Critical Care Medicine最新文献

{"title":"The Impact of Hospital-Level Median Door-to-Extracorporeal Cardiopulmonary Resuscitation Time on the Prognosis of Patients With Refractory Out-of-Hospital Cardiac Arrest.","authors":"Daisuke Kasugai, Yohei Okada, Yuka Mizutani, Junta Honda, Toru Kondo, Shingo Kazama, Takanori Yamamoto","doi":"10.1097/CCM.0000000000006808","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006808","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the impact of hospital-level median door-to-extracorporeal cardiopulmonary resuscitation (ECPR) time on survival and neurologic outcomes in patients with out-of-hospital cardiac arrest (OHCA) requiring ECPR.</p><p><strong>Design: </strong>Secondary analysis of the Japanese Association for Acute Medicine OHCA registry, a nationwide Japanese database of OHCA patients.</p><p><strong>Setting: </strong>Fifty-three hospitals across Japan.</p><p><strong>Patients: </strong>Adult patients who underwent ECPR between 2014 and 2021 were included. Hospitals were categorized into \"rapid\" or \"delayed\" groups based on their median door-to-ECPR times.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The primary outcome was 30-day survival. Secondary outcomes included 30-day and 90-day survival with favorable neurologic outcomes. Propensity score weighting was applied to adjust for confounders. In total, 2136 patients treated at 53 hospitals were included. Hospitals with shorter median door-to-ECPR times had higher 30-day survival rates (odds ratio [OR], 1.36; 95% CI, 1.21-1.53). Neurologic outcomes were better in the rapid hospital group at both 30 days (OR, 1.47; 95% CI, 1.24-1.73) and 90 days (OR, 1.47; 95% CI, 1.25-1.73) follow-ups.</p><p><strong>Conclusions: </strong>Hospital-level median door-to-ECPR time is a crucial predictor of survival and neurologic outcomes in OHCA patients requiring ECPR. Shorter door-to-ECPR times should be considered a key quality metric for ECPR processes.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642032","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":"Melatonin Use in the ICU: A Systematic Review and Meta-Analysis.","authors":"Brian Hao Yuan Tang, Judith Manalo, Saifur R Chowdhury, J Matthew Aldrich, Gerald L Weinhouse, Makayla Cordoza, Patricia R Louzon, Michele C Balas, Joanna L Stollings, Molly McNett, Karin Dearness, Jose Estrada-Codecido, Dipayan Chaudhuri, Kallirroi Laiya Carayannopoulos, Kimberley Lewis","doi":"10.1097/CCM.0000000000006767","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006767","url":null,"abstract":"<p><strong>Objectives: </strong>Melatonin has wide-ranging effects on the body, including the regulation of circadian rhythm, and potentiation of cellular immune and antioxidant activities. In critically ill patients, endogenous melatonin has been shown to be markedly deranged and reduced. Therefore, the purpose of this systematic review and meta-analysis was to determine if exogenous supplementation of melatonin improves patient-centered outcomes.</p><p><strong>Data sources: </strong>We searched five electronic databases.</p><p><strong>Study selection: </strong>Randomized clinical trials (RCTs) that compared melatonin to no melatonin in adults admitted to the ICU were identified.</p><p><strong>Data extraction: </strong>We aggregated data as relative risks, mean differences (MDs), and standard mean differences (SMDs) using a random-effects model. Supporting evidence for each effect was evaluated for certainty using the Grading Recommendations, Assessment, Development, and Evaluations approach.</p><p><strong>Data synthesis: </strong>In total, 32 RCTs (n = 3895 patients) were included. We found that melatonin may reduce delirium (relative risk [RR] 0.72; 95% CI, 0.58-0.89; low certainty), may slightly reduce ICU length of stay (MD -0.57 d; 95% CI, -0.95 to -0.18 d; low certainty), and may improve reported sleep quality (SMD 0.54; 95% CI, 0.01-1.07; low certainty). Melatonin may result in a slight reduction in the frequency of adverse events (low certainty). Evidence was uncertain with regards to the frequency of sleep awakenings, anxiety level, agitation, and post-traumatic stress disorder incidence (all very low certainty), as well as to ICU mortality and post-ICU functional status (both low certainty).</p><p><strong>Conclusions: </strong>Our findings suggest that melatonin administration in the critically ill may improve perceived sleep and reduce delirium, without increasing adverse effects. Certainty of evidence was negatively affected by the risk of bias and inconsistency. Future RCTs should focus on identifying optimal dosing, administration timing, improving measurements of sleep outcomes, and target populations.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636433","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":"Factors Influencing Quality of Life After Intensive Care: A Systematic Review and Meta-Analysis.","authors":"Weilin Jiang, Qiqi Ni, Chuchu Zhang, Yuheng Dong, Jia Yi, Ran Yan, Zhenzhen Huang, Li Wang, Weijing Sui, Xiaoyan Gong, Yiyu Zhuang","doi":"10.1097/CCM.0000000000006770","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006770","url":null,"abstract":"<p><strong>Objectives: </strong>The factors influencing quality of life (QOL) after intensive care are diverse and complex, and the QOL levels remain unclear. This systematic review and meta-analysis aimed to identify the factors influencing QOL and QOL levels in post-ICU patients.</p><p><strong>Data sources: </strong>We searched eight databases: PubMed, Embase, EBSCOhost, Cochrane Library, Web of Science, China National Knowledge Infrastructure, WeiPu, and WanFang, from inception to October 15, 2024.</p><p><strong>Study selection: </strong>We included observational studies that examined factors influencing QOL in post-ICU patients.</p><p><strong>Data extraction: </strong>Two independent reviewers extracted and recorded the data.</p><p><strong>Data synthesis: </strong>A total of 65 studies, encompassing 17,298 post-ICU patients, met the inclusion criteria. The key pre-ICU factors are advanced age (per 1-yr increase) (β: -0.045 [95% CI, -0.057 to -0.033]) and female gender (odds ratio: 1.104 (95% CI, 1.035-1.177]). The key intra-ICU factors are length of ICU stay (per 1-d increase) (β: -0.012 [95% CI, -0.019 to -0.005]), length of mechanical ventilation (per 1-d increase) (β: -0.005 [95% CI, -0.009 to -0.001]), and length of hospital stay (per 1-d increase) (β: -0.107 [95% CI, -0.161 to -0.054]). The pooled overall QOL score was 58.835 (95% CI, 52.935-64.735), the pooled physical component summary (PCS) score was 49.517 (95% CI, 45.781-53.253), the pooled mental component summary (MCS) score was 53.509 (95% CI, 50.301-56.718), and the pooled overall QOL index was 0.750 (95% CI, 0.713-0.787).</p><p><strong>Conclusions: </strong>Most pre-ICU and intra-ICU factors demonstrated strong associations with post-ICU QOL. The QOL in post-ICU patients remains at a moderate level, with the PCS score indicating greater impairment than the MCS score. Further research is highly recommended to explore effective intervention strategies to improve QOL in post-ICU patients, particularly concerning their physical well-being.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636473","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 Effect of Early Fluid Resuscitation on Mortality in Sepsis: A Systematic Review and Meta-Analysis.","authors":"Michael A Ward, Hani I Kuttab, Robert G Badgett","doi":"10.1097/CCM.0000000000006769","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006769","url":null,"abstract":"<p><strong>Objectives: </strong>While general agreement exists on many sepsis management principles, the details of early fluid resuscitation in sepsis remain contentious. The aim of the current review is to examine the impact of early (≤ 8 hr) fluid dosing, timing, and guideline-based resuscitation on mortality in sepsis.</p><p><strong>Data sources: </strong>PubMed, Scopus, Cochrane, and Google Scholar from January 1, 2000, to November 8, 2024.</p><p><strong>Study selection: </strong>Randomized controlled trials and observational data, adjusting for confounding, for adults (≥ 18 yr) with sepsis.</p><p><strong>Data extraction: </strong>From 2,169 citations, 30 studies with 119,583 patients were included.</p><p><strong>Data synthesis: </strong>Dosing: three randomized trials suggest no mortality difference between more liberal (~43-72 mL/kg) vs. more restrictive (as low as 30 mL/kg) fluid resuscitative strategies (relative risk, 1.00 [0.81-1.24]). Eleven of 13 studies observed mortality risk when low-fluid volumes were administered (< 20 mL/kg; effect direction/sign test: p < 0.001). Six of 11 studies observed mortality risk when fluid volume dosing exceeded higher limits (> 45 mL/kg; p = 0.55). Timing: four of four studies observed a survival benefit with earlier completion of 30 mL/kg (within 3 hr; p = 0.12). Thirty mL/kg by discrete time: less than or equal to 1 and less than or equal to 2 hours-two studies observed survival benefit; less than or equal to 3 hours-one study observed survival benefit and three studies observed no mortality impact; and less than or equal to 6 hours-two studies observed a survival benefit, four studies observed no impact, and two studies observed increased mortality risk (both > 30 groups received > 50 and > 70 mL/kg).</p><p><strong>Conclusions: </strong>For fluid resuscitation within 8 hours of sepsis diagnosis: 1) randomized trials suggest no mortality difference between more restrictive and more liberal fluid resuscitative strategies (certainty of evidence: low); 2) dosing less than 20 mL/kg has an effect on increased mortality (low certainty); 3) observational studies trend toward increased mortality with higher volume resuscitation (> 45 mL/kg) but are not supported by randomized trials (very low certainty); and 4) survival benefit is observed when 30 mL/kg is completed within 3 hours (low certainty).</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599634","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":"Added Value of Late Auditory Evoked Potentials in the Multimodal Prognostication of Patients With Disorders of Consciousness.","authors":"Julie Lévi-Strauss, Sarah Benghanem, Bertrand Hermann, Eléonore Bouchereau, Camille Legouy, Tarek Sharshar, Martine Gavaret, Estelle Pruvost-Robieux","doi":"10.1097/CCM.0000000000006766","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006766","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to evaluate the added prognostic value of late auditory evoked potentials (AEPs): mismatch negativity (MMN) and P3, alongside other prognostic markers (electroencephalogram, somatosensory evoked potentials, absent pupillary reflex), in the prognostication of patients with disorders of consciousness. We stratified our analysis based on the type of brain injury: hypoxic-ischemic brain injury (HIBI) vs. non-HIBI.</p><p><strong>Design and setting: </strong>We performed a single-center retrospective study comparing the prognostic values of late AEPs and other neurophysiologic markers in predicting unfavorable outcomes, defined as a Glasgow Outcome Scale-Extended of 1-2 at 3 months, in both HIBI and non-HIBI groups. We compared the prognostic performance of a model including late AEPs to a model including only well-established markers.</p><p><strong>Patients: </strong>We included 148 patients from one institution at the subacute phase after coma onset (median, 20.0 d). The main cause of disorder of consciousness was HIBI in 43.9% of cases, followed by stroke in 31.8%.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The absence of P3 and MMN responses had a positive predictive value (PPV) for unfavorable outcome of 92.9% and 88.4% in HIBI, and 67.9% and 57.4% in non-HIBI, respectively. Predictive values of neurophysiologic markers were generally lower in non-HIBI compared with HIBI patients. Specifically, the PPV for unfavorable outcome of electroencephalogram malignant patterns and absent reactivity was significantly higher in HIBI compared with non-HIBI patients (76.9% vs. 31.3%, and 88.9% vs. 33.3%; p = 0.04, respectively). A model including AEPs significantly reduced the differences between individual predicted probabilities and actual outcome, both in the HIBI and non-HIBI contexts.</p><p><strong>Conclusions: </strong>Integrating late AEPs into multimodal assessments enhances the model's predictive performance. Their contribution to neuroprognostication may be particularly relevant in the non-HIBI context, where the predictive values of neurophysiologic tools are lower than in the HIBI context. Late AEPs are interesting and cost-effective tools for neuroprognostication in both HIBI and non-HIBI contexts.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599632","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":"Parsimonious Subphenotyping Algorithms Perform Differently in Patients With Sepsis and Hematologic Malignancy.","authors":"Lukas Ronner, Heather M Giannini, Todd A Miano, Caroline A G Ittner, Alexandra P Turner, Thomas G Dunn, Roseline S Agyekum, Anushka Dasgupta, Kirstin West, Tiffanie K Jones, Michael G S Shashaty, John P Reilly, Nuala J Meyer","doi":"10.1097/CCM.0000000000006774","DOIUrl":"10.1097/CCM.0000000000006774","url":null,"abstract":"<p><strong>Objectives: </strong>Latent class assignment-derived subphenotyping algorithms may identify treatment-responsive subgroups of critically ill patients with sepsis and acute respiratory distress syndrome. It is unclear if these algorithms are generalizable to patients with comorbid malignancy, a state which may perturb influential inflammatory biomarkers. This study aimed to test whether malignancy or neutropenia modified the effect of subphenotype assignment by two algorithms as applied to a prospective cohort enriched for ICU patients with active malignancy.</p><p><strong>Design: </strong>Prospective cohort study at a single U.S. quaternary referral center.</p><p><strong>Setting/patients: </strong>ICU patients older than 18 admitted to an ICU with a primary admission indication of sepsis.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We applied two published subphenotyping algorithms utilizing either interleukin (IL)-6 or IL-8 (in addition to soluble tumor necrosis factor receptor 1 and bicarbonate) to our cohort of 930 patients with sepsis, 396 (42%) of whom had active malignancy. A greater proportion of hematologic malignancy patients were assigned the \"hyperinflammatory\" subphenotype by the IL-8-utilizing algorithm than the IL-6 algorithm (58% vs. 32%). Patients with leukemia and neutropenia were overrepresented among those classified as hyperinflammatory by IL-8 algorithm. We constructed Cox proportional hazards models to assess for interaction between the presence of solid malignancy, hematologic malignancy, and severe neutropenia and the subphenotype/mortality association. Hematologic malignancy uniquely appeared to attenuate the associated mortality of the IL-6-assigned hyperinflammatory subphenotype (interaction; p = 0.037), but not the IL-8-assigned hyperinflammatory subphenotype (interaction; p = 0.260), which retained an independent association with mortality in hematologic malignancy subjects (hazard ratio, 1.50; 95% CI, 1.08-2.07; p = 0.014).</p><p><strong>Conclusions: </strong>As subphenotyping algorithms are being tested as point-of-care prognostic tools, it is important to understand their generalizability to patients with comorbid malignancy, which constitute an increasing proportion of ICU patients. The differential behavior of these algorithms in patients with hematologic malignancy suggests a need for independent derivation and validation in this specific population.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599633","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 Varying Impact of Frailty With Increasing Body Mass Index on Survival Up To 3 Years After ICU Admission: A Retrospective Registry-Based Study.","authors":"Ashwin Subramaniam, Ryan Ruiyang Ling, Ryo Ueno, Emma J Ridley, Sandra Peake, David Pilcher","doi":"10.1097/CCM.0000000000006773","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006773","url":null,"abstract":"<p><strong>Objectives: </strong>Frailty is associated with poorer outcomes in critical illness, but it is unclear if this relationship is consistent across different body mass index (BMI) levels.</p><p><strong>Design: </strong>A retrospective multicentric registry-based observational study using the Australia New Zealand Intensive Care Society Adult Patient Database.</p><p><strong>Setting: </strong>Criticallly ill patients admitted to 1170 ICUs between January 1, 2018, and March 31, 2022.</p><p><strong>Patients: </strong>All adults aged 16 years and older with a documented Clinical Frailty Scale (CFS) and BMI.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The primary outcome was survival up to 3 years following ICU admission. We used Cox proportional hazards models, linear and nonlinear regression models to investigate the association between frailty (defined as CFS, 5-8), in reference to those without frailty, and the mortality risk up to 3 years, and whether this association varied with BMI, after adjusting for key confounders. We included 282,586 patients, of whom 49,070 (17.4%) were frail. Frailty was most prevalent in patients with BMI less than 18.5 kg/m2 (34.8%), became less frequent as BMI increased, and more prevalent again in BMI greater than or equal to 40 kg/m² (18.8%). Overall, frailty was associated with lower 3-year survival (47.5% vs. 82.2%) and increased mortality (hazard ratio, 1.67; 95% CI, 1.62-1.73). However, the association between frailty and survival was not uniform. The concomitant presence of frailty was associated with progressively larger increases in mortality as BMI categories increased beyond the reference group of 18.5-24.9 kg/m2. There was no effect of BMI on the relationship between frailty and mortality for BMI less than 18.5 kg/m2. This relationship was consistent in multiple sensitivity analyses.</p><p><strong>Conclusions: </strong>The association between frailty and outcomes after critical illness differed across BMI categories with a larger increase in the risk of mortality noted at higher BMI levels. Our findings may have implications for managing concurrent obesity, frailty, and critical illness.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599635","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 Initial Left Ventricular Systolic Dysfunction and Clinical Outcome in Sepsis: A Multicenter Cohort Study.","authors":"Hyunseung Nam, Ji Hyun Cha, Ki Hong Choi, Chi Ryang Chung, Jeong Hoon Yang, Gee Young Suh, Sunghoon Park, Chae-Man Lim, Ryoung-Eun Ko","doi":"10.1097/CCM.0000000000006771","DOIUrl":"10.1097/CCM.0000000000006771","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the association between the severities of left ventricular (LV) systolic dysfunction and clinical outcomes in patients with sepsis, with a particular focus on in-hospital mortality.</p><p><strong>Design: </strong>Multicenter cohort study.</p><p><strong>Setting: </strong>Nineteen tertiary or university-affiliated hospitals in South Korea.</p><p><strong>Patients: </strong>A total of 2274 adult patients with sepsis or septic shock underwent echocardiographic examination within 24 hours of sepsis recognition.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Patients were stratified by left ventricular ejection fraction (LVEF) into three groups: normal (> 50%, n = 1803), mild-to-moderate dysfunction (30-50%, n = 356), and severe dysfunction (< 30%, n = 115). In-hospital mortality is significantly associated with LV dysfunction severity (normal: 25.73%, mild-to-moderate: 29.49%, severe: 40.00%; p = 0.023). After propensity score matching using three different methodologies, severe LV dysfunction remained independently associated with increased in-hospital mortality (adjusted odds ratio [OR] 1.81; 95% CI, 1.09-3.03). This effect was more pronounced in patients without preexisting cardiovascular disease (CVD) (OR 1.84; 95% CI, 1.08-3.13) and those with bacteremia (OR 2.20; 95% CI, 1.5-3.22). Cardiopulmonary arrest rates increased significantly with dysfunction severity (normal: 2.11%, mild-to-moderate: 3.93%, severe: 10.43%; p < 0.001), while other ICU complications showed no significant differences.</p><p><strong>Conclusions: </strong>Severe LV systolic dysfunction (LVEF < 30%) is associated with significantly increased in-hospital mortality in sepsis patients, particularly in those with bacteremia and without preexisting CVD. These findings highlight the importance of early cardiac function assessment in sepsis and suggest that infection status and underlying cardiovascular health modify the relationship between LV dysfunction and clinical outcome.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144539326","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":""},"PeriodicalIF":7.7,"publicationDate":"2025-07-02","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":"Association Between Driving Pressure and Subsequent Development of Acute Kidney Injury in Acute Respiratory Distress Syndrome.","authors":"Ioannis Andrianopoulos, Panagiotis Kremmydas, Eleni Papoutsi, Eleni N Sertaridou, Kyriaki Parisi, Eleni A Vavouraki, Ilias I Siempos, Stelios Kokkoris","doi":"10.1097/CCM.0000000000006772","DOIUrl":"10.1097/CCM.0000000000006772","url":null,"abstract":"<p><strong>Objectives: </strong>Although preclinical evidence indicates that injurious mechanical ventilation may lead to acute kidney injury (AKI), relevant clinical evidence is limited. We aimed to investigate the association of driving pressure (a marker of injurious mechanical ventilation) with subsequent development of AKI in patients with acute respiratory distress syndrome (ARDS).</p><p><strong>Design: </strong>Secondary analysis of individual patient-level data from seven ARDS Network and Prevention and Early Treatment of Acute Lung Injury (PETAL) Network randomized controlled clinical trials.</p><p><strong>Setting: </strong>Adult ICUs participating in the ARDS Network and PETAL Network trials.</p><p><strong>Patients: </strong>After exclusion of patients with early AKI (i.e., those who met AKI criteria within the first 2 d following ARDS onset), we classified the study population into two groups: \"late AKI\" and \"no AKI.\" The \"late AKI\" group included patients who developed AKI more than 2 days but no longer than 7 days following ARDS onset.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Of 5367 patients with ARDS initially enrolled in trials, 2960 patients were included in the main analysis. Late AKI developed in 1000 patients (33.8%). After controlling for confounders, baseline driving pressure was independently associated with development of late AKI (each 1 sd increase in driving pressure was associated with a 35% increase in the odds of late AKI [odds ratio, 1.35; 95% CI, 1.15-1.58]). This result persisted in the sensitivity analysis, which did not exclude patients with early AKI, and in the sensitivity analysis, which included patients who developed AKI later than 7 days following ARDS onset. There was a threshold of driving pressure equal to 15 cm H 2 O for its association with development of late AKI.</p><p><strong>Conclusions: </strong>Driving pressure was associated with subsequent development of AKI in patients with ARDS suggesting that injurious mechanical ventilation may lead to AKI.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144539325","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}