Critical Care Medicine最新文献

{"title":"Looking Ahead With Retrospective Studies for Bacterial Ventilator-Associated Lower Respiratory Tract Infections.","authors":"Giuseppe A Marraro, Claudio Spada","doi":"10.1097/CCM.0000000000006646","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006646","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728734","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 Systematic Review of the Prevalence and Characteristics of Oropharyngeal Dysphagia in Critically Ill Patients During the Acute and Postacute Recovery Phase.","authors":"Cara Donohue, Kaitlynn Raye, Pratik Pandharipande, Robert S Dittus, E Wesley Ely","doi":"10.1097/CCM.0000000000006669","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006669","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the prevalence and characteristics of oropharyngeal dysphagia in critically ill adults during acute and postacute care settings.</p><p><strong>Data sources: </strong>This systematic review was registered on PROSPERO and used Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Five electronic databases were searched (PubMed, Scopus, Cochrane Library, CINAHL, and Embase) from the time of inception to September 2024 using search terms: dysphagia, deglutition disorders, swallowing disorders, sepsis, postintensive care syndrome, COVID-19, critical illness.</p><p><strong>Study selection: </strong>Independent review of articles was conducted by two raters using four inclusion criteria: 1) adults older than 18 years; 2) diagnosis of COVID-19, sepsis, critical illness, or ostintensive care syndrome and dysphagia; 3) underwent clinical swallow evaluation; and 4) in acute or postacute care setting.</p><p><strong>Data extraction: </strong>Two raters independently assessed levels of research evidence and risk of bias using the Oxford center for Evidence-based Medicine Levels of Evidence and the Modified Downs and Black Checklist and extracted demographics, study design, dysphagia assessment methods, outcomes, and comorbidities.</p><p><strong>Data synthesis: </strong>After removing duplicates, 5058 articles were identified and 4844 screened out based on title/abstract. Full-text review was completed for 214 articles, and 51 met inclusion. Prevalence of dysphagia ranged from 15% to 100%. Dysphagia persisted in up to 74% of individuals at hospital discharge and up to 22% of patients 10 to 17 months posthospital discharge.</p><p><strong>Conclusions: </strong>Due to study design limitations, high risk of bias, and heterogeneity in methods/outcomes, firm conclusions cannot be drawn. However, current data suggest a high prevalence of dysphagia in critically ill adults who persists greater than or equal to 12 months posthospital discharge. Given the high rates of silent aspiration, prospective, longitudinal research is needed to further understand the prevalence and impact of chronic dysphagia on health and quality of life in critically ill adults.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718202","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":"Toward a Precision Approach in Managing Acute Respiratory Failure in the Immunocompromised Patient.","authors":"Ambika Tejpal, Laveena Munshi, Bruno L Ferreyro, Patrick R Lawler, Michael C Sklar","doi":"10.1097/CCM.0000000000006657","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006657","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708955","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 Challenges and Future of Peer Review.","authors":"Howard Bauchner, Frederick P Rivara","doi":"10.1097/CCM.0000000000006642","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006642","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708951","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":"https://doi.org/10.1097/CCM.0000000000006640","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-03-24","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":"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":"https://doi.org/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":""},"PeriodicalIF":7.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","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":"https://doi.org/10.1097/CCM.0000000000006644","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-03-19","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":"Early Antibiotic Initiation and Survival in Hospital-Acquired Pneumonia.","authors":"Subhadra Mandadi, Andre C Kalil","doi":"10.1097/CCM.0000000000006643","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006643","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656354","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":"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":"https://doi.org/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":""},"PeriodicalIF":7.7,"publicationDate":"2025-03-18","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":"Toward Optimizing Short-Acting Beta-Blockers in Septic Shock.","authors":"Nicholas A Bosch","doi":"10.1097/CCM.0000000000006638","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006638","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656357","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}