Critical Care Medicine最新文献

{"title":"Clinical Performance of Spo2/Fio2 and Pao2/Fio2 Ratio in Mechanically Ventilated Acute Respiratory Distress Syndrome Patients: A Retrospective Study.","authors":"Silvia Coppola, Tommaso Pozzi, Giulia Catozzi, Alessandro Monte, Enrico Frascati, Davide Chiumello","doi":"10.1097/CCM.0000000000006623","DOIUrl":"10.1097/CCM.0000000000006623","url":null,"abstract":"<p><strong>Objectives: </strong>The present study aims to evaluate the severity classification of acute respiratory distress syndrome (ARDS) in mechanically ventilated patients according to peripheral oxygen saturation by pulse oximetry (Spo2)/Fio2 ratio compared with Pao2/Fio2 ratio and the relationship between Spo2/Fio2 ratio and venous admixture.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Setting: </strong>Medical-surgical ICU.</p><p><strong>Patients: </strong>A cohort of 258 mechanically ventilated patients with ARDS already enrolled in previous studies.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Gas exchange, Spo2, and respiratory mechanics were measured on ICU admission and during the positive end-expiratory pressure (PEEP) trial. Radiological data from CTs were used to compute lung recruitability and to assess different lung compartments. A nonlinear association was found between Spo2/Fio2 and Pao2/Fio2. Considering the possible confounding factors of the pulse oximeter on the relationship between Spo2/Fio2 and Pao2/Fio2 ratio, arterial pH, and Paco2 had no effect. Spo2/Fio2 and Pao2/Fio2 ratio demonstrated a moderate agreement in classifying ARDS severity (intraclass correlation coefficient = 0.63). Between the correspondent classes according to Spo2/Fio2 vs. Pao2/Fio2 ratio-derived severity classifications, there was no difference in terms of respiratory mechanics, gas exchange, lung radiological characteristics and mortality in ICU, and within two levels of PEEP. A Spo2/Fio2 ratio less than 235 was able to detect 89% of patients with a venous admixture greater than 20%, similarly to a Pao2/Fio2 ratio less than 200.</p><p><strong>Conclusions: </strong>Spo2/Fio2 ratio can detect oxygenation impairment and classify ARDS severity similarly to Pao2/Fio2 ratio in a more rapid and handy way, even during a PEEP trial. However, our results may not be applicable to different patient populations; in fact, the pulse oximeter is merely a monitoring device and the information should be personalized by the physician on the patient's characteristics and conditions.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11952690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540471","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":"Omega-3 Polyunsaturated Fatty Acids in Sepsis: From Prevention to Early Treatment.","authors":"Evangelos J Giamarellos-Bourboulis","doi":"10.1097/CCM.0000000000006626","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006626","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540472","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":"Time to Renal Replacement Therapy Initiation in Critically Ill Patients With Acute Kidney Injury: A Secondary Analysis of the Standard Versus Accelerated Initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) Trial.","authors":"Rachel Jeong, Sean M Bagshaw, Ehsan Ghamarian, Andrea Harvey, Michael Joannidis, Brian Kirkham, Danny McAuley, Marlies Ostermann, Jean-Pierre Quenot, Paul J Young, Ron Wald","doi":"10.1097/CCM.0000000000006616","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006616","url":null,"abstract":"<p><strong>Objectives: </strong>Among critically ill patients with severe acute kidney injury (AKI) who lack emergent indications for renal replacement therapy (RRT), a strategy of preemptive RRT initiation does not lead to improved outcomes. However, for patients with persistent AKI and without urgent indications for RRT, the safety of prolonged delays in RRT initiation is unclear. We sought to assess the association between progressively longer delays in RRT initiation and clinical outcomes.</p><p><strong>Design: </strong>A post hoc secondary analysis.</p><p><strong>Setting: </strong>The multinational STandard vs. Accelerated initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial.</p><p><strong>Patients: </strong>Participants allocated to the standard strategy of the STARRT-AKI trial.</p><p><strong>Interventions: </strong>The exposure was time from randomization to RRT initiation, evaluated in quartiles and as a continuous variable.</p><p><strong>Measurements and main results: </strong>The primary outcome was all-cause mortality at 90 days. Secondary outcomes were RRT dependence, RRT-free days, and hospital-free days, all at 90 days, as well length of ICU and hospital stay. Of the 1462 participants allocated to the standard strategy group, 903 (62%) received RRT. Median time (interquartile range) to RRT initiation was 12.1 hours (8.3-13.8 hr), 24.5 hours (21.8-26.5 hr), 46.8 hours (35.2-52.1 hr), and 96.1 hours (76.7-139.2 hr) in quartiles 1-4, respectively. Prolonged time to RRT initiation was associated with a lower risk of death at 90 days (quartile 4 vs. 1: adjusted odds ratio, 0.63 [95% CI, 0.42-0.94]); further analyses using cubic splines and inverse probability weighting to account for immortal time bias showed no association with the risk of death. There was no association between time to RRT initiation and RRT-free days, hospital-free days, or lengths of ICU or hospital stay. Longer delay to RRT initiation had a linear association with RRT dependence at 90 days.</p><p><strong>Conclusions: </strong>Among patients with no urgent indications and who received RRT in the standard strategy of the STARRT-AKI trial, longer deferral of RRT initiation was not associated with a higher risk of mortality.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540473","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":"A Focused Update to the Clinical Practice Guidelines for the Prevention and Management of Pain, Anxiety, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU.","authors":"Kimberley Lewis, Michele C Balas, Joanna L Stollings, Molly McNett, Timothy D Girard, Gerald Chanques, Michelle E Kho, Pratik P Pandharipande, Gerald L Weinhouse, Nathan E Brummel, Linda L Chlan, Makayla Cordoza, Jeremiah J Duby, Céline Gélinas, Erin L Hall-Melnychuk, Anna Krupp, Patricia R Louzon, Judith A Tate, Bethany Young, Ron Jennings, Anitra Hines, Chris Ross, Kallirroi Laiya Carayannopoulos, J Matthew Aldrich","doi":"10.1097/CCM.0000000000006574","DOIUrl":"10.1097/CCM.0000000000006574","url":null,"abstract":"<p><strong>Rationale: </strong>Critically ill adults are at risk for a variety of distressing and consequential symptoms both during and after an ICU stay. Management of these symptoms can directly influence outcomes.</p><p><strong>Objectives: </strong>The objective was to update and expand the Society of Critical Care Medicine's 2018 Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU.</p><p><strong>Panel design: </strong>The interprofessional inclusive guidelines task force was composed of 24 individuals including nurses, physicians, pharmacists, physiotherapists, psychologists, and ICU survivors. The task force developed evidence-based recommendations using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Conflict-of-interest policies were strictly followed in all phases of the guidelines, including task force selection and voting.</p><p><strong>Methods: </strong>The task force focused on five main content areas as they pertain to adult ICU patients: anxiety (new topic), agitation/sedation, delirium, immobility, and sleep disruption. Using the GRADE approach, we conducted a rigorous systematic review for each population, intervention, control, and outcome question to identify the best available evidence, statistically summarized the evidence, assessed the quality of evidence, and then performed the evidence-to-decision framework to formulate recommendations.</p><p><strong>Results: </strong>The task force issued five statements related to the management of anxiety, agitation/sedation, delirium, immobility, and sleep disruption in adults admitted to the ICU. In adult patients admitted to the ICU, the task force issued conditional recommendations to use dexmedetomidine over propofol for sedation, provide enhanced mobilization/rehabilitation over usual mobilization/rehabilitation, and administer melatonin. The task force was unable to issue recommendations on the administration of benzodiazepines to treat anxiety, and the use of antipsychotics to treat delirium.</p><p><strong>Conclusions: </strong>The guidelines task force provided recommendations for pharmacologic management of agitation/sedation and sleep, and nonpharmacologic management of immobility in critically ill adults. These recommendations are intended for consideration along with the patient's clinical status.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e711-e727"},"PeriodicalIF":7.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467085","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":"A Promising New Intervention to Improve the Mental Health of Family Caregivers of Critically Ill Patients.","authors":"O Joseph Bienvenu","doi":"10.1097/CCM.0000000000006583","DOIUrl":"10.1097/CCM.0000000000006583","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e728-e729"},"PeriodicalIF":7.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001634","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":"Higher Versus Lower Protein Delivery in Critically Ill Patients: A Systematic Review and Bayesian Meta-Analysis.","authors":"Samuel Heuts, Zheng-Yii Lee, Charles Chin Han Lew, Julia L M Bels, Andrea Gabrio, Michal J Kawczynski, Daren K Heyland, Matthew J Summers, Adam M Deane, Dieter Mesotten, Lee-Anne S Chapple, Christian Stoppe, Marcel C G van de Poll","doi":"10.1097/CCM.0000000000006562","DOIUrl":"10.1097/CCM.0000000000006562","url":null,"abstract":"<p><strong>Objectives: </strong>Recent multicenter trials suggest that higher protein delivery may result in worse outcomes in critically ill patients, but uncertainty remains. An updated Bayesian meta-analysis of recent evidence was conducted to estimate the probabilities of beneficial and harmful treatment effects.</p><p><strong>Data sources: </strong>An updated systematic search was performed in three databases until September 4, 2024. The study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and the protocol was preregistered in PROSPERO (CRD42024546387).</p><p><strong>Study selection: </strong>Randomized controlled trials that studied adult critically ill patients comparing protein doses delivered enterally and/or parenterally with similar energy delivery between groups were included.</p><p><strong>Data extraction: </strong>Data extraction was performed by two authors independently, using a predefined worksheet. The primary outcome was mortality. Posterior probabilities of any benefit (relative risk [RR] < 1.00) or harm (RR > 1.00) and other important beneficial and harmful effect size thresholds were estimated. Risk of bias assessment was performed using the risk of bias 2.0 tool. All analyses were performed using a Bayesian hierarchical random-effects models, under vague priors.</p><p><strong>Data synthesis: </strong>Twenty-two randomized trials ( n = 4164 patients) were included. The mean protein delivery in the higher and lower protein groups was 1.5 ± 0.6 vs. 0.9 ± 0.4 g/kg/d. The median RR for mortality was 1.01 (95% credible interval, 0.84-1.16). The posterior probability of any mortality benefit from higher protein delivery was 43.6%, while the probability of any harm was 56.4%. The probabilities of a 1% (RR < 0.99) and 5% (RR < 0.95) mortality reduction by higher protein delivery were 38.7% and 22.9%, respectively. Conversely, the probabilities of a 1% (RR > 1.01) and 5% (RR > 1.05) mortality increase were 51.5% and 32.4%, respectively.</p><p><strong>Conclusions: </strong>There is a considerable probability of an increased mortality risk with higher protein delivery in critically ill patients, although a clinically beneficial effect cannot be completely eliminated based on the current data.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e645-e655"},"PeriodicalIF":7.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892769","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.","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.0000000000006572","DOIUrl":"10.1097/CCM.0000000000006572","url":null,"abstract":"<p><strong>Rationale: </strong>Advances in technology, infection control challenges-as with the COVID-19 pandemic-and evolutions in patient- and family-centered care highlight ideal aspects of ICU design and opportunities for enhancement.</p><p><strong>Objectives: </strong>To provide evidence-based recommendations for clinicians, administrators, and healthcare architects to optimize design strategies in new or renovation projects.</p><p><strong>Panel design: </strong>A guidelines panel of 27 members with experience in ICU design met virtually from the panel's inception in 2019 to 2024. The panel represented clinical professionals, architects, engineers, and clinician methodologists with expertise in developing evidence-based clinical practice guidelines. A formal conflict of interest policy was followed throughout the guidelines-development process.</p><p><strong>Methods: </strong>Embase, Medline, CINAHL, Central, and Proquest were searched from database inception to September 2023. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to determine certainty in the evidence and to formulate recommendations, suggestions, and practice statements for each Population, Intervention, Control, and Outcomes (PICO) question based on quality of evidence and panel consensus. Recommendations were provided when evidence was actionable; suggestions, when evidence was equivocal; and practice statements when the benefits of the intervention appeared to outweigh the risks, but direct evidence to support the intervention did not exist.</p><p><strong>Results: </strong>The ICU Guidelines panel issued 17 recommendations based on 15 PICO questions relating to ICU architecture and design. The panel strongly recommends high-visibility ICU layouts, windows and natural lighting in all patient rooms to enhance sleep and recovery. The panel suggests integrated staff break/respite spaces, advanced infection prevention features, and flexible surge capacity. Because of insufficient evidence, the panel could not make a recommendation around in-room supplies, decentralized charting, and advanced heating, ventilation, and air conditioning systems.</p><p><strong>Conclusions: </strong>This ICU design guidelines is intended to provide expert guidance for clinicians, administrators, and healthcare architects considering erecting a new ICU or revising an existing structure.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e690-e700"},"PeriodicalIF":7.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467150","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 Search for Sepsis Biomarkers: A Tale of Promises, Pitfalls, and Potential.","authors":"Tobias Zimmermann, David Brealey, Mervyn Singer","doi":"10.1097/CCM.0000000000006560","DOIUrl":"10.1097/CCM.0000000000006560","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e543-e547"},"PeriodicalIF":7.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846004","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":"Challenging Dogma: Calcium Treatment in Hyperkalemia.","authors":"G Jan Zijlstra","doi":"10.1097/CCM.0000000000006456","DOIUrl":"10.1097/CCM.0000000000006456","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 3","pages":"e760-e761"},"PeriodicalIF":7.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540476","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":"Exploring the Role of Early Mobilization in Preventing ICU Readmission.","authors":"Ginga Suzuki","doi":"10.1097/CCM.0000000000006507","DOIUrl":"10.1097/CCM.0000000000006507","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 3","pages":"e743-e744"},"PeriodicalIF":7.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540478","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}