Critical Care Medicine最新文献

{"title":"Modulation of Metabolomic Profile in Sepsis According to the State of Immune Activation.","authors":"Eleftheria Kranidioti, Isis Ricaño-Ponce, Nikolaos Antonakos, Evdoxia Kyriazopoulou, Antigone Kotsaki, Iraklis Tsangaris, Dimitra Markopoulou, Nikoleta Rovina, Eleni Antoniadou, Ioannis Koutsodimitropoulos, George N Dalekos, Glykeria Vlachogianni, Karolina Akinosoglou, Vasilios Koulouras, Apostolos Komnos, Theano Kontopoulou, George Dimopoulos, Mihai G Netea, Vinod Kumar, Evangelos J Giamarellos-Bourboulis","doi":"10.1097/CCM.0000000000006391","DOIUrl":"10.1097/CCM.0000000000006391","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the metabolomic profiles associated with different immune activation states in sepsis patients.</p><p><strong>Design: </strong>Subgroup analysis of the PROVIDE (a Personalized Randomized trial of Validation and restoration of Immune Dysfunction in severe infections and Sepsis) prospective clinical study.</p><p><strong>Setting: </strong>Results of the PROVIDE study showed that patients with sepsis may be classified into three states of immune activation: 1) macrophage-activation-like syndrome (MALS) characterized by hyperinflammation, sepsis-induced immunoparalysis, and 3) unclassified or intermediate patients without severe immune dysregulation.</p><p><strong>Patients or subjects: </strong>Two hundred ten patients from 14 clinical sites in Greece meeting the Sepsis-3 definitions with lung infection, acute cholangitis, or primary bacteremia.</p><p><strong>Interventions: </strong>During our comparison, we did not perform any intervention.</p><p><strong>Measurements and main results: </strong>Untargeted metabolomics analysis was performed on plasma samples from 210 patients (a total of 1394 products). Differential abundance analysis identified 221 significantly different metabolites across the immune states. Metabolites were enriched in pathways related to ubiquinone biosynthesis, tyrosine metabolism, and tryptophan metabolism when comparing MALS to immunoparalysis and unclassified patients. When comparing MALS to unclassified, 312 significantly different metabolites were found, and pathway analysis indicated enrichment in multiple pathways. Comparing immunoparalysis to unclassified patients revealed only two differentially regulated metabolites.</p><p><strong>Conclusions: </strong>Findings suggest distinct metabolic dysregulation patterns associated with different immune dysfunctions in sepsis: the strongest metabolic dysregulation is associated with MALS.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"52 11","pages":"e536-e544"},"PeriodicalIF":7.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459875","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 Impact of Multi-Institution Datasets on the Generalizability of Machine Learning Prediction Models in the ICU.","authors":"Patrick Rockenschaub, Adam Hilbert, Tabea Kossen, Paul Elbers, Falk von Dincklage, Vince Istvan Madai, Dietmar Frey","doi":"10.1097/CCM.0000000000006359","DOIUrl":"10.1097/CCM.0000000000006359","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the transferability of deep learning (DL) models for the early detection of adverse events to previously unseen hospitals.</p><p><strong>Design: </strong>Retrospective observational cohort study utilizing harmonized intensive care data from four public datasets.</p><p><strong>Setting: </strong>ICUs across Europe and the United States.</p><p><strong>Patients: </strong>Adult patients admitted to the ICU for at least 6 hours who had good data quality.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Using carefully harmonized data from a total of 334,812 ICU stays, we systematically assessed the transferability of DL models for three common adverse events: death, acute kidney injury (AKI), and sepsis. We tested whether using more than one data source and/or algorithmically optimizing for generalizability during training improves model performance at new hospitals. We found that models achieved high area under the receiver operating characteristic (AUROC) for mortality (0.838-0.869), AKI (0.823-0.866), and sepsis (0.749-0.824) at the training hospital. As expected, AUROC dropped when models were applied at other hospitals, sometimes by as much as -0.200. Using more than one dataset for training mitigated the performance drop, with multicenter models performing roughly on par with the best single-center model. Dedicated methods promoting generalizability did not noticeably improve performance in our experiments.</p><p><strong>Conclusions: </strong>Our results emphasize the importance of diverse training data for DL-based risk prediction. They suggest that as data from more hospitals become available for training, models may become increasingly generalizable. Even so, good performance at a new hospital still depended on the inclusion of compatible hospitals during training.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"1710-1721"},"PeriodicalIF":7.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141491225","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":"Direct Laryngoscopy Versus Video Laryngoscopy for Intubation in Critically Ill Patients: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Trials.","authors":"Garrett G McDougall, Holden Flindall, Ben Forestell, Devan Lakhanpal, Jessica Spence, Daniel Cordovani, Sameer Sharif, Bram Rochwerg","doi":"10.1097/CCM.0000000000006402","DOIUrl":"10.1097/CCM.0000000000006402","url":null,"abstract":"<p><strong>Objectives: </strong>Given the uncertainty regarding the optimal approach to laryngoscopy for the intubation of critically ill adult patients, we conducted a systematic review and meta-analysis to compare video laryngoscopy (VL) vs. direct laryngoscopy (DL) for intubation in emergency department and ICU patients.</p><p><strong>Data sources: </strong>We searched MEDLINE, PubMed, Embase, Cochrane Library, and unpublished sources, from inception to February 27, 2024.</p><p><strong>Study selection: </strong>We included randomized controlled trials (RCTs) of critically ill adult patients randomized to VL compared with DL for endotracheal intubation.</p><p><strong>Data extraction: </strong>Reviewers screened abstracts, full texts, and extracted data independently and in duplicate. We pooled data using a random-effects model, assessed risk of bias using the modified Cochrane tool and certainty of evidence using the Grading Recommendations Assessment, Development, and Evaluation approach. We pre-registered the protocol on PROSPERO (CRD42023469945).</p><p><strong>Data synthesis: </strong>We included 20 RCTs ( n = 4569 patients). Compared with DL, VL probably increases first pass success (FPS) (relative risk [RR], 1.13; 95% CI, 1.06-1.21; moderate certainty) and probably decreases esophageal intubations (RR, 0.47; 95% CI, 0.27-0.82; moderate certainty). VL may result in fewer aspiration events (RR, 0.74; 95% CI, 0.51-1.09; low certainty) and dental injuries (RR, 0.46; 95% CI, 0.19-1.11; low certainty) and may have no effect on mortality (RR, 0.97; 95% CI, 0.88-1.07; low certainty) compared with DL.</p><p><strong>Conclusions: </strong>In critically ill adult patients undergoing intubation, the use of VL, compared with DL, probably leads to higher rates of FPS and probably decreases esophageal intubations. VL may result in fewer dental injuries as well as aspiration events compared with DL with no effect on mortality.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"1674-1685"},"PeriodicalIF":7.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281539","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 Impact of Point-of-Care Ultrasound-Guided Resuscitation on Clinical Outcomes in Patients With Shock: A Systematic Review and Meta-Analysis.","authors":"John Basmaji, Robert Arntfield, Karishma Desai, Vincent I Lau, Kim Lewis, Bram Rochwerg, Kyle Fiorini, Kimia Honarmand, Marat Slessarev, Aleks Leligdowicz, Brian Park, Ross Prager, Michelle Y S Wong, Philip M Jones, Ian M Ball, Nicolas Orozco, Maureen Meade, Lehana Thabane, Gordon Guyatt","doi":"10.1097/CCM.0000000000006399","DOIUrl":"10.1097/CCM.0000000000006399","url":null,"abstract":"<p><strong>Objective: </strong>To determine the impact of point-of-care ultrasound (POCUS)-guided resuscitation on clinical outcomes in adult patients with shock.</p><p><strong>Data source: </strong>We searched MEDLINE, Embase, and unpublished sources from inception to December 2023.</p><p><strong>Study selection: </strong>We included randomized controlled trials (RCTs) that examined the use of POCUS to guide resuscitation in patients with shock.</p><p><strong>Data extraction: </strong>We collected data regarding study and patient characteristics, POCUS protocol, control group interventions, and outcomes.</p><p><strong>Data synthesis: </strong>We identified 18 eligible RCTs. POCUS slightly influences physicians' plans for IV fluid (IVF) and vasoactive medication prescription (moderate certainty), but results in little to no changes in the administration of IVF (low to high certainty) or inotropes (high certainty). POCUS may result in no change in the number of CT scans performed (low certainty) but probably reduces the number of diagnostic echocardiograms performed (moderate certainty). POCUS-guided resuscitation probably reduces 28-day mortality (relative risk [RR] 0.88; 95% CI, 0.78-0.99), the duration of vasoactive medication (mean difference -0.73 d; 95% CI, -1.16 to -0.30), and the need for renal replacement therapy (RRT) (RR 0.80; 95% CI, 0.63-1.02) (low to moderate certainty evidence), and lactate clearance (high certainty evidence). POCUS-guided resuscitation may results in little to no difference in ICU or hospital admissions, ICU and hospital length of stay, and the need for mechanical ventilation (MV) (low to moderate certainty evidence). There is an uncertain effect on the risk of acute kidney injury and the duration of MV or RRT (very low certainty evidence).</p><p><strong>Conclusions: </strong>POCUS-guided resuscitation in shock may yield important patient and health system benefits. Due to lack of sufficient evidence, we were unable to explore how the thresholds of operator competency, frequency, and timing of POCUS scans impact patient outcomes.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"1661-1673"},"PeriodicalIF":7.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281560","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":"Video Laryngoscopy in Critically Ill Adults: Nascent, Evolving, or Established?","authors":"Craig S Jabaley, Tricia R Pendergrast, Rebecca A Aslakson, Clifford S Deutschman","doi":"10.1097/CCM.0000000000006420","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006420","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"52 11","pages":"1793-1796"},"PeriodicalIF":7.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459949","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":"Central Venous Oxygen Saturation for Estimating Mixed Venous Oxygen Saturation and Cardiac Index in the ICU: A Systematic Review and Meta-Analysis.","authors":"Pouya Motazedian, Nickolas Beauregard, Isabelle Letourneau, Ida Olaye, Sarah Syed, Eric Lam, Pietro Di Santo, Rebecca Mathew, Edward G Clark, Manish M Sood, Manoj M Lalu, Benjamin Hibbert, Ann Bugeja","doi":"10.1097/CCM.0000000000006398","DOIUrl":"10.1097/CCM.0000000000006398","url":null,"abstract":"<p><strong>Objectives: </strong>The objectives of our systematic review and meta-analyses were to determine the diagnostic accuracy of central venous oxygen saturation (Scv o2 ) in estimating mixed venous oxygen saturation (Sv o2 ) and cardiac index in critically ill patients.</p><p><strong>Data sources: </strong>A systematic search using MEDLINE, Cochrane Central Register of Controlled Trials, and Embase was completed on May 6, 2024.</p><p><strong>Study selection: </strong>Studies of patients in the ICU for whom Scv o2 and at least one reference standard test was performed (thermodilution and/or Sv o2 ) were included.</p><p><strong>Data extraction: </strong>Individual patient data were used to calculate the pooled intraclass correlation coefficient (ICC) for Sv o2 and Spearman correlation for cardiac index. The Quality Assessment of Diagnostic Accuracy Studies-2 and Grading Recommendations Assessment, Development, and Evaluation tools were used for the risk of bias and certainty of evidence assessments.</p><p><strong>Data synthesis: </strong>Of 3427 studies, a total of 18 studies with 1971 patients were identified. We meta-analyzed 16 studies (1335 patients) that used Sv o2 as a reference and three studies (166 patients) that used thermodilution as reference. The ICC for reference Sv o2 was 0.83 (95% CI, 0.75-0.89) with a mean difference of 2.98% toward Scv o2 . The Spearman rank correlation for reference cardiac index is 0.47 (95% CI, 0.46-0.48; p < 0.0001).</p><p><strong>Conclusions: </strong>There is moderate reliability for Scv o2 in predicting Sv o2 in critical care patients with variability based on sampling site and presence of sepsis. There is limited evidence on the independent use of Scv o2 in predicting cardiac index.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e568-e577"},"PeriodicalIF":7.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281537","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":"Characteristics and Outcomes of Children and Young Adults With Sepsis Requiring Continuous Renal Replacement Therapy: A Comparative Analysis From the Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK).","authors":"Natalja L Stanski, Katja M Gist, Denise Hasson, Erin K Stenson, JangDong Seo, Nicholas J Ollberding, Melissa Muff-Luett, Gerard Cortina, Rashid Alobaidi, Emily See, Ahmad Kaddourah, Dana Y Fuhrman","doi":"10.1097/CCM.0000000000006405","DOIUrl":"10.1097/CCM.0000000000006405","url":null,"abstract":"<p><strong>Objectives: </strong>Pediatric sepsis-associated acute kidney injury (AKI) often requires continuous renal replacement therapy (CRRT), but limited data exist regarding patient characteristics and outcomes. We aimed to describe these features, including the impact of possible dialytrauma (i.e., vasoactive requirement, negative fluid balance) on outcomes, and contrast them to nonseptic patients in an international cohort of children and young adults receiving CRRT.</p><p><strong>Design: </strong>A secondary analysis of Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK), an international, multicenter, retrospective study.</p><p><strong>Setting: </strong>Neonatal, cardiac and PICUs at 34 centers in nine countries from January 1, 2015, to December 31, 2021.</p><p><strong>Patients: </strong>Patients 0-25 years old requiring CRRT for AKI and/or fluid overload.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Among 1016 patients, 446 (44%) had sepsis at CRRT initiation and 650 (64%) experienced Major Adverse Kidney Events at 90 days (MAKE-90) (defined as a composite of death, renal replacement therapy [RRT] dependence, or > 25% decline in estimated glomerular filtration rate from baseline at 90 d from CRRT initiation). Septic patients were less likely to liberate from CRRT by 28 days (30% vs. 38%; p < 0.001) and had higher rates of MAKE-90 (70% vs. 61%; p = 0.002) and higher mortality (47% vs. 31%; p < 0.001) than nonseptic patients; however, septic survivors were less likely to be RRT dependent at 90 days (10% vs. 18%; p = 0.011). On multivariable regression, pre-CRRT vasoactive requirement, time to negative fluid balance, and median daily fluid balance over the first week of CRRT were not associated with MAKE-90; however, increasing duration of vasoactive requirement was independently associated with increased odds of MAKE-90 (adjusted OR [aOR], 1.16; 95% CI, 1.05-1.28) and mortality (aOR, 1.20; 95% CI, 1.1-1.32) for each additional day of support.</p><p><strong>Conclusions: </strong>Septic children requiring CRRT have different clinical characteristics and outcomes compared with those without sepsis, including higher rates of mortality and MAKE-90. Increasing duration of vasoactive support during the first week of CRRT, a surrogate of potential dialytrauma, appears to be associated with these outcomes.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"1686-1699"},"PeriodicalIF":7.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281538","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":"Sae-Yeon Won, Thomas M Freiman, Daniel Dubinski, Florian Gessler, Adam Strzelczyk","doi":"10.1097/CCM.0000000000006412","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006412","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"52 11","pages":"e590-e591"},"PeriodicalIF":7.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459878","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":"Healthcare Use and Expenditures in Rural Survivors of Hospitalization for Sepsis.","authors":"Kyle R Stinehart, J Madison Hyer, Shivam Joshi, Nathan E Brummel","doi":"10.1097/CCM.0000000000006397","DOIUrl":"10.1097/CCM.0000000000006397","url":null,"abstract":"<p><strong>Objectives: </strong>Sepsis survivors have greater healthcare use than those surviving hospitalizations for other reasons, yet factors associated with greater healthcare use in this population remain ill-defined. Rural Americans are older, have more chronic illnesses, and face unique barriers to healthcare access, which could affect postsepsis healthcare use. Therefore, we compared healthcare use and expenditures among rural and urban sepsis survivors. We hypothesized that rural survivors would have greater healthcare use and expenditures.</p><p><strong>Design, setting, and patients: </strong>To test this hypothesis, we used data from 106,189 adult survivors of a sepsis hospitalization included in the IBM MarketScan Commercial Claims and Encounters database and Medicare Supplemental database between 2013 and 2018.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We identified hospitalizations for severe sepsis and septic shock using the International Classification of Diseases , 9th Edition (ICD-9) or 1CD-10 codes. We used Metropolitan Statistical Area classifications to categorize rurality. We measured emergency department (ED) visits, inpatient hospitalizations, skilled nursing facility admissions, primary care visits, physical therapy visits, occupational therapy visits, and home healthcare visits for the year following sepsis hospitalizations. We calculated the total expenditures for each of these categories. We compared outcomes between rural and urban patients using multivariable regression and adjusted for covariates. After adjusting for age, sex, comorbidities, admission type, insurance type, U.S. Census Bureau region, employment status, and sepsis severity, those living in rural areas had 17% greater odds of having an ED visit (odds ratio [OR] 1.17; 95% CI, 1.13-1.22; p < 0.001), 9% lower odds of having a primary care visit (OR 0.91; 95% CI, 0.87-0.94; p < 0.001), and 12% lower odds of receiving home healthcare (OR 0.88; 95% CI, 0.84-0.93; p < 0.001). Despite higher levels of ED use and equivalent levels of hospital readmissions, expenditures in these areas were 14% (OR 0.86; 95% CI, 0.80-0.91; p < 0.001) and 9% (OR 0.91; 95% CI, 0.87-0.96; p < 0.001) lower among rural survivors, respectively, suggesting these services may be used for lower-acuity conditions.</p><p><strong>Conclusions: </strong>In this large cohort study, we report important differences in healthcare use and expenditures between rural and urban sepsis survivors. Future research and policy work is needed to understand how best to optimize sepsis survivorship across the urban-rural continuum.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"1729-1738"},"PeriodicalIF":7.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975327","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 Impact of Delayed Transition From Noninvasive to Invasive Mechanical Ventilation on Hospital Mortality in Immunocompromised Patients With Sepsis.","authors":"Yang Xu, Yi-Fan Wang, Yi-Wei Liu, Run Dong, Yan Chen, Yi Wang, Li Weng, Bin Du","doi":"10.1097/CCM.0000000000006400","DOIUrl":"10.1097/CCM.0000000000006400","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether mortality differed between initial invasive mechanical ventilation (IMV) or noninvasive ventilation (NIV) followed by delayed IMV in immunocompromised patients with sepsis.</p><p><strong>Design: </strong>Retrospective analysis using the National Data Center for Medical Service claims data in China from 2017 to 2019.</p><p><strong>Setting: </strong>A total of 3530 hospitals across China.</p><p><strong>Patients: </strong>A total of 36,187 adult immunocompromised patients with sepsis requiring ventilation.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The primary outcome was hospital mortality. Patients were categorized into NIV initiation or IMV initiation groups based on first ventilation. NIV patients were further divided by time to IMV transition: no transition, immediate (≤ 1 d), early (2-3 d), delayed (4-7 d), or late (≥ 8 d). Mortality was compared between groups using weighted Cox models. Over the median 9-day follow-up, mortality was similar for initial NIV versus IMV (adjusted hazard ratio [HR] 1.006; 95% CI, 0.959-1.055). However, among NIV patients, a longer time to IMV transition is associated with stepwise increases in mortality, from immediate transition (HR 1.65) to late transition (HR 2.51), compared with initial IMV. This dose-response relationship persisted across subgroups and sensitivity analyses.</p><p><strong>Conclusions: </strong>Prolonged NIV trial before delayed IMV transition is associated with higher mortality in immunocompromised sepsis patients ultimately intubated.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"1739-1749"},"PeriodicalIF":7.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142016604","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}