Critical Care Medicine最新文献

{"title":"Society of Critical Care Medicine Guidelines for the Treatment of Heat Stroke.","authors":"Jeffrey F Barletta, Tina L Palmieri, Shari A Toomey, Fayez AlShamsi, Rebecca L Stearns, Asad E Patanwala, Nicole F Siparsky, Neeraj Badjatia, Brian Schultz, Crystal M Breighner, Eric Bruno, Christopher G Harrod, Tanya Trevilian, Leandro Braz de Carvalho, James Houser, John M Harahus, Yang Liu, Ryan Swoboda, Paulin Ruhato Banguti, Heatherlee Bailey","doi":"10.1097/CCM.0000000000006551","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006551","url":null,"abstract":"<p><strong>Rationale: </strong>Predicted increases in heat-related weather phenomena will result in increasing heat exposures and heat injuries, like heat stroke. Prompt recognition, early intervention, and evidence-based management are necessary to optimize outcomes.</p><p><strong>Objectives: </strong>The objective of these guidelines was to develop evidence-based recommendations for the treatment of patients with heat stroke.</p><p><strong>Design: </strong>The Society of Critical Care Medicine convened a multidisciplinary panel of 18 international clinicians, comprising expertise in critical care, emergency medicine, neurocritical care, surgery, trauma/burn surgery, sports medicine, athletic training, military medicine, nursing, pharmacy, respiratory therapy, and one patient representative. The panel also included a guidelines methodologist specialized in developing evidence-based recommendations in alignment with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Conflict-of-interest policies were strictly followed during all phases of guidelines development including panel selection and voting.</p><p><strong>Methods: </strong>The panel members identified Patient, Intervention, Comparison, and Outcomes questions in two main areas: cooling modalities and medications that affect temperature. A systematic review for each question was conducted to identify the best available evidence, statistically analyze the evidence, and assess the certainty of the evidence using the GRADE methodology. The GRADE evidence-to-decision framework was used to formulate the recommendations. Good practice statements were included to provide additional clinical guidance.</p><p><strong>Results: </strong>The panel generated two strong recommendations, five good practice statements and one \"only-in-the-context of research\" statement. Active cooling measures are recommended over passive cooling methods, with cold- or ice-water immersion achieving the fastest cooling rate. This method should be prioritized where available. In heat stroke patients, there is no evidence to support pharmacological interventions that affect temperature control and they should be avoided.</p><p><strong>Conclusions: </strong>The guidelines task force provided recommendations for the management of patients with heat stroke. These recommendations should be considered along with the patient's clinical status and available resources.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 2","pages":"e490-e500"},"PeriodicalIF":7.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467195","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":"Securing Jugular Central Venous Catheters With Dressings Fixed to a Liquid Adhesive to Prevent Dressing Failure in Intensive Care Patients (the STICKY Trial): A Randomized Controlled Trial.","authors":"Nicole Marsh, Catherine O'Brien, Emily N Larsen, Evan Alexandrou, Robert S Ware, India Pearse, Fiona Coyer, Maharshi S Patel, Ruth H Royle, Claire M Rickard, Kellie Sosnowski, Patrick N A Harris, Kevin B Laupland, Michelle J Bauer, John F Fraser, Craig McManus, Joshua Byrnes, Amanda Corley","doi":"10.1097/CCM.0000000000006533","DOIUrl":"10.1097/CCM.0000000000006533","url":null,"abstract":"<p><strong>Objectives: </strong>Central venous catheters (CVCs) are vital for treating ICU patients. However, up to a quarter of CVCs fail from mechanical or infective complications. Poor securement of CVCs to the skin contributes to catheter failure, particularly CVCs placed in the jugular vein, which are highly vulnerable to pullout forces. This study evaluated the effectiveness of medical liquid adhesive (MLA) for improving jugular CVC dressing adhesion.</p><p><strong>Design: </strong>Multisite parallel group, superiority, randomized controlled trial.</p><p><strong>Setting: </strong>Four metropolitan Australian ICUs.</p><p><strong>Patients: </strong>Eligible patients were 18 years old or older, within 12 hours of jugular CVC insertion, expected to need the CVC for greater than or equal to 72 hours, and remain in ICU for greater than or equal to 24 hours.</p><p><strong>Interventions: </strong>Patients were randomly allocated (stratified by hospital and gender) to standard CVC dressings with the application of MLA to skin under the dressing border (intervention) or standard care CVC dressings (control).</p><p><strong>Measurements and main results: </strong>The primary endpoint was dressing failure within 7 days due to lifting edges. Secondary outcomes included the total number of dressing changes, skin injury, and CVC failure. In total, 160 participants (82 control; 78 intervention) were enrolled. There were 22 (28%) and 41 (50%) cases of premature dressing failure in the intervention and control groups respectively (odds ratio, 0.39; 95% CI, 0.20-0.76; p = 0.005). The intervention group had fewer dressing changes (incidence rate ratio [IRR], 0.74; 95% CI, 0.55-0.99). Time to dressing failure (log-rank test; p = 0.12) and all-cause CVC failure (IRR, 1.44; 95% CI, 0.36-5.79) did not differ between groups. Three skin injuries occurred: one in the intervention (blister) and two in the control (maceration and skin tear) groups.</p><p><strong>Conclusions: </strong>MLA is associated with significantly decreased jugular CVC dressing failure and longer dressing dwell, with an acceptable safety profile. MLA should be considered to preserve jugular CVC dressings in ICU.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 2","pages":"e282-e293"},"PeriodicalIF":7.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467248","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":"Society of Critical Care Medicine Guidelines on Adult Critical Care Ultrasonography: Focused Update 2024.","authors":"José L Díaz-Gómez, Sameer Sharif, Enyo Ablordeppey, Michael J Lanspa, John Basmaji, Thomas Carver, Jayne Chirdo Taylor, Luna Gargani, Alberto Goffi, Allyson M Hynes, Antonio Hernandez, Jan Kasal, Abhilash Koratala, Smadar Kort, Peter Lindbloom, Rachel Liu, Pete Livezey, Viveta Lobo, Susan Malone, Paul Mayo, Carol Mitchell, Ng Niu, Nova Panebianco, Madhavi Parekh, Susana Price, Aarti Sarwal, Felipe Teran, Gabriele Via, Antoine Vieillard-Baron, Anthony Weekes, Brandon Wiley, Kimberley Lewis, Sara Nikravan","doi":"10.1097/CCM.0000000000006530","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006530","url":null,"abstract":"<p><strong>Rationale: </strong>Critical care ultrasonography (CCUS) is rapidly evolving with new evidence being published since the prior 2016 guideline.</p><p><strong>Objectives: </strong>To identify and assess the best evidence regarding the clinical outcomes associated with five CCUS applications in adult patients since the publication of the previous guidelines.</p><p><strong>Panel design: </strong>An interprofessional, multidisciplinary, and diverse expert panel of 36 individuals including two patient/family representatives was assembled via an intentional approach. Conflict-of-interest policies were strictly followed in all phases of the guidelines, including task force selection and voting.</p><p><strong>Methods: </strong>Focused research questions based on Population, Intervention, Control, and Outcomes (PICO) for adult CCUS application were developed. Panelists applied the guidelines revision process described in the Standard Operating Procedures Manual to analyze supporting literature and to develop evidence-based recommendations as a focused update. The evidence was statistically summarized and assessed for quality using the Grading of Recommendations, Assessment, Development, and Evaluation approach. The evidence-to-decision framework was used to formulate recommendations as strong or conditional.</p><p><strong>Results: </strong>The Adult CCUS Focused Update Guidelines panel aimed to understand the current impact of CCUS on patient important outcomes as they related to five PICO questions in critically ill adults. A rigorous systematic review of evidence to date informed the panel's recommendations. In adult patients with septic shock, acute dyspnea/respiratory failure, or cardiogenic shock, we suggest using CCUS to guide management. Given evidence supporting an improvement in mortality, we suggest the use of CCUS for targeted volume management as opposed to usual care without CCUS. Last, there was insufficient data to determine if CCUS should be used over standard care without CCUS in the management of patients with cardiac arrest.</p><p><strong>Conclusions: </strong>The guidelines panel achieved strong agreement regarding the recommendations for CCUS to improve patient outcomes. These recommendations are intended for consideration along with the patient's existing clinical status.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 2","pages":"e447-e458"},"PeriodicalIF":7.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467199","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":"Executive Summary: Society of Critical Care Medicine Guidelines on Family-Centered Care for Adult ICUs.","authors":"David Y Hwang, Simon J W Oczkowski, Kimberley Lewis, Barbara Birriel, James Downar, Christian E Farrier, Kirsten M Fiest, Rik T Gerritsen, Joanna Hart, Christiane S Hartog, Gabriel Heras-La Calle, Aluko A Hope, Ann L Jennerich, Nancy Kentish-Barnes, Ruth Kleinpell, Erin K Kross, Andrea P Marshall, Peter Nydahl, Theodora Peters, Regis G Rosa, Elizabeth Scruth, Nneka Sederstrom, Joanna L Stollings, Alison E Turnbull, Thomas S Valley, Giora Netzer, Rebecca A Aslakson, Ramona O Hopkins","doi":"10.1097/CCM.0000000000006548","DOIUrl":"10.1097/CCM.0000000000006548","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 2","pages":"e459-e464"},"PeriodicalIF":7.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467229","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":"Refining Outcome Interpretations in Pediatric Sepsis: Mortality, Fluid Management, and Renal Recovery.","authors":"Lexi Huang, Dan Shan","doi":"10.1097/CCM.0000000000006497","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006497","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 2","pages":"e515-e516"},"PeriodicalIF":7.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467246","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":"10.1097/CCM.0000000000006531","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e508-e510"},"PeriodicalIF":7.7,"publicationDate":"2025-02-01","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":"Enhancing Bereavement Care in Critical Care Settings: A Focus on Prolonged Grief, Posttraumatic Stress Disorder, and Depression Among ICU Surrogates.","authors":"Yanqi Wang","doi":"10.1097/CCM.0000000000006503","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006503","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 2","pages":"e519-e520"},"PeriodicalIF":7.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467222","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":"Ketamine Versus Etomidate for Endotracheal Intubation of Critically Ill Patients.","authors":"Andrew B Leibowitz","doi":"10.1097/CCM.0000000000006536","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006536","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 2","pages":"e504-e507"},"PeriodicalIF":7.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467232","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":"Performance of the Healthy Aging Brain Care Monitor Self Report in Monitoring Post-Intensive Care Syndrome Among Acute Respiratory Failure Survivors.","authors":"Parth K Savsani, Sikandar H Khan, Anthony J Perkins, Sophia Wang, Samreen Jawaid, Salwa Moiz, Patrick O Monahan, Kurt Kroenke, Sujuan Gao, Babar A Khan","doi":"10.1097/CCM.0000000000006522","DOIUrl":"10.1097/CCM.0000000000006522","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the performance of the Healthy Aging Brain Care Monitor Self Report (HABC-M SR) in assessment of post-intensive care syndrome (PICS) among Acute Respiratory Failure ICU survivors.</p><p><strong>Design: </strong>Secondary data analysis of a randomized controlled trial.</p><p><strong>Setting: </strong>Patients evaluated by a nurse care coordinator in an out-of-hospital setting.</p><p><strong>Patients: </strong>English-speaking adults 18 years old or older who were admitted to the ICU with acute respiratory failure requiring invasive or noninvasive mechanical ventilation for greater than or equal to 24 hours.</p><p><strong>Interventions: </strong>Patients randomized to the intervention arm of the mobile critical care recovery program, a negative trial testing multidisciplinary care to improve quality of life.</p><p><strong>Measurements and main results: </strong>HABC-M SR scale was used to assess PICS in the intervention group at ICU discharge, 3, and 6 months post-discharge. Hospital Anxiety and Depression Scale; Pain, Enjoyment of Life, and General Activity Scale; Timed Up and Go; and Patient-Reported Outcomes Measurement Information System sleep scores were obtained at the same time. Mini-Mental State Examination (MMSE) was administered at baseline and 6 months. ICU survivors reported mild PICS symptoms, which improved over 6 months (mean HABC-M SR scores: baseline [8.5, sd 7.6], 3 mo [5.3 mo, sd 6.6 mo], and 6 mo [5.2 mo, sd 6.9 mo; p < 0.001]). HABC-M SR total score had moderate internal consistency that improved over time (Cronbach's alpha = 0.78 at baseline and 0.84 at 6 mo). The psychological subscale of HABC-M SR was moderately correlated with standardized scales for mood, pain, and sleep. The cognitive subscale was not significantly correlated with MMSE.</p><p><strong>Conclusions: </strong>While HABC-M SR correlated with mood, physical, and sleep symptoms, the cognitive subscale was less sensitive compared with standardized scales.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e341-e352"},"PeriodicalIF":7.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616188","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":"The Need for Institutional Policies for Innovative Therapy: Existing Approaches and Key Elements.","authors":"Emily Rao, Christine Grady, David Wendler","doi":"10.1097/CCM.0000000000006517","DOIUrl":"10.1097/CCM.0000000000006517","url":null,"abstract":"<p><strong>Objectives: </strong>Innovative therapy is common in many areas of medicine. Yet, it is unknown whether medical centers have policies to ensure innovative therapy is conducted appropriately.</p><p><strong>Design: </strong>We contacted three informants at leading U.S. medical centers to determine whether the center has a policy for innovative therapy and, if so, what requirements the policies include and whether the policies lack any important elements.</p><p><strong>Setting: </strong>Existing policies and published recommendations.</p><p><strong>Patients: </strong>None.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Our search found that 46 of 58 responding centers (79%) do not have a policy for innovative therapy. Of the ten policies available for review, half lack requirements to report patient outcomes, and half do not explicitly coordinate innovative therapy with research.</p><p><strong>Conclusions: </strong>A majority of leading U.S. medical centers do not have a policy for innovative therapy. In addition, existing policies lack important elements, especially with respect to reporting patient outcomes and coordinating innovative therapy with research. Based on the existing policies and recommendations in the literature, we thus identify eight key elements that should be included in policies for innovative therapy. Future research should assess whether these elements can be feasibly implemented and whether, in practice, they offer patients appropriate protection.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e320-e327"},"PeriodicalIF":7.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616192","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}