Critical Care Medicine最新文献

{"title":"Net Fluid Balance Impacts Pediatric Continuous Renal Replacement Therapy Liberation.","authors":"Sameer Thadani, Harsha V Jujjavarapu, Christin Silos, Katja M Gist, Poyyapakkam Srivaths, Katri Typpo, Christopher Horvat, Michael J Bell, Dana Y Fuhrman, Ayse Akcan Arikan","doi":"10.1097/CCM.0000000000006636","DOIUrl":"10.1097/CCM.0000000000006636","url":null,"abstract":"<p><strong>Objectives: </strong>The optimal fluid management strategy on continuous renal replacement therapy (CRRT) is unknown for critically ill children. The pace of ultrafiltration has been highlighted as a risk predictor for adverse outcomes in adult cohorts. Whether CRRT can cause dialytrauma through excessive ultrafiltration rates (UFRs) in children is undetermined. Although fluid overload (FO) at CRRT start has been associated with adverse outcomes, net fluid balance (NFB) on CRRT has not been investigated as a predictor for renal recovery.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Two quaternary PICUs.</p><p><strong>Patients or subjects: </strong>Children and young adults admitted between 2/2014 and 2/2020 at two quaternary pediatric hospitals who received CRRT.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Three hundred and seventy-one patients were included in this study with the median age of 85 months (interquartile range [IQR] 17-172), 180 (50%) were female. Three hundred and forty-five (96%) had acute kidney injury at CRRT start, 102 (28%) patients had FO > 15%. The median NFB on day 1 was 0.33 mL/kg/hr (-0.43 to 1.18), day 2 was -0.14 mL/kg/hr (-0.72 to 0.52), and day 3 was -0.24 mL/kg/hr (-0.85 to 0.42). Patients with a preserved urine output (UOP) greater than 0.3 mL/kg/hr over the study period had 5.6 more CRRT-free days and had decreased odds of major adverse kidney events at 30 days (MAKE-30). A NFB between -4.46 and -0.305 mL/kg/hr was independently associated with more CRRT-free days (β 2.90 [0.24-5.56]) and decreased odds of MAKE-30 (adjusted odds ratio 0.41 [0.22-0.79]).</p><p><strong>Conclusions: </strong>Ultrafiltration practices in children receiving CRRT are substantially different compared to adult cohorts. Patients with a more positive NFB had fewer CRRT-free days. Preservation of UOP was associated with more CRRT-free days. Whether UFR causes direct dialytrauma in critically ill children through impairment of organ perfusion and hemodynamics require further study to allow personalization of CRRT prescriptions to improve outcomes.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1033-e1044"},"PeriodicalIF":7.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656355","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":"Updating the Understanding of the Association Between Body Mass Index and Survival in Venous-Venous Extracorporeal Membrane Oxygenation.","authors":"Carmen Silvia Valente Barbas","doi":"10.1097/CCM.0000000000006644","DOIUrl":"10.1097/CCM.0000000000006644","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1158-e1159"},"PeriodicalIF":7.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656359","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 Salty Start to Resuscitation: Does It Matter?","authors":"Mujtaba Mahmud, Susan E Hamblin","doi":"10.1097/CCM.0000000000006640","DOIUrl":"10.1097/CCM.0000000000006640","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1163-e1165"},"PeriodicalIF":7.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691354","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":"Comparing Ketamine and Etomidate for Short-Term Mortality in Rapid Sequence Intubation.","authors":"Yu Leng, Yaoxin Yang, Cheng Zhou","doi":"10.1097/CCM.0000000000006610","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006610","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 5","pages":"e1166-e1167"},"PeriodicalIF":7.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970060","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":"Kyung Won Shin, Hyongmin Oh","doi":"10.1097/CCM.0000000000006645","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006645","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 5","pages":"e1171"},"PeriodicalIF":7.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965267","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":"Prognostic Impact of Early Appropriate Antimicrobial Therapy in Critically Ill Patients With Nosocomial Pneumonia Due to Gram-Negative Pathogens: A Multicenter Cohort Study.","authors":"François Barbier, Niccolò Buetti, Claire Dupuis, Carole Schwebel, Élie Azoulay, Laurent Argaud, Yves Cohen, Vivien Hong Tuan Ha, Marc Gainnier, Shidasp Siami, Jean-Marie Forel, Christophe Adrie, Étienne de Montmollin, Jean Reignier, Stéphane Ruckly, Jean-Ralph Zahar, Jean-François Timsit","doi":"10.1097/CCM.0000000000006606","DOIUrl":"10.1097/CCM.0000000000006606","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate whether early appropriate antimicrobial therapy (EAAT) is associated with improved outcomes in critically ill patients with hospital-acquired pneumonia (HAP), ventilated HAP (vHAP), or ventilator-associated pneumonia (VAP) involving Gram-negative bacteria (GNB).</p><p><strong>Design: </strong>Retrospective cohort study based on prospectively collected data.</p><p><strong>Setting: </strong>Thirty-two French ICUs (OutcomeRéa network).</p><p><strong>Patients: </strong>All patients with a first HAP, vHAP, or VAP due to GNB during their ICU stay.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The relationship between EAAT and day 28 all-cause mortality (primary endpoint) was explored through Cox proportional-hazard models, with subgroup analyses according to pneumonia types, causative GNB, features of EAAT, and the occurrence of septic shock at pneumonia diagnosis. The course of Sequential Organ Failure Assessment (SOFA) score values, the clinical cure rate at day 14, and the time to mechanical ventilation (MV) weaning and ICU discharge after pneumonia diagnosis were investigated as secondary endpoints. Among the 804 included patients, 495 (61.6%) received EAAT (single-drug, 25.4%; combination, 36.2%). Day 28 mortality was 32.6%. EAAT was not independently associated with this outcome (adjusted hazard ratio, 0.87; 95% CI, 0.67-1.12). This result was confirmed in subgroup analyses as in a second model considering all episodes of pneumonia occurring during the ICU stay. EAAT was not associated with a faster decrease in SOFA score values ( p = 0.11), a higher day 14 clinical cure rate (overall, 43.7%), or a shorter MV duration (cause-specific hazard ratio [HR] for extubation, 0.84; 95% CI, 0.69-1.01) or ICU stay (cause-specific HR for discharge alive, 0.85; 95% CI, 0.72-1.00).</p><p><strong>Conclusions: </strong>In this study, EAAT was not associated with a reduced day 28 mortality, a faster resolution of organ failure, a higher day 14 clinical cure rate, or a shorter time to MV weaning or ICU discharge in critically ill patients with HAP, vHAP, or VAP due to GNB. However, a prognostic benefit from EAAT cannot be ruled out due to lack of statistical power.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1066-e1079"},"PeriodicalIF":7.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143499611","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":"Artificial Intelligence-Guided Bronchoscopy is Superior to Human Expert Instruction for the Performance of Critical-Care Physicians: A Randomized Controlled Trial.","authors":"Kaladerhan O Agbontaen, Kristoffer M Cold, David Woods, Vimal Grover, Hatem Soliman Aboumarie, Sundeep Kaul, Lars Konge, Suveer Singh","doi":"10.1097/CCM.0000000000006629","DOIUrl":"10.1097/CCM.0000000000006629","url":null,"abstract":"<p><strong>Objectives: </strong>Bronchoscopy in the mechanically ventilated patient is an important skill for critical-care physicians. However, training opportunity is heterogenous and limited by infrequent caseload or inadequate instructor feedback for satisfactory competencies. A new artificial intelligence (AI) navigational system using augmented reality - the Ambu Broncho Simulator - can guide bronchoscopy training. Is training with the AI system comparable to bedside, expert tutor instruction in improving bronchoscopy performance?</p><p><strong>Design: </strong>A nonblinded, parallel group randomized controlled trial was conducted.</p><p><strong>Setting: </strong>The study was conducted in a simulated setting at an academic university hospital.</p><p><strong>Subjects: </strong>Critical-care physicians were invited to take part in the study.</p><p><strong>Interventions: </strong>Forty participants received 30 minutes of bronchoscopy training, either guided by AI only (artificial intelligence group [AIG]) or by expert tutor feedback (expert tutor group [ETG]). All participants performed a final full navigation bronchoscopy performance test and completed a cognitive load questionnaire, the NASA Task Load Index .</p><p><strong>Measurements and main results: </strong>Mean intersegmental time (MIT = PT/DC), diagnostic completeness (DC), procedure time (PT), structured progress (SP), and number of segments revisited (SR) were measured. The primary outcome measure assessed was MIT, a measure of bronchoscopic performance efficiency. The secondary outcome measures were DC, PT, SP, and SR. Nineteen participants were randomized to the AIG and 21 participants to the ETG. MIT, PT, and SR were significantly better in the AIG compared to the ETG (median difference, p ): MIT (-7.9 s, 0.027), PT (-77 s, 0.022), SR (-7 segments, 0.019); all showing moderate effect sizes (0.35, 0.36, and 0.37, respectively) as per Cohen's classification.There was no significant difference between the groups for all other final test measures.</p><p><strong>Conclusions: </strong>Training using an AI system resulted in faster and more efficient bronchoscopy performance by critical-care physicians when compared to expert human tutor instruction. This could change the future of bronchoscopy training in critical care and warrants validation in patients through clinical studies.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1105-e1115"},"PeriodicalIF":7.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12047642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662951","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":"Should CT Angiography Be Routinely Employed After Extracorporeal Membrane Oxygenation Weaning?","authors":"Liangshan Wang, Xiaotong Hou","doi":"10.1097/CCM.0000000000006597","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006597","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 5","pages":"e1172-e1173"},"PeriodicalIF":7.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981549","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":"Sameer Sharif, Alisha Greer, Bram Rochwerg","doi":"10.1097/CCM.0000000000006635","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006635","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 5","pages":"e1168-e1169"},"PeriodicalIF":7.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984094","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":"Impact of Short-Acting Beta-Blockers on the Outcomes of Patients With Septic Shock: A Systematic Review and Meta-Analysis.","authors":"Chris McChesney, Nicolas Orozco, Kyle Fiorini, Michelle Yee Suet Wong, Marat Slessarev, Ross Prager, Raymond Kao, Aleksandra Leligdowicz, Sameer Sharif, Kimberley Lewis, Bram Rochwerg, Kimia Honarmand, Ian M Ball, Robert Arntfield, Rachael Houlton, Logan VanNynatten, John Basmaji","doi":"10.1097/CCM.0000000000006604","DOIUrl":"10.1097/CCM.0000000000006604","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the impact of short-acting beta-blocker therapy on outcomes in adult patients with septic shock.</p><p><strong>Data sources: </strong>We searched MEDLINE, Embase, and unpublished sources from inception to April 19, 2024.</p><p><strong>Study selection: </strong>We included randomized controlled trials (RCTs) that evaluated short-acting beta-blockers compared with usual care in patients with septic shock.</p><p><strong>Data extraction: </strong>We collected data regarding study and patient characteristics, beta-blocker administration, and clinical, hemodynamic, and biomarker outcomes.</p><p><strong>Data synthesis: </strong>Twelve RCTs proved eligible ( n = 1170 patients). Short-acting beta-blockers may reduce 28-day mortality (relative risk [RR], 0.76; 95% CI, 0.62-0.93; low certainty) and probably reduce new-onset tachyarrhythmias (RR, 0.37; 95% CI, 0.18-0.78; moderate certainty) but may increase the duration of vasopressors (mean difference [MD], 1.04 d; 95% CI, 0.37-1.72; low certainty). Furthermore, there is an uncertain effect as to whether short-acting beta blockers impact 90-day mortality (RR, 0.98; 95% CI, 0.73-1.31), ICU length of stay (MD, -0.75 d; 95% CI, -3.43 to 1.93 d), hospital length of stay (MD, 1.03 d; 95% CI, -1.92 to 3.98 d), duration of mechanical ventilation (MD, -0.10 d; 95% CI, -1.25 to 1.05 d) (all very low certainty), bradycardia episodes (RR, 3.14; 95% CI, 0.91-14.01), and hypotension episodes (RR, 4.74; 95% CI, 1.62-14.01) (all very low certainty).</p><p><strong>Conclusions: </strong>In patients with septic shock, short-acting beta-blockers may improve survival and reduce new-onset tachyarrhythmias. However, these findings were based on low certainty evidence and given ongoing concerns regarding adverse effects and the increase duration of vasopressor use, we need larger and more rigorous RCTs to evaluate this intervention.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1125-e1139"},"PeriodicalIF":7.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143499529","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}