Critical Care Medicine最新文献

{"title":"The Aftermath of Acute Surge Events: Quantifying the \"Bystander Effect\" During the COVID-19 Pandemic.","authors":"George L Anesi, Rachel Kohn","doi":"10.1097/CCM.0000000000006821","DOIUrl":"10.1097/CCM.0000000000006821","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e2095-e2097"},"PeriodicalIF":6.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788471","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":"Justifying Pharmacist Services in the ICU: When Is Enough, Enough?","authors":"Eric W Mueller, Sandra L Kane-Gill","doi":"10.1097/CCM.0000000000006831","DOIUrl":"10.1097/CCM.0000000000006831","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e2101-e2104"},"PeriodicalIF":6.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820770","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":"Shock First, Epinephrine Later: Rethinking Resuscitation Priorities in Pediatric In-Hospital Cardiac Arrest With Shockable Rhythms.","authors":"Julia Garcia Mancebo, Cameron Dezfulian, Venessa L Pinto","doi":"10.1097/CCM.0000000000006829","DOIUrl":"10.1097/CCM.0000000000006829","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e2105-e2107"},"PeriodicalIF":6.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834409","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":"Determination of Cerebral Autoregulation at the Bedside: A Narrative Review.","authors":"Jeffrey R Vitt, Spyridoula Tsetsou, Laura Galarza, Aarti Sarwal, Swarna Rajagopalan","doi":"10.1097/CCM.0000000000006790","DOIUrl":"10.1097/CCM.0000000000006790","url":null,"abstract":"<p><strong>Objectives: </strong>To summarize the current evidence on cerebral autoregulation (CAR) monitoring techniques in critical care settings, highlighting their advantages, limitations, and practical applications at the bedside to inform understanding and clinical decision-making for various acute brain injuries and systemic illnesses.</p><p><strong>Data sources: </strong>Articles were retrieved using Ovid MEDLINE, PubMed, and Cochrane library using a comprehensive combination of subject headings and key words including \"cerebral autoregulation,\" \"transcranial Doppler,\" \"near-infrared spectroscopy,\" and \"intracranial pressure.\" See Supplemental Appendix A ( https://links.lww.com/CCM/H763 ) for complete list of search terms. Relevant articles as well as those discovered through the review process (e.g., references in selected articles) were incorporated into the article.</p><p><strong>Study selection: </strong>Original research, review articles, commentaries, and guidelines focusing on bedside CAR monitoring methodologies, their validation, and applications in critically ill patients were included. The review encompassed both acute brain injury and systemic critical illness conditions.</p><p><strong>Data extraction: </strong>Data from included publications were evaluated and synthesized into a comprehensive narrative review examining CAR monitoring methods and clinical applications.</p><p><strong>Data synthesis: </strong>Three commonly used bedside approaches for assessing CAR were identified. Transcranial Doppler ultrasound measures vessel flow velocity response to blood pressure changes, either through vasopressor administration or monitoring spontaneous fluctuations. Near-infrared spectroscopy evaluates regional cerebral oxygenation changes in response to hemodynamic alterations through continuous, noninvasive forehead sensors. Intracranial pressure monitoring enables assessment of pressure reactivity index through analyzing the correlation between intracranial and arterial blood pressure. CAR impairment is common across critical illness, from acute brain injury to systemic conditions like sepsis, cardiac surgery, and hepatic failure, where dysregulation can lead to secondary brain injury and worse outcomes. While each technique offers unique insights into CAR status, they vary in invasiveness, continuous monitoring capability, and technical requirements. Evidence suggests these methods can help to detect impaired CAR, identify optimal perfusion targets, and may guide individualized management strategies.</p><p><strong>Conclusions: </strong>Bedside CAR monitoring represents a promising approach for personalizing hemodynamic management in critically ill patients. While current evidence supports its role in prognostication and management decisions, further research is needed to standardize assessment methods and validate CAR-guided therapy across different critical care conditions. Multimodal monitoring approaches may provide complementary ","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e2062-e2075"},"PeriodicalIF":6.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871849","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 Vasopressor Utilization in Critically Ill Patients With Acute Traumatic Spinal Cord Injury: A Retrospective Cohort Study.","authors":"Mona Hashemaghaie, Tetsu Ohnuma, Ruba Sajdeya, Shreya Khandelwal, N David Yanez, Vijay Krishnamoorthy, Karthik Raghunathan, Michael J Devinney, Aparna Depuru, Miriam M Treggiari","doi":"10.1097/CCM.0000000000006791","DOIUrl":"10.1097/CCM.0000000000006791","url":null,"abstract":"<p><strong>Objectives: </strong>Evidence regarding vasopressor support for acute spinal cord injury (SCI) is lacking. We report early vasopressor use and hospital outcomes in patients with SCI.</p><p><strong>Design: </strong>Propensity-score standardized mortality ratio-weighted retrospective cohort study.</p><p><strong>Setting: </strong>U.S. hospitals participating in the Premier Healthcare Database, 2016-2020.</p><p><strong>Patients: </strong>Adults 18 years old or older with acute traumatic SCI at T8 level or above who received vasopressors within 48 hours of hospitalization.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Of 3636 patients included (mean [ sd ] age, 56 [19]; 2757 [75%] males), 2055 (57%) received phenylephrine, 548 (15%) received norepinephrine, 110 (3%) received other single vasopressor, and 923 (25%) received multiple vasopressors. Baseline cervical SCIs, higher Injury Severity Scores, neurogenic shock, and mechanical ventilation were more likely with norepinephrine administration. The primary outcome was death/hospice/skilled nursing facility vs. home/inpatient care facility/rehabilitation facility. Compared with the phenylephrine group, the norepinephrine group was more likely to have a discharge disposition of death/hospice/or skilled nursing facility (odds ratio [OR], 1.50; 95% CI, 1.14-1.99), and adverse events, including urinary tract infections (OR, 1.66; 95% CI, 1.17-2.35), cardiac arrest (OR, 2.70; 95% CI, 1.74-4.19), acute kidney injury (OR, 1.91; 95% CI, 1.32-2.77), tracheostomy (OR, 1.39; 95% CI, 1.04-1.86), death (OR, 2.04; 95% CI, 1.42-2.93), and longer hospital length of stay (estimate, 3.68 d; 95% CI, 1.63-5.74 d). We observed no differences in pneumonia, thromboembolic events, or cerebrovascular accidents.</p><p><strong>Conclusions: </strong>Phenylephrine and norepinephrine were the most used vasopressors in SCI patients, with norepinephrine more frequently selected in patients with higher injury severity. While indication bias and residual confounding may explain our findings, these data raise the question whether phenylephrine and norepinephrine have different efficacy and safety profiles. Future research should focus on comparative trials of these two commonly prescribed agents.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1952-e1962"},"PeriodicalIF":6.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144689093","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":"Supplemental Prevention of Sepsis?","authors":"Alison E Fox-Robichaud","doi":"10.1097/CCM.0000000000006823","DOIUrl":"10.1097/CCM.0000000000006823","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e2092-e2094"},"PeriodicalIF":6.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788470","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":"Georg Gelbenegger, Anselm Jorda","doi":"10.1097/CCM.0000000000006782","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006782","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 10","pages":"e2122-e2123"},"PeriodicalIF":6.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238476","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":"Acetylcholinesterase Inhibitors for Delirium Prevention: A Systematic Review and Meta-Analysis.","authors":"Leonardo Zumerkorn Pipek, Giovanna Salema Pascual, Rafaela Farias Vidigal Nascimento, Guilherme Diogo Silva, Luiz H Castro","doi":"10.1097/CCM.0000000000006786","DOIUrl":"10.1097/CCM.0000000000006786","url":null,"abstract":"<p><strong>Objectives: </strong>Delirium is a frequent complication in hospitalized patients, particularly in older adults, and is associated with significant morbidity and mortality. Acetylcholinesterase inhibitors (AChEIs) have been proposed as potential agents to reduce occurrence and severity of delirium. This study aimed to evaluate the efficacy of AChEIs for both prophylaxis and treatment of delirium in hospitalized patients.</p><p><strong>Data sources: </strong>We searched PubMed, Embase, and Web of Science. The study was registered on PROSPERO (CRD42024563798).</p><p><strong>Study selection: </strong>Studies comparing AChEIs and placebo for delirium in hospitalized patients.</p><p><strong>Data extraction: </strong>The main outcome of interest was delirium occurrence, while secondary outcomes included duration, severity, and hospital length of stay (LOS).</p><p><strong>Data synthesis: </strong>Subgroup analyses were performed based on prophylaxis or treatment of delirium. Statistical analysis was performed in RStudio 4.4.0 with a random effects model, and heterogeneity was assessed with I2 . Risk of Bias 2 was used for bias assessment. We screened 1306 records and included ten studies: eight studies focusing on prophylaxis after surgery and two on treatment of established delirium. A total of 731 patients were analyzed: 365 in the AChEIs group and 366 in the placebo group. AChEIs significantly reduced delirium occurrence (risk ratio = 0.68 [0.47-0.98]; p = 0.039). No significant effects were observed for delirium duration (mean difference [MD] = -0.16 d [-0.9 to 0.62 d]; p = 0.23), delirium severity (standardized mean difference [SMD] = -0.08 [-0.58 to 0.41]; p = 0.74), or LOS (MD = -0.82 d [-2.03 to 0.40 d]; p = 0.19). Subgroup analysis showed a tendency for better outcomes when AChEIs were used as prophylaxis, with a significant reduction in delirium duration in this subgroup (SMD= -0.32 [-0.56 to -0.07]; p < 0.01). No significant differences in adverse events were identified.</p><p><strong>Conclusions: </strong>AChEIs are effective in reducing occurrence of delirium when used prophylactically in patients undergoing elective surgery. AChEIs did not significantly impact on delirium duration, severity, or hospital LOS. Further studies are needed to explore the potential benefits or harms of AChEIs in different patient populations and settings.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e2054-e2061"},"PeriodicalIF":6.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774846","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":"Sex- and Age-Related Differences in Post-Burn Pathophysiology.","authors":"Diana Julia Tedesco, Maria Fernanda Hutter, Fadi Khalaf, Gregory R Pond, Marc G Jeschke","doi":"10.1097/CCM.0000000000006789","DOIUrl":"10.1097/CCM.0000000000006789","url":null,"abstract":"<p><strong>Objectives: </strong>Sex and its effects on outcomes after burn are controversially discussed. In particular, the impact of sex on physiologic responses post-burn remains largely unknown. To bridge this knowledge gap, this study aimed to explore outcomes and the underlying pathophysiological responses in males and females across different age groups.</p><p><strong>Design: </strong>Cohort study.</p><p><strong>Setting: </strong>Tertiary burn center.</p><p><strong>Patients: </strong>Adult burn patients (≥ 18 yr) admitted with an acute burn injury.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We included all patients (≥ 18 yr) admitted with acute burn injuries between 2006 and 2021. Patients were stratified based on sex assigned at birth and age group: adult (< 60 yr) vs. older adult (≥ 60 yr). Clinical laboratory measures and inflammatory markers were compared throughout hospitalization between male and female burn patients within each age group. Outcomes included 30-day mortality, in-hospital complications, organ biomarkers, and inflammatory cytokine responses. A total of 2321 patients were included. Adult females experienced greater mortality (1% vs. 2%; p < 0.05) and increased skin graft loss (5% vs. 9%; p < 0.05) compared with their male counterparts. Furthermore, among adults, female sex was an independent predictor of mortality in a multivariate model (odds ratio, 3.6; 95% CI, 1.3-9.6; p < 0.05). Adult females showed acute decreases in pro-inflammatory cytokines (interferon-γ, interleukin [IL]-6, IL-1β, tumor necrosis factor-α; p < 0.05). Interestingly, no differences in mortality or complications were observed between older adult males and females. Older adult males and females also showed similar inflammatory responses and limited differences in organ function.</p><p><strong>Conclusions: </strong>In this large cohort study, we observed that adult females show increased mortality compared with their male counterparts. Differences in inflammatory responses underlie this observation, contributing to the observed poor outcomes. Importantly, sex differences in post-burn responses appear to diminish with age, highlighting the importance of deepening our understanding of the underlying physiologic mechanisms to optimize patient care.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1941-e1951"},"PeriodicalIF":6.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648717","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":"Progress, Not Just Predictions: Critical Care Medicine's Vision for Data Science in 2025.","authors":"Patrick G Lyons, David M Maslove","doi":"10.1097/CCM.0000000000006845","DOIUrl":"10.1097/CCM.0000000000006845","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1871-e1873"},"PeriodicalIF":6.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945864","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}