Critical Care Medicine最新文献

{"title":"Higher Versus Lower Protein Delivery in Critically Ill Patients: A Systematic Review and Bayesian Meta-Analysis.","authors":"Samuel Heuts, Zheng-Yii Lee, Charles Chin Han Lew, Julia L M Bels, Andrea Gabrio, Michal J Kawczynski, Daren K Heyland, Matthew J Summers, Adam M Deane, Dieter Mesotten, Lee-Anne S Chapple, Christian Stoppe, Marcel C G van de Poll","doi":"10.1097/CCM.0000000000006562","DOIUrl":"10.1097/CCM.0000000000006562","url":null,"abstract":"<p><strong>Objectives: </strong>Recent multicenter trials suggest that higher protein delivery may result in worse outcomes in critically ill patients, but uncertainty remains. An updated Bayesian meta-analysis of recent evidence was conducted to estimate the probabilities of beneficial and harmful treatment effects.</p><p><strong>Data sources: </strong>An updated systematic search was performed in three databases until September 4, 2024. The study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and the protocol was preregistered in PROSPERO (CRD42024546387).</p><p><strong>Study selection: </strong>Randomized controlled trials that studied adult critically ill patients comparing protein doses delivered enterally and/or parenterally with similar energy delivery between groups were included.</p><p><strong>Data extraction: </strong>Data extraction was performed by two authors independently, using a predefined worksheet. The primary outcome was mortality. Posterior probabilities of any benefit (relative risk [RR] < 1.00) or harm (RR > 1.00) and other important beneficial and harmful effect size thresholds were estimated. Risk of bias assessment was performed using the risk of bias 2.0 tool. All analyses were performed using a Bayesian hierarchical random-effects models, under vague priors.</p><p><strong>Data synthesis: </strong>Twenty-two randomized trials ( n = 4164 patients) were included. The mean protein delivery in the higher and lower protein groups was 1.5 ± 0.6 vs. 0.9 ± 0.4 g/kg/d. The median RR for mortality was 1.01 (95% credible interval, 0.84-1.16). The posterior probability of any mortality benefit from higher protein delivery was 43.6%, while the probability of any harm was 56.4%. The probabilities of a 1% (RR < 0.99) and 5% (RR < 0.95) mortality reduction by higher protein delivery were 38.7% and 22.9%, respectively. Conversely, the probabilities of a 1% (RR > 1.01) and 5% (RR > 1.05) mortality increase were 51.5% and 32.4%, respectively.</p><p><strong>Conclusions: </strong>There is a considerable probability of an increased mortality risk with higher protein delivery in critically ill patients, although a clinically beneficial effect cannot be completely eliminated based on the current data.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e645-e655"},"PeriodicalIF":7.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892769","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":"Society of Critical Care Medicine 2024 Guidelines on Adult ICU Design.","authors":"D Kirk Hamilton, Jodie C Gary, Elizabeth Scruth, Harry L Anderson, Charles D Cadenhead, Simon J Oczkowski, Vincent I Lau, Jason Adler, Adel Bassily-Marcus, Benjamin S Bassin, Joel Boyd, Katharina M Busl, James R Crabb, Clifford Harvey, Jason P Hecht, Milee Herweijer, Kyle J Gunnerson, Abdullahi S Ibrahim, Craig S Jabaley, Lewis J Kaplan, Sarah Monchar, Andrew Moody, Julie Lindeman Read, B Christian Renne, Michael G Sarosi, Sandra M Swoboda, Kelly A Thompson-Brazill, Chris L Wells, Diana C Anderson","doi":"10.1097/CCM.0000000000006572","DOIUrl":"10.1097/CCM.0000000000006572","url":null,"abstract":"<p><strong>Rationale: </strong>Advances in technology, infection control challenges-as with the COVID-19 pandemic-and evolutions in patient- and family-centered care highlight ideal aspects of ICU design and opportunities for enhancement.</p><p><strong>Objectives: </strong>To provide evidence-based recommendations for clinicians, administrators, and healthcare architects to optimize design strategies in new or renovation projects.</p><p><strong>Panel design: </strong>A guidelines panel of 27 members with experience in ICU design met virtually from the panel's inception in 2019 to 2024. The panel represented clinical professionals, architects, engineers, and clinician methodologists with expertise in developing evidence-based clinical practice guidelines. A formal conflict of interest policy was followed throughout the guidelines-development process.</p><p><strong>Methods: </strong>Embase, Medline, CINAHL, Central, and Proquest were searched from database inception to September 2023. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to determine certainty in the evidence and to formulate recommendations, suggestions, and practice statements for each Population, Intervention, Control, and Outcomes (PICO) question based on quality of evidence and panel consensus. Recommendations were provided when evidence was actionable; suggestions, when evidence was equivocal; and practice statements when the benefits of the intervention appeared to outweigh the risks, but direct evidence to support the intervention did not exist.</p><p><strong>Results: </strong>The ICU Guidelines panel issued 17 recommendations based on 15 PICO questions relating to ICU architecture and design. The panel strongly recommends high-visibility ICU layouts, windows and natural lighting in all patient rooms to enhance sleep and recovery. The panel suggests integrated staff break/respite spaces, advanced infection prevention features, and flexible surge capacity. Because of insufficient evidence, the panel could not make a recommendation around in-room supplies, decentralized charting, and advanced heating, ventilation, and air conditioning systems.</p><p><strong>Conclusions: </strong>This ICU design guidelines is intended to provide expert guidance for clinicians, administrators, and healthcare architects considering erecting a new ICU or revising an existing structure.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e690-e700"},"PeriodicalIF":7.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467150","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":"Nuanced Insights on ICU Guideline Implementation.","authors":"Guo-Qiang Song, Shan Zhou, Dan Shan","doi":"10.1097/CCM.0000000000006509","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006509","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 3","pages":"e757-e758"},"PeriodicalIF":7.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540481","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 Definition of the Intensivist in the Era of Global Healthcare: 2024 Consensus Statement From the Society of Critical Care Medicine Defining Intensivist Task Force.","authors":"Daniel Wu, Amy L Dzierba, Enyo A Ablordeppey, Todd Dorman, Bin Du, Alina O Dulu, Kyle Gunnerson, Pamela B Holly, Johannes Jansen van Rensburg, Teresa B Kortz, Sarah L Livesay, Javier Lorenzo, Maureen A Madden, Piyush Mathur, Sheila Nainan Myatra, Kathryn E Roberts, Gloria M Rodríguez-Vega, Tamas Szakmany, Ahmed Taha, Samuel A Tisherman","doi":"10.1097/CCM.0000000000006580","DOIUrl":"10.1097/CCM.0000000000006580","url":null,"abstract":"<p><strong>Objectives: </strong>The goal of this task force was to examine the 1992 definition of the intensivist, identify gaps, and initiate a path forward to define a concise and practical definition that could be applied globally.</p><p><strong>Design: </strong>A modified Delphi technique was used to develop a revised definition and roles of the intensivist. We determined a priori that 75% or greater participant agreement for the definition and essential roles of the intensivist was required.</p><p><strong>Setting: </strong>A task force consisting of physicians, a respiratory therapist, advanced practice providers, and a pharmacist that practice in critical/intensive care medicine, in various settings, was established with the goal of evaluating and revising the previous definition considering evolving healthcare.</p><p><strong>Subjects: </strong>The task force participated in online questionnaires related to the definition and roles of the intensivist.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The task force agreed on the following definition of an intensivist: \"A physician who has successfully completed an accredited program or equivalent critical care/intensive care medicine training and maintains advanced certification (if available); and shows dedication to the area of critical/intensive care medicine in the way of professional work.\" Additionally, the task force determined a list of essential roles of the intensivist categorized into Direct Clinical Care, Unit Management/Unit Involvement, Responsibility to the Community, and Administration and Leadership.</p><p><strong>Conclusions: </strong>The revised definition of the intensivist seeks to integrate the intensivist in the current realm of team-based healthcare. The intensivist is a physician who provides care to critically ill patients in collaboration with an interprofessional team. Establishment of a single, revised definition is intended to render clarity of an intensivist's role and responsibilities for patients, families, and the interprofessional team.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e548-e554"},"PeriodicalIF":7.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467154","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":"Time to Intubation in Immunocompromised Patients. Minutes or Hours? That Is the Question.","authors":"Francesco Alessandri, Vlad Cristian Sanda, Antonio Esquinas","doi":"10.1097/CCM.0000000000006508","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006508","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 3","pages":"e747-e748"},"PeriodicalIF":7.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540487","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":"Gabrielle Hornstein, Han Ting Wang, Marc Brosseau","doi":"10.1097/CCM.0000000000006582","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006582","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 3","pages":"e745-e746"},"PeriodicalIF":7.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540485","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":"Disorders of Lymphatic Architecture and Flow in Critical Illness.","authors":"Maxim Itkin, Jiri Horak, Jose L Pascual, Cherylee W J Chang, Deacon Lile, Beverly Tomita, Gary Alan Bass, Stephen J Kovach, Lewis J Kaplan","doi":"10.1097/CCM.0000000000006561","DOIUrl":"10.1097/CCM.0000000000006561","url":null,"abstract":"<p><strong>Objectives: </strong>To provide a narrative review of disordered lymphatic dynamics and its impact on critical care relevant condition management.</p><p><strong>Data sources: </strong>Detailed search strategy using PubMed and Ovid Medline for English language articles (2013-2023) describing congenital or acquired lymphatic abnormalities including lymphatic duct absence, injury, leak, or obstruction and their associated clinical conditions that might be managed by a critical care medicine practitioner.</p><p><strong>Study selection: </strong>Studies that specifically addressed abnormalities of lymphatic flow and their management were selected. The search strategy time frame was limited to the last 10 years to enhance relevance to current practice.</p><p><strong>Data extraction: </strong>Relevant descriptions or studies were reviewed, and abstracted data were parsed into structural or functional etiologies, congenital or acquired conditions, and their management within critical care spaces in an acute care facility.</p><p><strong>Data synthesis: </strong>Abnormal lymph flow may be identified stemming from congenital lymphatic anomalies including lymphatic structure absence as well as acquired obstruction or increased flow from clinical entities or acute therapy. Macro- and microsurgical as well as interventional radiological techniques may address excess, inadequate, or obstructed lymph flow. Patients with deranged lymph flow often require critical care, and those who require critical care may concomitantly demonstrate deranged lymph flow that adversely impacts care.</p><p><strong>Conclusions: </strong>Critical care clinicians ideally demonstrate functional knowledge of conditions that are directly related to, or are accompanied by, deranged lymphatic dynamics to direct timely diagnostic and therapeutic interventions during a patient's ICU care episode.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e665-e682"},"PeriodicalIF":7.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946044","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 Caregiver Pathway Intervention Can Contribute to Reduced Post-Intensive Care Syndrome Among Family Caregivers of ICU Survivors: A Randomized Controlled Trial.","authors":"Solbjørg Watland, Lise Solberg Nes, Øivind Ekeberg, Morten Rostrup, Elizabeth Hanson, Mirjam Ekstedt, Una Stenberg, Milada Hagen, Elin Børøsund","doi":"10.1097/CCM.0000000000006546","DOIUrl":"10.1097/CCM.0000000000006546","url":null,"abstract":"<p><strong>Objectives: </strong>Explore short-term effects of \"The Caregiver Pathway,\" an intervention for family caregiver follow-up, on Post-Intensive Care Syndrome symptoms among families (PICS-F).</p><p><strong>Design: </strong>A randomized controlled trial.</p><p><strong>Setting: </strong>A medical ICU at a Norwegian University Hospital.</p><p><strong>Participants: </strong>One hundred ninety-six family caregivers of critically ill patients randomized to an intervention ( n = 101) or control group ( n = 95).</p><p><strong>Interventions: </strong>\"The Caregiver Pathway\" four-step model offers individual and structured follow-up, including: 1) mapping family caregivers' needs and concerns with an assessment tool followed by a conversation with an ICU nurse within the first days at the ICU, 2) a supportive card when leaving the ICU, 3) offer for the family caregivers to receive a phone call after ICU patient discharge, and 4) a follow-up conversation within 3 months.</p><p><strong>Measurements and main results: </strong>Data were collected at baseline and after 3 months and analyzed using linear regression. No significant effects were detected when comparing all participants completing 3-month outcome measurements ( n = 144). A subgroups analysis stratified on patient survival, however, showed statistically significant effect for family caregivers of patients surviving the ICU stay receiving the intervention compared with controls. Caregivers of surviving patients reported improved symptoms related to post-traumatic stress disorder, measured by Impact of Event Scale-Revised (B = -8.2 [95% CI, -14.2 to -2.2]; p = 0.008), anxiety (B = -2.2 [95% CI, -4.0 to -0.5]; p = 0.014), and depression (B = -1.5 [95% CI, -2.9 to -0.1]; p = 0.035); measured by the Hospital Anxiety and Depression Scale, subscore physical functioning in health-related quality of life (B = 9.7 [95% CI, 0.3-19.0]; p = 0.043); measured by Short Form 12-Item Health Survey; and hope (B = 2.4 [95% CI, 0.4-4.3]; p = 0.017) and measured by the Herth Hope Index. At 3-month, the model did not appear to improve the outcomes for family caregivers of nonsurviving patients.</p><p><strong>Conclusions: </strong>\"The Caregiver Pathway\" intervention was associated with reduced symptoms of PICS-F in family caregivers of surviving ICU patients compared with controls.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e555-e566"},"PeriodicalIF":7.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881682","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":"Windows in the ICU and Postoperative Delirium: A Retrospective Cohort Study.","authors":"Diana C Anderson, Paige E Warner, Matthew R Smith, Marissa L Albanese, Ariel L Mueller, John Messervy, B Christian Renne, Samuel J Smith","doi":"10.1097/CCM.0000000000006557","DOIUrl":"10.1097/CCM.0000000000006557","url":null,"abstract":"<p><strong>Objectives: </strong>The ICU built environment-including the presence of windows-has long been thought to play a role in delirium. This study investigated the association between the presence or absence of windows in patient rooms and ICU delirium.</p><p><strong>Design: </strong>Retrospective single institution cohort study. Delirium was assessed with the Confusion Assessment Method for the ICU.</p><p><strong>Setting and patients: </strong>ICU patients between January 1, 2020, and September 1, 2023, were categorized into windowed or nonwindowed groups based on their ICU room design. The primary outcome was the presence or absence of delirium at any time during the patient's ICU stay. Secondary outcomes included the presence of delirium during the first 7 days of the ICU stay, hospital length of stay, ICU length of stay, in-hospital mortality, pain scores, and Richmond Agitation-Sedation Scale scores.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>A total of 3527 patient encounters were included in the final analysis, of which 1292 distinct patient encounters were admitted to a room without windows (37%). Delirium was observed in 21% of patients (460/2235) in windowed rooms and 16% of patients (206/1292) in nonwindowed rooms. In adjusted analyses, patients in windowed rooms were associated with an increase in the odds of the presence of delirium (odds ratio, 1.29; 95% CI, 1.07-1.56; p = 0.008). Patients in windowed rooms were found to have longer hospital (adjusted hazard ratio [aHR], 0.94; 95% CI, 0.87-1.00) and ICU length of stay (aHR, 0.93; 95% CI, 0.87-1.00) compared with patients in the nonwindowed rooms, although this was not statistically significant in adjusted analyses ( p = 0.06 and 0.05, respectively). No statistically significant difference was observed in other secondary outcomes.</p><p><strong>Conclusions: </strong>The current study provides insightful information regarding associations between a component of the ICU built environment, specifically the presence or absence of windows, and the frequency of delirium.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e590-e599"},"PeriodicalIF":7.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945976","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 Associated With Readmission After Discharge From the ICU.","authors":"Guanyu Yang","doi":"10.1097/CCM.0000000000006501","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006501","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 3","pages":"e736"},"PeriodicalIF":7.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540479","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}