Critical Care Medicine最新文献

{"title":"RBC Transfusion Practices in Critically Ill Patients With Sepsis.","authors":"Myung Jin Song, Woo-In Seo, Yeonhoon Jang, Sunghoon Park, RyoungEun Ko, Gee Young Suh, Dong Kyu Oh, Su Yeon Lee, Mi Hyeon Park, Chae-Man Lim, Se Young Jung, Sung Yoon Lim","doi":"10.1097/CCM.0000000000006892","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006892","url":null,"abstract":"<p><strong>Objective: </strong>To assess real-world RBC transfusion practices during early resuscitation in sepsis and evaluate their association with 60-day mortality.</p><p><strong>Design: </strong>Secondary analysis of a prospective, multicenter observational cohort (the Korean Sepsis Alliance cohort) from September 2019 to December 2022.</p><p><strong>Setting: </strong>Thirteen ICUs across South Korea.</p><p><strong>Patients: </strong>Adults (19 yr old or older) admitted to the ICU with sepsis were categorized into transfused and non-transfused groups based on whether they received RBC transfusions during ICU days 1-3.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Among 2613 patients (mean age 71.9 ± 13.3 yr old), 45.3% received RBC transfusions during the early resuscitation phase. The mean lowest hemoglobin level on the day of transfusion was 8.8 ± ;1.7 g/dL. RBC transfusion was associated with clinical factors beyond hemoglobin levels, including higher Simplified Acute Physiology Score 3 and Sepsis-Induced Coagulopathy scores, septic shock, surgical source control, elevated lactate and bilirubin levels, low platelet counts, the use of two or more vasopressors, and continuous renal replacement therapy. In the propensity score-matched cohort, there was no overall difference in 60-day mortality between groups. However, a significant qualitative interaction was observed when stratifying by an ICU day 1 hemoglobin threshold of 10 g/dL (p for interaction = 0.0124). RBC transfusion was linked to higher mortality at hemoglobin greater than or equal to 10 g/dL, but showed a trend toward decreased mortality below this threshold.</p><p><strong>Conclusions: </strong>RBC transfusions are common in critically ill patients with sepsis, highlighting a gap between clinical practice and guideline recommendations. Although not associated with overall mortality, a qualitative interaction was observed at a hemoglobin threshold of 10 g/dL. Transfusion decisions may be guided by physiologic markers up to 9-10 g/dL, but should be avoided when hemoglobin levels exceed 10 g/dL due to the potential for harm.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145291484","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":"Variability in Venovenous Extracorporeal Membrane Oxygenation Candidacy Decision-Making: An International Survey.","authors":"James C Henderson, Annette M Ilg, Melissa A Meeker, Jacqueline M Kruser, Alison S Witkin, Eddy Fan, Jonah Rubin","doi":"10.1097/CCM.0000000000006889","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006889","url":null,"abstract":"<p><strong>Objective: </strong>To characterize the variability in venovenous extracorporeal membrane oxygenation (VV-ECMO) candidacy decision-making processes across international Extracorporeal Life Support Organization (ELSO) member institutions.</p><p><strong>Design: </strong>An international survey study of ELSO centers performing adult VV-ECMO.</p><p><strong>Setting: </strong>Internet-based survey conducted between February 2024 and April 2024.</p><p><strong>Participants: </strong>ECMO clinicians representing ELSO member institutions, including ECMO directors, physicians, coordinators, and others listed in the ELSO institutional directory as of January 2024.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Measurements included center characteristics, decision-making processes, contraindications used, and clinician perceptions of consistency in candidacy determinations. Most centers (82%) reported having formal inclusion and exclusion criteria, with 95% having absolute contraindications to initiating VV-ECMO as a bridge to recovery. However, very few centers shared identical sets of contraindications. The most common absolute contraindications were severe neurologic injury (77%) and disseminated malignancy (75%). Clinician judgment was perceived as equally or more important than institutional guidelines in 93% of centers. Representatives from 54% of centers believed that candidacy decisions were not always consistent between clinically identical patients, and less than half of centers routinely reviewed all prior candidacy decisions.</p><p><strong>Conclusions: </strong>This study reveals significant variability in VV-ECMO candidacy decision-making processes across international ELSO centers. The observed inconsistencies in contraindications, reliance on clinical judgment, and perceived variability in decisions suggest a need for more standardized, evidence-based approaches to ECMO candidacy determination. Implementing routine review processes and developing more robust guidelines could improve consistency and equity in ECMO allocation.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145291449","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":"Five Years After Extracorporeal Membrane Oxygenation: A Prospective Cohort Study of Health-Related Quality of Life and Patient Outcomes.","authors":"Floris E J Jolink, Marisa Onrust, Dinis Dos Reis Miranda, Loes Mandigers, Thijs Delnoij, Jacinta J Maas, S Jorinde Raasveld, Alexander P J Vlaar, Dirk W Donker, Erik Scholten, Jesse de Metz, Judith van den Brule, Marijn Kuijpers, Karin M Vermeulen, Peter H J van der Voort, Walter M van den Bergh, Annemieke Oude Lansink-Hartgring","doi":"10.1097/CCM.0000000000006900","DOIUrl":"10.1097/CCM.0000000000006900","url":null,"abstract":"<p><strong>Objectives: </strong>To report on 5-year survival, health-related quality of life (HRQoL), and occupational status of patients with respiratory or cardiac failure, who were supported with extracorporeal membrane oxygenation (ECMO).</p><p><strong>Design: </strong>A prospective multicenter observational cohort follow-up study.</p><p><strong>Setting: </strong>ICUs of ten ECMO centers in the Netherlands, representing more than 90% of all patients supported with ECMO in the Netherlands.</p><p><strong>Patients: </strong>Patients supported with ECMO between August 2017 and July 2019.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Survival was assessed by consulting the Dutch municipal records database. All 5-year survivors received a questionnaire. HRQoL was assessed using the standardized EuroQol 5D Five Levels instrument, and occupational status was assessed using the standardized Institute for Medical Technology Assessment Productivity Cost Questionnaire. Of the initial 428 participants, 230 (54%) survived the hospital admission, 213 (50%) survived the first year, and 155 (36%) survived 5 years. Five-year survival rates were 42% for patients receiving ECMO for respiratory support, 39% for cardiac support, and 25% for extracorporeal cardiopulmonary resuscitation. The response rate to the questionnaire was 72%. HRQoL was rated satisfactory at 5 years, with a median EuroQol index of 0.82 (interquartile range, 0.73-0.98). Five-year survivors reported slight-to-moderate impairment of mobility (39%), impairment of usual activities (44%), and pain or discomfort (60%). After 5 years, the majority of patients were either employed (41%), retired (31%), or permanently declared unfit for work (26%).</p><p><strong>Conclusions: </strong>Long-term outcome in patients supported with ECMO is good. Five-year survivors reported that HRQoL was satisfactory despite some impairment in day-to-day functioning.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145291422","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":"Hyperosmolar Dehydration in Sepsis: Implications for Initial Fluid Management.","authors":"Kyung-Eui Lee, Jinwoo Lee, Sang-Min Lee, Dong Kyu Oh, Su Yeon Lee, Dong-Gon Hyun, Mi Hyeon Park, Chae-Man Lim, Hong Yeul Lee","doi":"10.1097/CCM.0000000000006891","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006891","url":null,"abstract":"<p><strong>Objective: </strong>Patients with sepsis are prone to hypovolemia which can lead to hyperosmolar dehydration and result in intracellular volume depletion. This study aimed to assess the effect of hyperosmolar dehydration on the clinical outcomes of patients with sepsis and its potential as an indicator of optimal initial fluid management.</p><p><strong>Design: </strong>A nationwide propensity score-matched cohort study analyzing data prospectively collected between September 2019 and December 2021.</p><p><strong>Setting: </strong>Twenty tertiary- or university-affiliated hospitals in South Korea.</p><p><strong>Patients: </strong>Adult patients with sepsis or septic shock admitted to the ICU.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Hyperosmolar dehydration was defined as serum osmolarity greater than or equal to 295 mOsm/L. The primary outcome, 30-day mortality, was compared using logistic regression adjusted for key prognostic factors in a 1:1 propensity score-matched cohort. Restricted cubic-spline models were used to analyze the clinical outcomes using the pre-ICU fluid volume as a continuous variable. Of the 4,487 patients, 2,605 (58.1%) had hyperosmolar dehydration. After matching, 1,537 pairs were analyzed. The 30-day mortality was higher in the hyperosmolar dehydration group (29.9%) than in the non-dehydration group (27.3%) (adjusted odds ratio, 1.18; 95% CI, 1.00-1.39). Liberal fluid management (greater than30 mL/kg) before ICU admission was associated with improved lactate levels in the hyperosmolar dehydration group (p = 0.009) without increasing sequential organ failure assessment score (p = 0.111). Among patients without dehydration, liberal fluid management was associated with an increased Sequential Organ Failure Assessment score (p = 0.034) and a higher risk for mechanical ventilation (p < 0.001), and without improving lactate levels (p = 0.388).</p><p><strong>Conclusions: </strong>Hyperosmolar dehydration at the diagnosis of sepsis was associated with increased 30-day mortality. A liberal fluid management benefits patients with hyperosmolar dehydration by improving lactate levels without increasing sequential organ failure assessment score. These findings highlight the importance of individualized fluid management based on the dehydration status in sepsis management.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250296","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":"Critical Illness-Associated Hyperglycemia and New-Onset Diabetes: A Retrospective Cohort Study.","authors":"Navid Soltani, Henrike Häbel, David Nelson, Johan Mårtensson","doi":"10.1097/CCM.0000000000006884","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006884","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the relationship between critical illness-associated hyperglycemia (CIAH) during ICU treatment and the development of incident diabetes in ICU survivors without pre-existing diabetes or prediabetes.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Setting: </strong>Four university hospital ICUs in Stockholm, Sweden.</p><p><strong>Patients: </strong>A total of 6633 ICU survivors admitted between 2010 and 2021, with no prior diabetes diagnosis recorded in the Swedish National Diabetes Register (NDR) and a glycated hemoglobin A1c level below 42 mmol/mol (6%) at admission.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>CIAH was defined as insulin administration to maintain blood glucose between 6 and 10 mmol/L (108-180 mg/dL) in ICU. Incident diabetes was defined as an NDR registration after ICU discharge, occurring beyond 30 days until September 2023. Overall, 3100 (46.7%) patients developed CIAH in the ICU. The 5-year cumulative diabetes incidence was higher in patients with CIAH (4.1%, 95% CI, 3.4-4.9%) compared with those without CIAH (1.8%, 95% CI, 1.3-2.3%). On multivariable Cox regression, the adjusted hazard ratio for incident diabetes was 2.15 (95% CI, 1.52-3.03) in patients with CIAH. Similarly, multivariable competing risk analysis revealed an adjusted sub-hazard ratio of 2.20 (95% CI, 1.57-3.08) for CIAH.</p><p><strong>Conclusions: </strong>CIAH in ICU patients without pre-existing diabetes or prediabetes was associated with a higher risk of developing incident diabetes within 5 years of ICU discharge.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231703","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":"Habitual Glucosamine Use and Risk of Sepsis: A 16-Year Follow-Up Study.","authors":"Shaokang Xu, Xiaoke Kong, Jian Shi, Yiting Tang, Bin Zhao, Fang Fang, Jiaqi Huang, Ben Lu","doi":"10.1097/CCM.0000000000006742","DOIUrl":"10.1097/CCM.0000000000006742","url":null,"abstract":"<p><strong>Objectives: </strong>Despite the well-documented anti-inflammatory and antioxidant properties of glucosamine, a supplement commonly used to relieve osteoarthritis and joint pain, its potential link with sepsis is yet to be elucidated. To evaluate the association between habitual glucosamine use and the risk of sepsis and 28-day mortality following sepsis in a large cohort.</p><p><strong>Design: </strong>A large-scale cohort study.</p><p><strong>Setting: </strong>This was a retrospective cohort study of prospectively collected data, including 437,133 participants of the U.K. Biobank.</p><p><strong>Patients: </strong>A total of 437,133 participants from the U.K. Biobank.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Information on glucosamine use was collected through touchscreen questionnaires at baseline. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs for the associations between habitual glucosamine use and risk of sepsis and 28-day mortality following sepsis. During a median follow-up of 13.6 years, 13,458 incident cases of sepsis and 2,555 deaths within 28 days post-sepsis were identified. In the multivariable-adjusted model, habitual glucosamine use was associated with a lower risk of sepsis (HR, 0.87; 95% CI, 0.83-0.92) and 28-day mortality following sepsis (HR, 0.79; 95% CI, 0.70-0.89). These associations were consistent across stratified and sensitivity analyses. Mediation analysis revealed that 1.2-7.0% of the association for sepsis and 2.8-5.4% of the association for 28-day mortality following sepsis were mediated through inflammatory biomarkers, including C-reactive protein and systemic immune-inflammation index (all p < 0.001).</p><p><strong>Conclusions: </strong>Our findings elucidated that habitual use of glucosamine was associated with lower risks of sepsis and post-sepsis mortality. The observed associations might be partially mediated through inflammatory pathways.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1906-e1917"},"PeriodicalIF":6.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282782","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":"Trends of Physical and Occupational Therapy Utilization in ICU Patients Undergoing Mechanical Ventilation in the United States: 2008-2021.","authors":"Joel Mintz, Mohammed Mustafa, Rose M Puthumana, Juan P Uribe, Christopher M Mallow, Hayley B Gershengorn","doi":"10.1097/CCM.0000000000006795","DOIUrl":"10.1097/CCM.0000000000006795","url":null,"abstract":"<p><strong>Background: </strong>Physical and occupational therapy (PT/OT) during invasive mechanical ventilation (IMV) may improve outcomes, however, utilization patterns are understudied.</p><p><strong>Objectives: </strong>Determine trends over time and by hospital in PT/OT utilization.</p><p><strong>Design: </strong>Retrospective study.</p><p><strong>Setting: </strong>Premier Healthcare Database hospitals (2008-2021).</p><p><strong>Patients: </strong>Adults beginning IMV by hospitalization day 3 and receiving IMV continuously for 3-14 days.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The primary outcome was PT/OT usage within the first 3 days of IMV (early PT/OT). Cochran-Armitage tests were used to evaluate unadjusted trends across discharge years. A multilevel multivariable logistic regression model was then created with discharge hospital as a random effect and clinical, sociodemographic, and hospital characteristics as covariables. The median odds ratio (mOR) was calculated to quantify the association of discharge hospital with PT/OT utilization. Across 814 hospitals, 1,228,909 early IMV hospitalizations were identified. Of those, 118,662 (9.7%) had early PT/OT. Frequency of early PT/OT rose from 2008 to 2019 (8.5-10.8%; ptrend < 0.001) before declining in 2020 (9.5%) and 2021 (8.9%). Across hospitals, median early PT/OT usage was 5.4% (interquartile range, 2.9-11.0%). After multivariable adjustment, patients were increasingly more likely to get early PT/OT every year until 2016 (adjusted odds ratio [aOR] for 2016 vs. 2008, 1.52; 95% CI, 1.46-1.59). Use then remained relatively flat until 2020 when it began to decline (aOR for 2020, 1.23; 95% CI, 1.18-1.29 and aOR for 2021, 1.20; 95% CI, 1.15-1.26). The odds of receiving early PT/OT in higher use hospitals was nearly three-fold higher than in lower use hospitals (mOR, 2.82; 95% CI, 2.67-2.97).</p><p><strong>Conclusions: </strong>Early PT/OT usage rose during the early period, before declining significantly in 2020 and 2021. However, use in 2020 and 2021 remained higher than in 2008. Individual hospital of discharge was an important factor in determining who got PT/OT during IMV.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e2076-e2081"},"PeriodicalIF":6.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144689094","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":"Comparison of the Incidence of Arterial Pressure Line Insufficiency Between Polyethylene and Polyurethane Catheters in the ICU: A Randomized Study.","authors":"Kimito Minami, Masahiro Kazawa, Tatsutoshi Shimatani, Masahiro Morinaga, Akira Shimokawa, Takuma Maeda, Muneyuki Takeuchi","doi":"10.1097/CCM.0000000000006794","DOIUrl":"10.1097/CCM.0000000000006794","url":null,"abstract":"<p><strong>Objectives: </strong>Continuous arterial pressure monitoring is crucial for critically ill patients. However, the impact of catheter type on arterial line insufficiency remains unexamined.</p><p><strong>Design: </strong>Double-blinded, superiority, randomized controlled trial.</p><p><strong>Setting: </strong>A cardiovascular center in Japan.</p><p><strong>Patients: </strong>Adult patients scheduled for elective cardiovascular surgery and postoperative admission to the ICU.</p><p><strong>Interventions: </strong>Patients were randomly assigned either polyethylene or polyurethane catheters.</p><p><strong>Measurements and main results: </strong>The outcome of interest was arterial line insufficiency, defined by one or more of the following four criteria: flattened or overdamped blood pressure waveform, sluggish free backflow of blood (> 2 s) when the stopcock was opened to the atmosphere, inability to draw blood from the arterial line, and inability to flush the catheter. The frequency of arterial line insufficiency was observed at the first noon after ICU admission. An interim analysis using the chi-square test was performed after half of the participants were enrolled, with early termination if p value of less than 0.005 based on the O'Brien-Fleming method. Interim analysis of 132 patients revealed significant differences in primary outcomes, leading to early termination of the trial. Arterial line insufficiency occurred in four of 69 patients (5.8%) with polyethylene catheters and 18 of 63 patients (28.6%) with polyurethane catheters (relative risk, 0.15; 95% CI, 0.05-0.48; p = 0.001).</p><p><strong>Conclusions: </strong>This study demonstrated a lower occurrence rate of arterial line insufficiency with polyethylene arterial catheters than polyurethane catheters.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1973-e1981"},"PeriodicalIF":6.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642030","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 Sepsis Chain of Survival: A Comprehensive Framework for Improving Sepsis Outcomes.","authors":"Jorge L Hidalgo, Vishakha K Kumar, Samuel O Akech, Sheila N Myatra, Shevin T Jacob, Teresa Kortz, Amanda A Vasquez, Maria Cristina Jiménez Bazzano, Marilia Diaz, Jennifer Del Rio Rodríguez, Ana Luisa Najera Garcia, Rocio Giron, Judith Jacobi, Maureen A Madden, Vinay Nadkarni","doi":"10.1097/CCM.0000000000006796","DOIUrl":"10.1097/CCM.0000000000006796","url":null,"abstract":"<p><p>The \"Chain of Survival\" concept, developed for cardiac arrest, emphasizes a seamless and interconnected set, of time-critical interventions that are not strictly linear, to improve survival. This paradigm of urgent recognition and response to life-threatening conditions has evolved to apply to acute medical conditions, including sepsis. The \"Sepsis Chain of Survival\" underscores the importance of early recognition, prompt emergency medical services activation, timely antimicrobial administration and appropriate fluid resuscitation, optimized critical care management, effective source control and infection management, and comprehensive post-sepsis care. By adopting this approach, healthcare systems can improve sepsis outcomes through a coordinated, multifaceted strategy. This model highlights the critical role of public and healthcare worker awareness, education, community response, and continuous monitoring. Addressing the importance and interdependence of each link, this framework aims to improve survival rates and patient recovery by ensuring timely and effective sepsis management across diverse resource settings in infants, children, and adults.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1886-e1892"},"PeriodicalIF":6.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12490334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642033","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":"Cardiac Rhythm Conversions and the Outcome in Refractory Out-of-Hospital Cardiac Arrest: Extracorporeal Versus Conventional Resuscitation.","authors":"Stepan Havranek, Jakub Neuhöfer, Michaela Vesela, Petra Kavalkova, Daniel Rob, Zdenka Fingrova, Jana Smalcova, Ondrej Franek, Michal Huptych, Milan Dusik, Jan Pudil, Vojtech Weiss, Ales Linhart, Jan Belohlavek","doi":"10.1097/CCM.0000000000006787","DOIUrl":"10.1097/CCM.0000000000006787","url":null,"abstract":"<p><strong>Objectives: </strong>A Prague out-of-hospital cardiac arrest (OHCA) study has demonstrated that an invasive approach (early transport to the hospital, extracorporeal cardiopulmonary resuscitation [ECPR]) is a feasible and effective treatment strategy in refractory OHCA. This post hoc analysis of the Prague OHCA study aimed to stratify the prognosis of patients according to the detailed course of heart rhythm during prehospital and early hospital periods.</p><p><strong>Design, setting, and patients: </strong>This analysis included all 256 patients (median age 58, 17% females) randomized to the Prague OHCA study. The sequence of heart rhythms during the prehospital period was analyzed in terms of neurologic outcomes after 180 days. The primary outcome was a composite of survival with Cerebral Performance Category 1 or 2 at 180 days.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Within the study cohort, 156 (61%) manifested ventricular fibrillation (VF), 45 pulseless electrical activity, and 55 asystole as the initial rhythm. Patients with an initial VF who reached a sustained recovery of spontaneous circulation (ROSC) had the highest proportion of reaching a primary outcome (32/44 [73%]). Patients who had one or more episodes of asystole during cardiopulmonary resuscitation had the lowest rate of primary endpoint (5/39 [13%]). Patients who experienced intermittent ROSC showed a higher success rate in achieving the primary outcome when treated with an invasive-based approach (including ECPR) compared with the conventional strategy (26/34 [76%] vs. 24/50 [48%]; p < 0.05).</p><p><strong>Conclusions: </strong>Achieving ROSC is the best prognostic marker in OHCA patients with an initially refractory VF. Patients with intermittent ROSC after the initial VF and ongoing VF seem to be optimal candidates for an invasive approach. Asystole detection at any time during resuscitation is a strong negative prognostic marker, irrespective of the initial rhythm.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1930-e1940"},"PeriodicalIF":6.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12490342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642029","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}