Critical Care Medicine最新文献

{"title":"We Need a Clinically Relevant Sepsis Screening Tool.","authors":"Takahiro Shiraishi, Koji Hosokawa","doi":"10.1097/CCM.0000000000006499","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006499","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 3","pages":"e755-e756"},"PeriodicalIF":7.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540488","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":"Inability to Stand at ICU Discharge and Readmission: Addressing Missing Data and Confounding Factors.","authors":"Zhonglei Shen, Sheng Li","doi":"10.1097/CCM.0000000000006504","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006504","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 3","pages":"e739-e740"},"PeriodicalIF":7.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540480","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":"Qi Li, Han Ting Wang, Marc Brosseau","doi":"10.1097/CCM.0000000000006568","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006568","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 3","pages":"e741-e742"},"PeriodicalIF":7.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540484","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: Executive Summary.","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.0000000000006571","DOIUrl":"10.1097/CCM.0000000000006571","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e683-e689"},"PeriodicalIF":7.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467153","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":"Environmental Sustainability in ICUs: A Report From the Society of Critical Care Medicine Sustainability Task Force.","authors":"Michele Domico, Matthew J Meyer, Laura Blackburn, Shari A Toomey, Megan E Gooch, Vinay M Nadkarni, Yvonne Huckleberry, Andy Draper, Tina L Palmieri, Lama H Nazer, Amjad Nader, E Kate Valcin, Susan Evans, Tamara Al-Hakim, Srinivas Murthy","doi":"10.1097/CCM.0000000000006581","DOIUrl":"10.1097/CCM.0000000000006581","url":null,"abstract":"<p><strong>Objectives: </strong>The charge of the newly formed Society of Critical Care Medicine Sustainability Task Force is to describe actionable items supporting environmental stewardship for ICUs, to discuss barriers associated with sustainability initiatives and outline opportunities for future impact.</p><p><strong>Data sources: </strong>Ovid Medline, EBSCOhost CINAHL, Elsevier Embase, and Scopus databases were searched through to March 2024 for studies reporting on environmental sustainability and critical care.</p><p><strong>Study selection: </strong>Systematic reviews, narrative reviews, quality improvement projects, randomized clinical trials, and observational studies were prioritized for review. Bibliographies from retrieved articles were scanned for articles that may have been missed.</p><p><strong>Data extraction: </strong>Data regarding environmental sustainability initiatives that aimed to quantify, manage, or mitigate pollution and/or carbon emissions with a focus on ICUs, barriers to change, and opportunities for development were qualitatively assessed.</p><p><strong>Data synthesis: </strong>ICUs are resource-intensive and as such, methods to attenuate carbon emissions and waste can play a substantial role in mitigating the sizable burden of healthcare-related pollution and greenhouse gas emissions. Several initiatives and strategies exist for clinicians and providers to engage in environmental stewardship, with specific attention to avoiding low-value care while maintaining or improving patient safety and high-quality care. Increased focus on sustainability can be met with resistance to change, including institutional, financial, and behavioral barriers. Collaboration and innovative thinking create valuable opportunities for clinicians, patients, families, and policymakers to advocate for patient and planetary health.</p><p><strong>Conclusions: </strong>Within the healthcare system, ICUs are well positioned to lead sustainability action, policy, and practice. Critical care teams have the capability and the moral responsibility to mitigate the negative impact of critical care medicine upon our environment and become change agents promoting sustainable healthcare for the benefit of human health.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e632-e644"},"PeriodicalIF":7.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467187","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.0000000000006567","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006567","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 3","pages":"e737-e738"},"PeriodicalIF":7.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540483","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":"Obesity Is Associated With Increased Mortality in Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation.","authors":"Colin G McCloskey, Kevin W Hatton, David Furfaro, Milo Engoren","doi":"10.1097/CCM.0000000000006547","DOIUrl":"10.1097/CCM.0000000000006547","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the relationship between all-cause hospital mortality and morbidity in patients treated with venoarterial extracorporeal membrane oxygenation (ECMO) and to assess whether this relationship is mediated via body mass index (BMI).</p><p><strong>Design: </strong>Using the Extracorporeal Life Support Organization (ELSO) registry, venoarterial ECMO runs from 2015 to 2021 were retrospectively analyzed. Patient demographics, ECMO indications, and complications for survivors and decedents were univariately compared. Logistic regression with fractional polynomials was used to estimate the relationship between BMI and both mortality and complications in venoarterial ECMO patients.</p><p><strong>Setting: </strong>Contributing centers to the ELSO ECMO registry.</p><p><strong>Patients: </strong>Patients that underwent venoarterial ECMO at an ELSO contributing ECMO center.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Twenty-two thousand eight hundred twenty-five venoarterial ECMO runs met inclusion criteria for analysis. The mean BMI for survivors was 28.4 ± 6.5 vs. 29.5 ± 6.9 kg/m 2 for decedents. BMI was significantly associated with mortality ( p < 0.001), with the proportion of patients dying increasing with increasing BMI: 47% of underweight patients died, increasing to 50% for the normal range, to 53%, 56%, 58%, and 65% for preobese, class 1, class 2, and class 3 obese patients, respectively. Relative to a BMI of 25, a BMI of 35 had an odds ratio (OR) of death of 1.15 (1.09-1.18), and a BMI of 45 an OR of 1.46 (1.25-1.57). BMI was significantly associated with increased mechanical and renal complications, but decreased pulmonary complications.</p><p><strong>Conclusions: </strong>In patients undergoing venoarterial ECMO, increasing BMI was associated with increasing all-cause mortality and mechanical and renal complications.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e567-e574"},"PeriodicalIF":7.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834533","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":"Covert Critical Illness Encephalopathy: Impairments That Escape Detection by Guideline Recommended, Protocolized Assessments.","authors":"Ruhi Shirodkar, Isaac J Bourgeois, Minjee Kim, Eyal Y Kimchi, Eric M Liotta, Matthew B Maas","doi":"10.1097/CCM.0000000000006558","DOIUrl":"10.1097/CCM.0000000000006558","url":null,"abstract":"<p><strong>Objectives: </strong>To determine whether cognitive impairments of important severity escape detection by guideline-recommended delirium and encephalopathy screening instruments in critically ill patients.</p><p><strong>Design: </strong>Cross-sectional study with random patient sampling.</p><p><strong>Setting: </strong>ICUs of a large referral hospital with protocols implementing the Society of Critical Care Medicine's ICU Liberation Bundle.</p><p><strong>Patients: </strong>Patients with a heterogeneous mix of primary organ system conditions leading to critical illness and with no abnormal findings scored in Confusion Assessment Method for the ICU (CAM-ICU) screening, Richmond Agitation-Sedation Scale (RASS) 0, and Glasgow Coma Scale (GCS) 15, indicating they were alert, fully oriented, and following commands with no delirium or findings to indicate subsyndromal delirium.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We evaluated 50 patients, age 54 ± 16 years. Trained critical care nurses assessed patients at regular intervals using the CAM-ICU, RASS, and GCS per a protocol. We performed a battery of psychometric cognitive tests using the NIH Toolbox. Executive functions linked to attention and inhibitory control, and processing speed were 1.5 sd below population norm (both p < 0.01). Working memory and cognitive flexibility were also significantly, but less severely, impaired ( p < 0.01 and p = 0.026). Nearly two-thirds (64%) of the patients scored at least 1.5 sd worse than demographically adjusted means in two or more cognitive domains, a commonly used diagnostic criterion for cognitive impairment.</p><p><strong>Conclusions: </strong>Substantial cognitive impairment is present among critically ill patients with no abnormalities detected by standard delirium and encephalopathy assessments.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e613-e618"},"PeriodicalIF":7.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881681","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":"Significant Disparities in Adolescents With Severe Traumatic Brain Injury Across Trauma Center Types: Wide Variation of Tracheostomy and Gastrostomy.","authors":"Morihiro Katsura, Shingo Fukuma, Shin Miyata, Tatsuyoshi Ikenoue, Sindhu Daggupati, Matthew J Martin, Kenji Inaba, Kazuhide Matsushima","doi":"10.1097/CCM.0000000000006577","DOIUrl":"10.1097/CCM.0000000000006577","url":null,"abstract":"<p><strong>Objectives: </strong>To explore practice variations in the rate and timing of tracheostomy and gastrostomy for adolescent with severe traumatic brain injury (TBI) across trauma center types.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Trauma centers participating in the American College of Surgeons Trauma Quality Improvement Program (2017-2021) included adult (ATC), mixed (MTC), and pediatric trauma centers (PTC).</p><p><strong>Patients: </strong>Adolescent 14-18 years old with severe TBI (Head Abbreviated Injury Scale: 3-5 and Glasgow Coma Scale: 3-8) requiring mechanical ventilation.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>A multilevel mixed-effect Poisson regression model assessed the association between trauma center type and tracheostomy/gastrostomy rates. Effect sizes for fixed effects were reported as adjusted incidence rate ratio (IRR) with 95% CI. Secondary analyses were performed to assess the association between trauma center types and ventilator-associated pneumonia (VAP). Of 6978 patients, tracheostomy and gastrostomy were performed in 22.5% and 21.3% at ATC, 20.8% and 21.3% at MTC, and 6.9% and 11.1% at PTC, respectively. The median time to tracheostomy was 10 days (interquartile range [IQR], 7-13 d) at ATC, 11 days (IQR, 7-15 d) at MTC, and 15 days (IQR, 11-23 d) at PTC, demonstrating a significantly later timing of tracheostomy at PTC. In the regression model adjusting for potential confounders, treatment at PTC was significantly associated with a decreased likelihood of tracheostomy and gastrostomy placement compared with ATC (adjusted IRR, 0.38; 95% CI, 0.28-0.52; p < 0.001 and adjusted IRR, 0.58; 95% CI, 0.44-0.75; p < 0.001, respectively). There was no significant difference in the occurrence rate of VAP between ATC, MTC, and PTC.</p><p><strong>Conclusions: </strong>Our results offer insights into the existing current practice variations between ATC, MTC, and PTC in tracheostomy and gastrostomy placement for adolescent with severe TBI. Further research is warranted to examine the impact of these observed disparities on short- and long-term outcomes and to standardize the care process for adolescent patients.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e600-e612"},"PeriodicalIF":7.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969945","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":"Guiding Principles for Data Sharing and Harmonization: Results of a Systematic Review and Modified Delphi From the Society of Critical Care Medicine Data Science Campaign.","authors":"Donna Lee Armaignac, Smith F Heavner, Michelle Rausen, Xiaohan Tanner Zhang, Tamara Al-Hakim, Yulia Levites Strekalova, Neel Shah, Kenneth Eugene Remy, Sean Manion, Melissa Haendel, Andrew A Kramer, Elizabeth A Scruth, Teresa A Rincon, Soojin Park, Laura E Evans, Tezcan Ozrazgat-Baslanti, Vitaly Herasevich, Krzysztof Laudanski, David J Murphy, Heidi J Engel, Andrea Sikora, Ashish K Khanna, Jerry J Zimmerman, Karin Reuter-Rice, J Perren Cobb, Gilles Clermont","doi":"10.1097/CCM.0000000000006578","DOIUrl":"10.1097/CCM.0000000000006578","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to establish a set of guiding principles for data sharing and harmonization in critical care, focusing on the use of real-world data (RWD) and real-world evidence (RWE) to improve patient outcomes and research efficacy. The principles were developed through a systematic literature review and a modified Delphi process, with the goal of enhancing data accessibility, standardization, and interoperability across critical care settings.</p><p><strong>Data sources: </strong>Data sources included a comprehensive search of peer-reviewed literature, specifically studies related to the use of RWD and RWE in healthcare, guidelines, best practices, and recommendations on data sharing and harmonization. A total of 8150 articles were initially identified through databases such as MEDLINE and Web of Science, with 257 studies meeting inclusion criteria.</p><p><strong>Study selection: </strong>Inclusion criteria focused on publications discussing health-related informatics, recommendations for RWD/RWE usage, data sharing, and harmonization principles. Exclusion criteria ruled out non-human studies, case studies, conference abstracts, and articles published before 2013, as well as those not available in English.</p><p><strong>Data extraction: </strong>From the 257 selected studies, 322 statements were extracted. After removing irrelevant definitions and off-topic content, 232 statements underwent content validation and thematic analysis. These statements were then consolidated into 24 candidate guiding principles after rigorous review and consensus-building among the expert panel.</p><p><strong>Data synthesis: </strong>A three-phase modified Delphi process was employed, involving a conceptualization group, a review group, and a Delphi group. In phase 1, experts identified key themes and search terms for the systematic review. Phase 2 involved validating and refining the prospective guiding principles, while phase 3 employed a Delphi panel to rate principles on acceptability, importance, and feasibility. This process resulted in 24 guiding principles, with high consensus achieved in rounds 2 and 3 on their relevance and applicability.</p><p><strong>Conclusions: </strong>The systematic review and Delphi process resulted in 24 guiding principles to improve data sharing and harmonization in critical care. These principles address challenges across the data lifecycle, including generation, storage, access, and usage of RWD and RWE. This framework is designed to promote more effective and equitable data practices, with relevance for the development of artificial intelligence-based decision support tools and clinical research. The principles are intended to guide the responsible use of data science in critical care, with emphasis on ethics and equity, while acknowledging the variability of resources across settings.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e619-e631"},"PeriodicalIF":7.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467193","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}