Critical Care Medicine最新文献

{"title":"Long-Term Effects of the Association of Early Neuromuscular Electrical Stimulation With Mobilization in Critically Ill Patients.","authors":"Thatiana Barboza Carnevalli Bueno, Débora Ribeiro Campos, Karina Stefania Marques de Oliveira, Rik Gosselink, Rinaldo Roberto de Jesus Guirro, Marcos de Carvalho Borges","doi":"10.1097/CCM.0000000000006866","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006866","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the long-term effects of the early combination of neuromuscular electrical stimulation (NMES) and early mobilization (EM) in critically ill patients.</p><p><strong>Design: </strong>Single-Center, randomized, controlled, and blinded clinical trial.</p><p><strong>Setting: </strong>Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo.</p><p><strong>Patients: </strong>Seventy-four patients who had been mechanically ventilated were randomized into two groups within the first 48 hours of ICU admission.</p><p><strong>Interventions: </strong>One group received daily EM starting within first 48 hours of ICU admission (EM group). The other group received the same EM protocol plus NMES, applied 5 days a week, also starting within the first 48 hours of ICU admission until ICU discharge (EM + NMES group).</p><p><strong>Measurements and main results: </strong>After hospital discharge, patients were assessed by telephone at 15 days and 6 months, and in person at 30 days and 3 months. Functional status, muscle strength, functional independence, quality of life, and symptoms of post-traumatic stress disorder (PTSD) were assessed. Baseline demographic and clinical characteristics were similar between groups. Patients in the EM + NMES group had significantly higher functional status, independence, and mobility compared with those in the EM group at all time points, as measured by the Barthel Index at 15 and 30 days, and at 3 and 6 months (p < 0.05), and the ICU Mobility Scale at 15 days, and at 3 and 6 months (p < 0.05). Additionally, quality of life was significantly improved in the EM + NMES group compared with the EM group, up to 6 months after hospital discharge (p < 0.05). There was no significant difference in PTSD scores between groups.</p><p><strong>Conclusions: </strong>The application of early NMES in addition to an EM protocol, when initiated within the first 48 hours of ICU admission, resulted in better functional outcomes and quality of life for critically ill patients up to 6 months post-discharge.</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":"145085257","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":"Early Enteral Nutrition and Clinical Outcomes in Critically Ill Pediatric Populations: A Systematic Review and Meta-Analysis.","authors":"Nicole Gilbert, Emma Schalm, Krista Wollny, Laurie Lee, Dana L Boctor, Tanis R Fenton","doi":"10.1097/CCM.0000000000006859","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006859","url":null,"abstract":"<p><strong>Objective: </strong>Guidelines recommend implementing early enteral nutrition (EN) (EEN) in critically ill children. The aim of the study was to determine if EEN for critically ill children is associated with improved clinical outcomes compared with delayed enteral nutrition (DEN), prioritizing associations adjusted for severity of illness. PROSPERO (CRD42021286271).</p><p><strong>Data sources: </strong>MEDLINE, Embase, CINAHL, and CENTRAL databases to October 2024.</p><p><strong>Study selection: </strong>The population was critically ill children, the intervention was EEN, the comparator was DEN, the outcome was mortality or clinical outcomes, and the study designs included randomized control trials (RCTs), quasi-experimental, observational cohort, or case-control.</p><p><strong>Data extraction: </strong>Screening, extraction, and risk of bias assessment using the Newcastle-Ottawa Scale and Cochrane Risk of Bias and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessment were conducted in duplicate by two reviewers. Eighteen of 8478 screened studies were included.</p><p><strong>Data synthesis: </strong>Mortality outcomes were pooled and meta-analyzed using random-effects models. Secondary outcomes were described qualitatively, and directions of associations were reported. Thirteen studies (1 RCT, 12 cohort) reported mortality; however, only three adjusted for illness severity. In the adjusted analysis, receiving EEN was associated with reduced mortality (adjusted odds ratio 0.36 (95% CI, 0.14-0.91), I2 = 78.6%, n = 5864). The certainty of evidence, as assessed by GRADE, was very low due to indirectness. In the qualitative review of 18 studies (1 RCT, 17 cohort studies, n = 9829), EEN had an association with reduced length of stay, length of invasive respiratory support, improved nutrition adequacy, reduced maximum pediatric logistic organ dysfunction score, and infection. No harmful effects of EEN were found after adjusting for confounding variables.</p><p><strong>Conclusions: </strong>EEN was associated with beneficial outcomes. However, the inclusion of mostly cohort studies with limited confounding adjustment, the small number of studies, the presence of between-study heterogeneity and residual confounding, and heterogeneity in measured outcomes and assessment methods resulted in very low certainty of evidence.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145074665","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":"We Really Do Think Early Venovenous Extracorporeal Membrane Oxygenation Is Best, But May Never Prove It.","authors":"Joseph E Tonna","doi":"10.1097/CCM.0000000000006887","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006887","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063659","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 Between Activation of a Rapid Response Team and Outcomes of Sepsis in General Wards: A Nationwide Observational Study Using the Japanese Intensive Care Patient Database.","authors":"Yoshitaka Aoki, Mikihiro Shimizu, Mikio Nakajima, Keisuke Ota, Richard H Kaszynski, Satoshi Naruse, Tsunehisa Sato, Hiromi Kato, Soichiro Mimuro, Yoshiki Nakajima","doi":"10.1097/CCM.0000000000006857","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006857","url":null,"abstract":"<p><strong>Objectives: </strong>Sepsis and septic shock require prompt intervention to improve outcomes. A rapid response team (RRT) system facilitates early recognition and management, including transfer to the ICU, but its impact on clinical outcomes remains unclear. This study assessed the association between RRT activation and clinical outcomes in septic patients initially managed in general wards, in a cohort of predominantly tertiary care hospitals in Japan.</p><p><strong>Design: </strong>Secondary analysis of prospectively collected data from the Japanese Intensive Care PAtient Database (JIPAD) for the fiscal years 2017-2022.</p><p><strong>Setting: </strong>A multicenter study using the JIPAD, which includes 324,037 patients across 95 ICUs in Japan.</p><p><strong>Patients: </strong>We identified 3883 adult patients admitted to the ICU with sepsis or septic shock after initial management in a general ward.</p><p><strong>Interventions: </strong>The patients were divided into those in whom the RRT was activated before ICU admission (the RRT group) and those in whom it was not (the control group).</p><p><strong>Measurements and main results: </strong>The primary outcome was in-hospital mortality. Secondary outcomes included rate of discharge to home, ICU mortality, length of hospital stay, and length of ICU stay. All outcome analyses were performed after stabilized inverse probability of treatment weighting using generalized estimating equations to account for clustering at the hospital level. There was no statistically significant difference in-hospital mortality between the RRT group (n = 850) and the control group (n = 3033; 38.6% vs. 37.1%; risk difference, 1.4%; 95% CI, -2.8% to 5.6%; p = 0.51). No significant differences were observed in secondary outcomes.</p><p><strong>Conclusions: </strong>In this nationwide study of septic patients requiring ICU admission, RRT activation was not associated with improvement of in-hospital mortality or other clinical outcomes. Despite the widespread implementation of RRTs, their impact on outcomes of sepsis in well-resourced healthcare systems such as Japan remains uncertain.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039473","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 in Six: Substance-Related Critical Care.","authors":"Tessa L Steel","doi":"10.1097/CCM.0000000000006861","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006861","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033063","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":"Innovating the Procedure of Evidence-Based Extubation Through Alternating Cluster-Controlled Trial Design.","authors":"Kevin G Buell, Krysta S Wolfe","doi":"10.1097/CCM.0000000000006854","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006854","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029117","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":"Patient-Ventilator Asynchronies: Do They Matter?","authors":"Erminio Santangelo, Sameer Jog, Niall D Ferguson","doi":"10.1097/CCM.0000000000006860","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006860","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029174","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":"Can a Machine Learning Model Personalize the Use of Sodium Bicarbonate and Neutralize Out-of-Hospital Cardiac Arrest?","authors":"Kevin G Buell, Emma J Graham Linck, Kevin P Seitz","doi":"10.1097/CCM.0000000000006846","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006846","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029195","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 Science to Improve ICU Benchmarking.","authors":"Jorge I F Salluh, Giulliana M Moralez, Filipe Amado, Gaston Burghi","doi":"10.1097/CCM.0000000000006851","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006851","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145014056","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":"Understanding ICU Outcomes: Lessons From National ICU Registries.","authors":"Giulliana M Moralez, Otavio T Ranzani, Amanda Quintairos, Jorge I F Salluh","doi":"10.1097/CCM.0000000000006853","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006853","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145014084","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}