Critical Care Medicine最新文献

{"title":"Plasma-Based Endotypes in Acute Respiratory Distress Syndrome Identify High-Risk Patients With Extrapulmonary Disease: Why Looking Outside the Lung Compartment Enriches for Nonpulmonary Morbidity and Mortality.","authors":"Andrew R Moore, Pavan K Bhatraju, Angela J Rogers","doi":"10.1097/CCM.0000000000006753","DOIUrl":"10.1097/CCM.0000000000006753","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1676-e1678"},"PeriodicalIF":6.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483440","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":"Incorporating Body Mass Index Into Risk Stratification Tools.","authors":"Liangshan Wang, Xiaotong Hou","doi":"10.1097/CCM.0000000000006706","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006706","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 8","pages":"e1689-e1690"},"PeriodicalIF":6.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783685","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":"James Downar, Julie Lapenskie, Salmaan Kanji, Irene Watpool, Jessica Haines, Uzma Saeed, Rebecca Porteous, Nadia Polskaia, Lisa Burry, Shuhira Himed, Alison Fox-Robichaud","doi":"10.1097/CCM.0000000000006752","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006752","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 8","pages":"e1711"},"PeriodicalIF":6.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783696","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":"Walter Dzik, Brian Healy, Maxwell Roth, Henry Paik, Patricia Brunker, Kristen Ruby, Julia Collins, Lorenzo Berra, Kenneth Shelton, Crystal M North, Robert Makar","doi":"10.1097/CCM.0000000000006730","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006730","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 8","pages":"e1698-e1699"},"PeriodicalIF":6.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788472","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":"Plasma Levels of Soluble ST2 Reflect Extrapulmonary Organ Dysfunction and Predict Outcomes in Acute Respiratory Failure.","authors":"Amy S Labar, Bryan C Ulrich, Tyler C Lovelace, William G Bain, Faraaz A Shah, Emma B White, Elizabeth A Abe, Francesca Giacona, George A Alba, B Taylor Thompson, Eric P Schmidt, Benjamin E Zuchelkowski, John W Evankovich, Haopu Yang, Raj Ramanan, Holt Murray, Ghady Haidar, Mark E Snyder, Shulin Qin, Xiahong Wang, Yingze Zhang, Seyed M Nouraie, Charles Dela Cruz, Hēth R Turnquist, Prabir Ray, Anuradha Ray, Barbara Methé, Panayiotis V Benos, Alison Morris, Bryan J McVerry, Jehan Alladina, Georgios D Kitsios","doi":"10.1097/CCM.0000000000006716","DOIUrl":"10.1097/CCM.0000000000006716","url":null,"abstract":"<p><strong>Objectives: </strong>Soluble ST2 (sST2), a decoy receptor for the alarmin interleukin-33 (IL-33), has been implicated in adverse clinical outcomes in acute respiratory failure (ARF). We evaluated sST2 distribution across diverse cohorts of patients with different etiologies of ARF, compared plasma and lower respiratory tract (LRT) concentrations, and examined associations with individual organ dysfunction, biological subphenotypes, and outcomes.</p><p><strong>Design: </strong>Observational study.</p><p><strong>Setting: </strong>Multicenter cohorts of ARF patients.</p><p><strong>Patients: </strong>A total of 1432 ARF patients, including 863 non-COVID and 569 COVID-19 cases, from five cohorts.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>sST2 levels were measured in plasma and LRT specimens (when available) and analyzed for associations with ARF etiology, severity, organ dysfunction, systemic host response, subphenotypes, and 30-day mortality. Plasma sST2 levels were higher in non-COVID ARF patients compared with COVID-19 patients ( p < 0.05) and were markedly elevated compared with LRT levels (> 19-fold), with weak intercompartmental correlation. Elevated plasma sST2 levels were associated with extrapulmonary organ dysfunction and a hyperinflammatory ARF subphenotype but not with respiratory indices, including hypoxemia. Plasma sST2 independently predicted 30-day mortality in pooled cohort data, adjusted for age, sex, and illness severity. In longitudinal measurements, nonsurvivors had persistently elevated plasma sST2 levels in the first 2 weeks of critical illness compared with survivors.</p><p><strong>Conclusions: </strong>Plasma sST2 levels independently predict outcomes in ARF and are strongly associated with extrapulmonary organ dysfunction. The weak correlation between plasma and LRT sST2 levels suggests a predominantly systemic source. These findings highlight the potential of the IL-33/ST2 axis as a therapeutic target and warrant further investigation into its role in multiple organ dysfunction in ARF.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1567-e1580"},"PeriodicalIF":6.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119147","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":"How Low Should We Go?-Blood Pressure Targets in Pediatric Sepsis.","authors":"Simon Nadel, David Inwald","doi":"10.1097/CCM.0000000000006751","DOIUrl":"10.1097/CCM.0000000000006751","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1679-e1681"},"PeriodicalIF":6.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144539327","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":"On Outcome Selection for Adult General ICU Patients: Are We There Yet?","authors":"Federico Fonda, Giovanni Aldegheri, Daniele Orso, Tiziana Bove","doi":"10.1097/CCM.0000000000006702","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006702","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 8","pages":"e1700-e1702"},"PeriodicalIF":6.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783686","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":"Effects of IV Fluid Restriction According to Standard Fluid Treatment Intensity Across Conservative Versus Liberal Approach to Fluid Therapy of Septic Shock in Intensive Care (CLASSIC) Trial Sites.","authors":"Praleene Sivapalan, Benjamin S Kaas-Hansen, Tine S Meyhoff, Peter B Hjortrup, Maj-Brit N Kjær, Jon H Laake, Maria Cronhjort, Stephan M Jakob, Maurizio Cecconi, Marek Nalos, Marlies Ostermann, Manu L N G Malbrain, Morten H Møller, Anders Perner, Anders Granholm","doi":"10.1097/CCM.0000000000006679","DOIUrl":"10.1097/CCM.0000000000006679","url":null,"abstract":"<p><strong>Objectives: </strong>In the Conservative vs. Liberal Approach to Fluid Therapy of Septic Shock in Intensive Care (CLASSIC) trial, restriction of IV fluid volumes led to similar overall mortality in ICU patients with septic shock. We assessed if variation in standard IV fluid treatment intensity across sites impacted the effects of fluid restriction.</p><p><strong>Design: </strong>Secondary analysis of randomized clinical trial.</p><p><strong>Setting: </strong>ICU.</p><p><strong>Patients: </strong>The CLASSIC trial enrolled adult ICU patients with septic shock. We included 1366 participants from 19 sites, representing 88% of the full trial population. All sites with greater than or equal to 15 participants in the standard-fluid group were included in this study.</p><p><strong>Interventions: </strong>Restrictive vs. standard IV fluid therapy.</p><p><strong>Measurements and main results: </strong>We used machine learning (eXtreme Gradient Boosting) to predict the IV fluid volumes in the first 24 hours in the standard-fluid group while accounting for participant characteristics that could contribute to treatment variations. We then classified sites into intensity subgroups based on the mean differences between predicted and administered IV fluid volumes in the first 24 hours in the standard-fluid group. We assessed the intervention effects on mortality, serious adverse events and reactions, days alive without life support, and days alive out of hospital at day 90 across these intensity subgroups, using hierarchical Bayesian models with weakly informative priors. Sensitivity analyses evaluated intervention effects separately in each site. In the standard-fluid group, the median absolute difference between administered and predicted IV fluid volumes was -118 mL (interquartile range, -1,341 to 1,731 mL; full range, -5,873 to 11,761 mL). Sites were categorized into five intensity subgroups. The absolute differences in mortality across these subgroups ranged from -2.7% point to 1.4% point. We found similar effects of restrictive vs. standard IV fluid treatment on all outcomes within the intensity subgroups. Results were similar in the sensitivity analyses.</p><p><strong>Conclusions: </strong>Among adult ICU patients with septic shock, variation in standard IV fluid volumes across sites did not substantially impact the effects of fluid restriction on outcomes after accounting for patient characteristics.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1590-e1600"},"PeriodicalIF":6.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989301","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 Multinational Randomized Trial of Mega-Dose Esomeprazole as Anti-Inflammatory Agent in Sepsis.","authors":"Giacomo Monti, Sonia Carta, Yuki Kotani, Andrea Bruni, Maiya Konkayeva, Fabio Guarracino, Aleksey Yakovlev, Giada Cucciolini, Maria Shemetova, Sara Scapol, Elena Momesso, Eugenio Garofalo, Giulia Brizzi, Rubia Baldassarri, Silvia Ajello, Alessandro Isirdi, Francesco Meroi, Martina Baiardo Redaelli, Nicoletta Boffa, Carmine Domenico Votta, Giovanni Borghi, Giorgia Montrucchio, Simon Rauch, Filippo D'Amico, Maria Caterina Pace, Gianluca Paternoster, Francesca Vitale, Giuseppe Giardina, Rosa Labanca, Rosalba Lembo, Marilena Marmiere, Matteo Marzaroli, Cristina Nakhnoukh, Valentina Plumari, Anna Mara Scandroglio, Tommaso Scquizzato, Stella Sordoni, Davide Valsecchi, Felice Eugenio Agrò, Gabriele Finco, Tiziana Bove, Francesco Corradi, Valery Likhvantsev, Federico Longhini, Aidos Konkayev, Giovanni Landoni, Rinaldo Bellomo, Alberto Zangrillo","doi":"10.1097/CCM.0000000000006720","DOIUrl":"10.1097/CCM.0000000000006720","url":null,"abstract":"<p><strong>Objectives: </strong>Proton pump inhibitors have dose-dependent immunomodulatory effects. We tested the hypothesis that mega-dose esomeprazole therapy would reduce organ dysfunction in patients with sepsis or septic shock.</p><p><strong>Design: </strong>A multinational, randomized, double-blind, placebo-controlled clinical trial.</p><p><strong>Setting: </strong>Seventeen ICUs or emergency departments in three countries.</p><p><strong>Patients: </strong>Adult patients with sepsis or septic shock.</p><p><strong>Interventions: </strong>Mega-dose (1024 mg) esomeprazole or placebo over a 72-hour period.</p><p><strong>Measurements and main results: </strong>The primary outcome was mean daily Sequential Organ Failure Assessment (SOFA) score to day 10. Secondary outcomes included antibiotics-free days, ICU-free days at day 28, and all-cause mortality. We also conducted a mechanistic study of the in vitro effects of esomeprazole in sepsis. We randomized 307 patients and assigned 148 to esomeprazole and 159 to placebo. Mean age was 71 years; 166 patients (54%) had septic shock and median SOFA score at randomization was 7. The median mean daily SOFA score in the first 10 days post-randomization was 5 (interquartile range [IQR], 3-9) in the esomeprazole group and 5 (IQR, 3-8) in the placebo group (risk difference, 0.1; 95% CI, -0.8 to 1.0; p > 0.99). No differences were observed in secondary outcomes. Monocytes isolated from patients' peripheral blood and activated with a toll-like receptor agonist exhibited a pro-inflammatory phenotype, which was not affected by esomeprazole therapy.</p><p><strong>Conclusions: </strong>Among patients with sepsis or septic shock, mega-dose esomeprazole did not reduce organ dysfunction or other patient-related or biological secondary outcomes.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1554-e1566"},"PeriodicalIF":6.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207883","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":"Further Evaluation of Parameters for Interpreting Emergency Department to ICU Transfer Times.","authors":"Satomi Omotani, Koji Hosokawa","doi":"10.1097/CCM.0000000000006700","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006700","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 8","pages":"e1685-e1686"},"PeriodicalIF":6.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783683","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}