Objectives: </strong>After ICU admission, the quality of life (QoL) of ICU survivors is often significantly lower compared to their peers. However, recent studies showed that this impaired QoL cannot be fully explained by the physical, mental, and cognitive problems post-ICU, alluding to other determinants of QoL. Therefore, we aimed to explore ICU survivors' experienced QoL 1-2 years post-ICU, focusing on factors beyond functional outcomes.</p><p><strong>Design: </strong>Qualitative interview study.</p><p><strong>Setting: </strong>Seven hospitals in the Netherlands.</p><p><strong>Patients: </strong>ICU survivors aged greater than or equal to 16 years admitted to the ICU between July 2022 and January 2023.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>ICU patients were purposively sampled. Interviews were audiotaped, transcribed, and analyzed according to the principles of thematic content analysis. All interviews were coded independently by two researchers and participant recruitment was continued until no new themes were identified. Twenty-four semistructured interviews were performed between March and June 2024. The interviews resulted in 28 categories, from which seven main themes emerged regarding patients' experienced QoL: functional impairments (e.g., physical problems), participation (e.g., independence, work), support (e.g., informal care), environment (e.g., financial resources, personal circumstances), individual values (e.g., perspective on life, religion), comparison (e.g., expectations, reference), and coping (e.g., adaptation, acceptance). Patients described how these themes affected their QoL, both positively and negatively.</p><p><strong>Conclusions: </strong>This study shows that perceived QoL after critical illness is impacted not only by patients' functional impairments but also by participation, support, environment, individual values, comparison, and coping. The themes identified in this study stress the importance of considering patients' individual and context factors to provide optimal post-ICU support.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1190-e1201"},"PeriodicalIF":7.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12124206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751449","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":"Effect of Monetary Incentives on Peer Review Acceptance and Completion: A Quasi-Randomized Interventional Trial.","authors":"Christopher S Cotton, Abid Alam, Sophie Tosta, Timothy G Buchman, David M Maslove","doi":"10.1097/CCM.0000000000006637","DOIUrl":"10.1097/CCM.0000000000006637","url":null,"abstract":"<p><strong>Objectives: </strong>Peer review typically relies on experts volunteering their time to review research. This process presents challenges for journals that may face a shortage of qualified referees, resulting in either delay in handling papers or less thorough review than is optimal. We experimentally tested the impact of providing cash incentives to complete peer review assignments at Critical Care Medicine .</p><p><strong>Design: </strong>Quasi-randomized, blinded, interventional study with an alternating treatment design.</p><p><strong>Setting: </strong>Critical Care Medicine (CCM ), a peer-reviewed specialty journal.</p><p><strong>Subjects: </strong>All reviewers receiving requests from CCM to review research articles during a 6-month period from September 2023 to March 2024 (excluding a 2-wk holiday window).</p><p><strong>Interventions: </strong>In alternating 2-week blocks, reviewer invitation letters were sent out, including either an offer of $250 for accepting the peer review request (treatment) or the standard letter with no cash offer (control). Reviewers who fulfilled incentivized invitations received a $250 check from the journal.</p><p><strong>Measurements and main results: </strong>Our primary outcome was the rate of invitation-to-completed-review conversion, defined as the number of reviews submitted divided by the number of reviewer invitations sent out. Secondary outcomes included the \"on-time\" conversion rate, invitation acceptance rate, time to invitation acceptance, time to review submission, and review quality. Seven hundred fifteen reviewer invitations were sent out, 414 of which (57.9%) included an incentive offer. Two hundred eighteen (52.7%) of the incentivized invitations were accepted, compared with 144 (47.8%) in the control group. A greater proportion of reviewer invitations led to submitted peer review reports in the incentive group than in the control group (49.8% [206/414] vs. 42.2% [127/301]; p = 0.04). In a \"survival analysis,\" invitations sent with an incentive offer were fulfilled faster on average (Cox proportional hazard ratio, 1.30 [1.04-1.62]; p = 0.02), corresponding to quicker review times of approximately 1 day (11 vs. 12 d). Of the 333 reviewer reports submitted, 205 (61.6%) were assessed by editors, with no difference in review quality noted between study arms.</p><p><strong>Conclusions: </strong>Providing cash incentive for completing peer review reports resulted in a modest increase in the share of invited reviewers who complete reviews for a specialty medical journal.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1181-e1189"},"PeriodicalIF":7.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566355","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":"Incidence and Associated Risk Factors for Falls in Adults Following Critical Illness: An Observational Study.","authors":"Selina M Parry, Peter E Morris, Jane Larkin, Lisa J Beach, Kirby P Mayer, Cristino C Oliveira, Jennifer McGinley, Zudin A Puthucheary, Digsu N Koye, Karen E Lamb, Linda Denehy, Catherine L Granger","doi":"10.1097/CCM.0000000000006668","DOIUrl":"10.1097/CCM.0000000000006668","url":null,"abstract":"<p><strong>Objective: </strong>To explore the incidence of falls and associated risk factors in the first year after hospital discharge in survivors of critical illness.</p><p><strong>Design: </strong>Prospective single-site observational study.</p><p><strong>Setting: </strong>University-affiliated mixed ICU.</p><p><strong>Patients: </strong>One hundred ICU adults who required invasive ventilation for 48 hours and in an ICU for at least 4 days.</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Measurements and main results: </strong>Falls were monitored prospectively for 1 year with completion of monthly falls calendars. Falls data included the number of people who had falls/no falls/recurrent falls, falls rate per person per year, and time to first fall. Fall severity was classified according to the Schwenck classification scheme to examine injurious falls requiring medical intervention. Other outcomes considered included assessments of balance, strength, function, cognition, psychologic health, and health-related quality of life. One hundred participants (31% female) were recruited with a mean age of 58.3 ± 16.2 years, and a median ventilation duration of 6.3 days [4.0-9.1]. Sixty-one percent fell at least once in the first year with the majority sustaining two or more falls (81.4%) and one in four sustained an injurious fall requiring medical attention. The falls incidence rate was 4.4 falls per person-year (95% CI, 3.2-5.9), with the highest incidence occurring less than 3 months after hospital discharge (5.9 falls/person-year [95% CI, 4.4-7.8]). Time to first fall or injurious fall was 36 [11-66] and 95 (95% CI, 40-155) days, respectively. Key risk factors for falls at the time of hospital discharge include comorbidities, higher discharge medications, balance, and muscle strength.</p><p><strong>Conclusions: </strong>There was a high falls incidence in ICU survivors. The study findings suggest a critical window may exist within the first 3 months after hospital discharge and the need for screening, pharmacological optimization, and exercise training in this patient group.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1257-e1268"},"PeriodicalIF":7.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12124207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969207","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":"Effects of Similar Mechanical Power Resulting From Different Combinations of Respiratory Variables on Lung Damage in Experimental Acute Respiratory Distress Syndrome.","authors":"Adriana L da Silva, Raquel F Magalhaes, Pedro H L Conceicao, Ana Carolina M Dos Santos, Catharina M Oliveira, Lauren T Thorton, Philip S Crooke, Camila M Baldavira, Vera L Capelozzi, Fernanda F Cruz, Cynthia S Samary, Pedro L Silva, John J Marini, Patricia Rieken Macedo Rocco","doi":"10.1097/CCM.0000000000006661","DOIUrl":"10.1097/CCM.0000000000006661","url":null,"abstract":"<p><strong>Objectives: </strong>Mechanical power is a crucial concept in understanding ventilator-induced lung injury (VILI). We adopted the null hypothesis that under the same mechanical power, resulting from combinations of different static and dynamic variables-some with high stress per cycle and others without-would inflict similar degrees of damage on lung epithelial and endothelial cells as well as on the extracellular matrix in experimental acute respiratory distress syndrome (ARDS). To test this hypothesis, we varied tidal volume (V t ), which correlates with the stretching force per cycle, while adjusting respiratory rate (RR) to yield similar mechanical power values for identical durations across all experimental groups.</p><p><strong>Design: </strong>Animal study.</p><p><strong>Setting: </strong>Laboratory investigation.</p><p><strong>Subjects: </strong>Thirty male Wistar rats (333 ± 26 g).</p><p><strong>Interventions: </strong>Twenty-four hours after intratracheal administration of Escherichia coli lipopolysaccharide, animals were anesthetized and mechanically ventilated (positive end-expiratory pressure = 3 cm H 2 O) with combination of V t and RR sufficient to induce similar mechanical power ( n = 8/group): V t = 6 mL/kg, RR = 140 breaths/minute (low V t -high RR [LVT-HRR]); V t = 12 mL/kg, RR = 70 breaths/minute (high V t -low RR [HVT-LRR]); and V t = 18 mL/kg, RR = 50 breaths/minute (very-high V t -very-low RR [VHVT-VLRR]). All groups were ventilated for 80 minutes. A control group, not subjected to mechanical ventilation (MV), was used for molecular biology analyses.</p><p><strong>Measurements and main results: </strong>After 80 minutes of MV, lung overdistension, alveolar/interstitial edema, fractional area of E-cadherin, and biomarkers of lung inflammation (interleukin-6), lung stretch (amphiregulin), damage to epithelial (surfactant protein B) and endothelial cells (vascular cell adhesion molecule 1 and angiopoietin-2), and extracellular matrix (versican and syndecan) were higher in group VHVT-VLRR than LVT-HRR. Plateau pressure and driving pressure increased progressively from LVT-HRR to HVT-LRR and VHVT-VLRR.</p><p><strong>Conclusions: </strong>In the current experimental model of ARDS, mechanical power alone is insufficient to account for VILI. Instead, the manner in which its components are applied determines the extent of injury at a given mechanical power value.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1303-e1313"},"PeriodicalIF":7.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751451","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":"A Study on the Diagnostic Accuracy of Tidal Volume-Diaphragmatic Contraction Velocity: A Novel Index for Weaning Outcome Prediction.","authors":"Apostolos A Menis, Vasiliki Tsolaki, Maria E Papadonta, Vasileios Vazgiourakis, Epaminondas Zakynthinos, Demosthenes Makris","doi":"10.1097/CCM.0000000000006660","DOIUrl":"10.1097/CCM.0000000000006660","url":null,"abstract":"<p><strong>Objectives: </strong>Weaning failure from mechanical ventilation (MV) is primarily caused by increased respiratory load and decreased respiratory neuromuscular competency, leading to a rapid shallow breathing pattern. We hypothesized that the product of diaphragmatic contraction velocity (a sonographic estimate of respiratory load) and tidal volume (an estimate of breathing pattern), termed the volume-velocity index (VVI), may predict weaning outcomes.</p><p><strong>Design: </strong>The diagnostic accuracy of VVI (mL*cm/s) in predicting weaning outcomes was prospectively assessed, along with its relationship to indices of breathing effort, including esophageal pressure swings (ΔPes), the pressure-time product of esophageal pressure (PTPes), and maximal inspiratory pressure (MIP). A power analysis, informed by the results of an inception cohort, determined the required sample size for the validation cohort. Patients were enrolled through consecutive sampling. Weaning failure was defined as failure of the spontaneous breathing trial (SBT) or the need for MV within 48 hours.</p><p><strong>Setting: </strong>The study was conducted in a tertiary academic ICU.</p><p><strong>Patients: </strong>VVI was evaluated in critical care patients undergoing a SBT for the first time.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>In the inception cohort ( n = 30), VVI was significantly higher in successful weaning compared to failures (764.76 [±432.61] vs. 278 [±183.66], p < 0.001). It correlated with ΔPes ( r = 0.74, R2 = 0.55), PTPes ( r = 0.76, R2 = 0.58), and MIP ( r = 0.75, R2 = 0.55) all p values less than 0.001. In the validation cohort ( n = 40), VVI was higher in successful weaning (840 [550, 1220] vs. 250 [225, 302.5], p < 0.001) and predicted weaning success with an area under the receiver operating characteristic of 0.92 (95% CI, 0.83-1).</p><p><strong>Conclusions: </strong>VVI effectively differentiates between weaning success and failure, shows a strong correlation with respiratory effort indices, and may enhance weaning protocols.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1214-e1223"},"PeriodicalIF":7.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751532","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":"Development and External Validation of a Detection Model to Retrospectively Identify Patients With Acute Respiratory Distress Syndrome.","authors":"Elizabeth Levy, Dru Claar, Ivan Co, Barry D Fuchs, Jennifer Ginestra, Rachel Kohn, Jakob I McSparron, Bhavik Patel, Gary E Weissman, Meeta Prasad Kerlin, Michael W Sjoding","doi":"10.1097/CCM.0000000000006662","DOIUrl":"10.1097/CCM.0000000000006662","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to develop and externally validate a machine-learning model that retrospectively identifies patients with acute respiratory distress syndrome (acute respiratory distress syndrome [ARDS]) using electronic health record (EHR) data.</p><p><strong>Design: </strong>In this retrospective cohort study, ARDS was identified via physician-adjudication in three cohorts of patients with hypoxemic respiratory failure (training, internal validation, and external validation). Machine-learning models were trained to classify ARDS using vital signs, respiratory support, laboratory data, medications, chest radiology reports, and clinical notes. The best-performing models were assessed and internally and externally validated using the area under receiver-operating curve (AUROC), area under precision-recall curve, integrated calibration index (ICI), sensitivity, specificity, positive predictive value (PPV), and ARDS timing.</p><p><strong>Patients: </strong>Patients with hypoxemic respiratory failure undergoing mechanical ventilation within two distinct health systems.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>There were 1,845 patients in the training cohort, 556 in the internal validation cohort, and 199 in the external validation cohort. ARDS prevalence was 19%, 17%, and 31%, respectively. Regularized logistic regression models analyzing structured data (EHR model) and structured data and radiology reports (EHR-radiology model) had the best performance. During internal and external validation, the EHR-radiology model had AUROC of 0.91 (95% CI, 0.88-0.93) and 0.88 (95% CI, 0.87-0.93), respectively. Externally, the ICI was 0.13 (95% CI, 0.08-0.18). At a specified model threshold, sensitivity and specificity were 80% (95% CI, 75%-98%), PPV was 64% (95% CI, 58%-71%), and the model identified patients with a median of 2.2 hours (interquartile range 0.2-18.6) after meeting Berlin ARDS criteria.</p><p><strong>Conclusions: </strong>Machine-learning models analyzing EHR data can retrospectively identify patients with ARDS across different institutions.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1224-e1234"},"PeriodicalIF":7.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802646","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}