Critical Care Medicine最新文献

{"title":"Interpreting Hyperoxemia in Venoarterial Extracorporeal Membrane Oxygenation Patients.","authors":"Claudio Ripa, Marco Giani, Emanuele Rezoagli, Matteo Pozzi","doi":"10.1097/CCM.0000000000007038","DOIUrl":"https://doi.org/10.1097/CCM.0000000000007038","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"54 5","pages":"1275-1276"},"PeriodicalIF":6.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834699","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 Guidelines on Caring for Older Adults in the ICU.","authors":"Lauren E Ferrante, Dipayan Chaudhuri, Kallirroi Laiya Carayannopoulos, Snigdha Jain, Judith A Tate, Evelyn Álvarez-Espinoza, C Adrian Austin, Lisa Burry, Michael J Devinney, William J Ehlenbach, Mary Beth Happ, Aluko A Hope, May Hua, Michelle E Kho, Jessica A Palakshappa, Leslie P Scheunemann, Liron Sinvani, Barbara Stahl, Sophia Wang, Hannah Wunsch, Bram Rochwerg, Nathan E Brummel","doi":"10.1097/CCM.0000000000007085","DOIUrl":"10.1097/CCM.0000000000007085","url":null,"abstract":"<p><strong>Rationale: </strong>Older adults (those 65 years old or greater) compose a substantial proportion of the ICU population. As older adults with critical illness possess unique factors and considerations relevant to their care and outcomes, there is a need for evidence-based recommendations to guide critical care clinicians in the care of older ICU patients.</p><p><strong>Objective: </strong>The objective of this guideline is to develop evidence-based recommendations addressing the care of older adults during and after critical illness.</p><p><strong>Design: </strong>The American College of Critical Care Medicine Board convened a 22-member interprofessional panel, comprising physicians, advanced practice providers, nurses, a pharmacist, physical therapist, occupational therapist, and a patient representative. The panel included two expert methodologists specialized in developing evidence-based recommendations in alignment with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Conflict-of-interest policies were strictly followed during all phases of guideline development including task force selection and voting.</p><p><strong>Methods: </strong>The panel members prioritized five Population, Intervention, Comparator, and Outcomes questions. A systematic review was conducted for each question to identify the best available evidence, synthesize the evidence and assess the certainty of evidence using GRADE. The evidence-to-decision framework was used to formulate recommendations.</p><p><strong>Results: </strong>The panel generated two conditional recommendations and three \"no recommendation\" statements. The conditional recommendations are: 1) We suggest a geriatric model of care for all older adults admitted to the ICU and 2) We suggest not using antipsychotic medications for the prevention of delirium in older adults with critical illness. The three \"no recommendation\" statements are: 1) We make no recommendation regarding specialized post-ICU follow-up for older survivors of critical illness, 2) For older adults (age 65 and over) admitted to the ICU with vasodilatory shock, we make no recommendation with regard to targeting a mean arterial pressure (MAP) of 60-65 mm Hg as compared with usual care (MAP target > 65 mm Hg), and 3) We make no recommendation regarding the use of antipsychotic medication in the treatment of delirium in older adults with critical illness.</p><p><strong>Conclusions: </strong>The guideline panel developed recommendations on caring for older adults during and after critical illness. Areas for future research were also identified during the guideline process.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"1060-1072"},"PeriodicalIF":6.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147484722","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":"Julie Lévi-Strauss, Sarah Benghanem, Bertrand Hermann, Éléonore Bouchereau, Camille Legouy, Tarek Sharshar, Martine Gavaret, Estelle Pruvost-Robieux","doi":"10.1097/CCM.0000000000007081","DOIUrl":"https://doi.org/10.1097/CCM.0000000000007081","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"54 5","pages":"1281-1282"},"PeriodicalIF":6.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834786","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":"Safety of Enteral Feeding in Patients on High-Flow Nasal Cannula.","authors":"Michael R West, Evan J Chen, Jack Rodman, Luis E Huerta","doi":"10.1097/CCM.0000000000007074","DOIUrl":"10.1097/CCM.0000000000007074","url":null,"abstract":"<p><strong>Objectives: </strong>The goal of this study was to assess the effect of enteral feeding on aspiration risk and progression of respiratory failure in adults on high-flow nasal cannula (HFNC) oxygen therapy.</p><p><strong>Design: </strong>Single-center retrospective cohort study.</p><p><strong>Setting: </strong>Keck Hospital of the University of Southern California, a tertiary care academic hospital.</p><p><strong>Patients: </strong>Hospitalized adults treated with HFNC between January 1, 2020, and December 31, 2022, were included. Exclusion criteria were chronic total parenteral nutrition, chronic tracheostomy, history of total laryngectomy, and \"Do Not Intubate\" code status.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The primary outcome was the progression of respiratory failure from HFNC to noninvasive positive pressure ventilation, mechanical ventilation, or extracorporeal membrane oxygenation. We included 220 patients in the primary analysis. The median age was 62.6 years, 54.1% of patients were male, and 43.6% of patients were White. The primary outcome of progression of respiratory failure occurred in 57 patients, of whom 19 (33.3%) were feeding enterally and 38 (66.7%) were NPO at the time of progression. Patients feeding enterally were less likely than those who were NPO to have progression of respiratory failure in a multivariate mixed effects linear regression model (odds ratio [OR], 0.33; 95% CI, 0.18-0.58; p < 0.001). Patients feeding enterally remained less likely to have progression of respiratory failure in a propensity score-matched analysis (OR, 0.30; 95% CI, 0.15-0.58; p < 0.001).</p><p><strong>Conclusions: </strong>In this single-center, retrospective cohort, enteral nutrition in patients on HFNC was associated with lower risk of progression of respiratory failure and was not associated with increased risk of poor clinical outcomes. Prospective multicenter studies are needed to confirm these findings.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"1114-1123"},"PeriodicalIF":6.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146218892","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":"Point-of-Care Electrolyte Measurement in ICU: Mind the Interpretation Bias, Operational, and Knowledge Gaps.","authors":"Venu M Velagapudi","doi":"10.1097/CCM.0000000000007055","DOIUrl":"10.1097/CCM.0000000000007055","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"1254-1260"},"PeriodicalIF":6.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147467252","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":"Pancreatic Stone Protein: A Novel Contribution Toward Early Sepsis Recognition.","authors":"Evangelos J Giamarellos-Bourboulis","doi":"10.1097/CCM.0000000000007101","DOIUrl":"10.1097/CCM.0000000000007101","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"1272-1274"},"PeriodicalIF":6.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147431290","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":"Executive Summary: Society of Critical Care Medicine Guidelines on Caring for Older Adults in the ICU.","authors":"Lauren E Ferrante, Dipayan Chaudhuri, Kallirroi Laiya Carayannopoulos, Snigdha Jain, Judith A Tate, Evelyn Álvarez-Espinoza, C Adrian Austin, Lisa Burry, Michael J Devinney, William J Ehlenbach, Mary Beth Happ, Aluko A Hope, May Hua, Michelle E Kho, Jessica A Palakshappa, Leslie P Scheunemann, Liron Sinvani, Barbara Stahl, Sophia Wang, Hannah Wunsch, Bram Rochwerg, Nathan E Brummel","doi":"10.1097/CCM.0000000000007084","DOIUrl":"10.1097/CCM.0000000000007084","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"1056-1059"},"PeriodicalIF":6.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147484660","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 Weight of the Situation: The Case for Standardizing Vasopressor Dosing Units.","authors":"Michael A Rudoni, Gretchen L Sacha, Siddharth Dugar, Nasim Motayar, Patrick M Wieruszewski","doi":"10.1097/CCM.0000000000007141","DOIUrl":"https://doi.org/10.1097/CCM.0000000000007141","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"54 5","pages":"1049-1055"},"PeriodicalIF":6.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834835","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 Protocolized Magnesium Supplementation and Atrial Fibrillation or Flutter in Critically Ill Patients: A Multicenter Retrospective Cohort Study.","authors":"Christopher J Yarnell, Federico Angriman, Eliot Beaubien, Jamie Brown, Selasi Bruce-Kemevor, Lisa Burry, Joshua Craig, Simon Donato-Woodger, Shannon M Fernando, Rob Fowler, Thecla Kattakkayam, Francois Lamontagne, Varuna Prakash, Tabo Sikaneta, Stephanie Sibley, Karim Soliman, George Tomlinson, Thomas Bodley","doi":"10.1097/CCM.0000000000007062","DOIUrl":"10.1097/CCM.0000000000007062","url":null,"abstract":"<p><strong>Objectives: </strong>Most ICUs use protocolized magnesium supplementation, yet the clinical effect of this practice is unknown.</p><p><strong>Design: </strong>Pseudo-randomized retrospective study comparing patients who were and were not assigned to receive magnesium supplementation, using a protocol where supplementation occurs when serum levels are less than or equal to 0.95 mmol/L (2.31 mg/dL). Primary outcome was atrial fibrillation or flutter within 24 hours. Secondary outcomes were tachyarrhythmia (supraventricular tachycardia or ventricular arrhythmia) and death within 24 hours.</p><p><strong>Setting: </strong>ICUs with a shared magnesium supplementation protocol, in five hospitals in Ontario, Canada, from January 1, 2022, to December 31, 2024.</p><p><strong>Patients: </strong>Adults (18 yr old or older) admitted to ICU with a magnesium protocol order, at their first magnesium level of 0.92-0.99 mmol/L (2.24-2.41 mg/dL). To minimize confounding, we included only patients with a level near the supplementation threshold.</p><p><strong>Interventions: </strong>None.</p><p><strong>Exposure: </strong>Magnesium level 0.92-0.95 mmol/L (2.24-2.31 mg/dL, supplementation group) vs. 0.96-0.99 mmol/L (2.32-2.41 mg/dL, no supplementation group).</p><p><strong>Measurements and main results: </strong>We identified 4198 patients; median age 70 years, 41% female, 39% invasively ventilated; 2144 (51%) in the supplementation group, of whom 77% received magnesium, and 2054 (49%) in the no supplementation group, of whom 9% received magnesium. Atrial fibrillation or flutter occurred within 24 hours in 355 (16.6%) in the supplementation group and 375 (18.3%) in the no supplementation group. Bayesian logistic regression, adjusted for hospital, showed a 1.6% absolute risk reduction associated with supplementation (95% credible interval, 3.8% reduction to 0.8% increase; probability of reduction, 0.91). For the composite outcome of atrial fibrillation and flutter, tachyarrhythmia, and death, the absolute risk reduction associated with supplementation was 2.2% (CrI, 4.3% reduction to 0.1% increase; probability of risk reduction, 0.97).</p><p><strong>Conclusions: </strong>Protocolized magnesium supplementation at a threshold of 0.95 mmol/L (2.31 mg/dL) may be associated with reduced 24-hour incidence of atrial fibrillation and flutter in critically ill patients.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"1136-1146"},"PeriodicalIF":6.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084654","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":"Middle-Latency Evoked Potentials and Quantitative Electroencephalogram: Valuable Complements in the Prognostication of Disorders of Consciousness.","authors":"Nathan De Lissnyder, Ilann Oueslati, Nadia Mahmoud, Soufiane Habryka, Patrick M Honoré","doi":"10.1097/CCM.0000000000007023","DOIUrl":"https://doi.org/10.1097/CCM.0000000000007023","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"54 5","pages":"1279-1280"},"PeriodicalIF":6.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834657","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}