Critical Care Medicine最新文献

{"title":"Preventing Delirium in Hospitalized Patients: No Magic Bullets.","authors":"Jessica D Spence, Renée Fournier, Emilie Belley-Côté","doi":"10.1097/CCM.0000000000006755","DOIUrl":"10.1097/CCM.0000000000006755","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483441","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":"Effects of Sevoflurane Inhalation on Pulmonary Hemodynamics in Moderate to Severe Acute Respiratory Distress Syndrome Patients With Septic Shock: A Prospective Cohort Study.","authors":"Giovanni Bousquet, Gabriel Parzy, Damien Barrau, Ines Gragueb-Chatti, Florence Daviet, Mélanie Adda, Saida Salmi, Geoffray Agard, Jean-Marie Forel, Antoine Roch, Laurent Papazian, Sami Hraiech, Christophe Guervilly","doi":"10.1097/CCM.0000000000006744","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006744","url":null,"abstract":"<p><strong>Objectives: </strong>Our study aimed to investigate the effects of sevoflurane inhalation on mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistances (PVRs) in acute respiratory distress syndrome (ARDS) patients during lung protective ventilation.</p><p><strong>Design: </strong>Prospective cohort study.</p><p><strong>Setting: </strong>Medical ICU of a university teaching hospital.</p><p><strong>Patients: </strong>Deeply sedated, intubated adult patients with moderate to severe ARDS with Pao2/Fio2 less than 150 mm Hg, with a positive end-expiratory pressure of greater than or equal to 5 cm H2O and septic shock monitored with a pulmonary arterial catheter.</p><p><strong>Interventions: </strong>Sedation was switched from IV midazolam to sevoflurane inhalation.</p><p><strong>Measurements and main results: </strong>Main objective was the change in mPAP between before (T0) and 1 hour (H + 1) after sevoflurane inhalation. Main secondary outcomes were mPAP 12-18 hours (H + 12-18) after inclusion, PVR indexed (PVRI), cardiac index, Pao2/Fio2, pulmonary shunt at H + 1, and H + 12-18 after inclusion. The H + 12-18 measurements were performed either in supine position (SP) or in prone position (PP), if Pao2/Fio2 ratio was less than 150 mm Hg at H + 1. Fifteen patients were included in interim analysis. mPAP was 24 ± 4 mm Hg at inclusion and remained unchanged after 1 hour (24 ± 5 mm Hg) and 12-18 hours (23 ± 6 mm Hg) of sevoflurane inhalation. The mean expired fraction of sevoflurane was 0.75% ± 0.25% at H + 1 and 0.71% ± 0.25% at H + 12-18. No significant variations in PVRI, cardiac index, mean arterial pressure, pulmonary shunt were observed at H + 1 and H + 12-18. An improvement of Pao2/Fio2 was observed at H + 12-18 in patients who remained in SP (from 158 ± 49 to 249 ± 86 mm Hg; p = 0.015) and in those turned prone (from 134 ± 36 to 241 ± 109 mm Hg; p = 0.018).</p><p><strong>Conclusions: </strong>In mechanically ventilated moderate to severe ARDS patients receiving lung protective ventilation, sevoflurane inhalation was not associated with decreases in mPAPs and PVRs. However, the smaller than planned sample size does not allow definitive conclusions.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301304","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":"Persistent Critical Illness Among Intensive Care Patients in India: A Registry-Embedded Cohort Study.","authors":"Bharath Kumar Tirupakuzhi Vijayaraghavan, Aasiyah Rashan, Nagarajan Ramakrishnan, Rashan Haniffa, Abi Beane, Neill K J Adhikari, Nazir Lone, Nicolette de Keizer","doi":"10.1097/CCM.0000000000006743","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006743","url":null,"abstract":"<p><strong>Objectives: </strong>Among patients admitted to an ICU in high-income countries, persistent critical illness arises when the admission diagnosis and acute physiologic derangements no longer predict outcomes better than antecedent characteristics. We evaluated this phenomenon in India.</p><p><strong>Design: </strong>Cohort study.</p><p><strong>Setting: </strong>Fifty-six ICUs in India belonging to the Indian Registry of Intensive Care.</p><p><strong>Patients: </strong>Adult critically ill patients.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We evaluated associations of acute illness characteristics (admission diagnoses and acute physiology variables), antecedent characteristics (age, sex, and Charlson Comorbidity Index), and their combination on hospital mortality. Analyses used generalized mixed-effects models. In post hoc analyses, we compared patients with or without a long ICU stay. We included 42,925 patients; hospital mortality was 17.4%. Prognostic performance of acute illness characteristics declined over time (area under the receiver operating characteristic curve [AUROC], 0.76 at admission; 0.69 at day 7) and was consistently poor for antecedent characteristics (AUROC, 0.56 at admission and day 7). Patients with ICU stay greater than 7 days were sicker (median [interquartile range (IQR)]; Acute Physiology and Chronic Health Evaluation II, 14 [9, 19] vs. 10 [6, 15]; p < 0.001), with higher hospital mortality (33.1% vs. 14.6%; odds ratio, 2.17; 95% CI, 2.03-2.31) and ICU mortality (30.3% vs. 13.2%); receipt of invasive ventilation (51.7% vs. 19.5%), noninvasive ventilation (18.4% vs. 7.6%), vasopressors (34.7% vs. 19.1%), and kidney replacement therapy (11.4% vs. 6.1%) were all significantly higher among those staying in ICU greater than 7 days.</p><p><strong>Conclusions: </strong>In this cohort of critically ill patients in India, as ICU stay increased, the prognostic performance of acute illness characteristics decreased whereas that of antecedent characteristics remained poor. Although patients with ICU stay greater than 7 days had higher mortality and received more organ support, the definition of persistent critical illness from high-income country cohorts was not replicated.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301305","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":"Pulse Oximetry and Arterial Blood Gas Oxygen Saturation Discrepancies and Mortality in Extracorporeal Cardiopulmonary Resuscitation Patients: An Extracorporeal Life Support Organization Registry Analysis.","authors":"Andrew Kalra, Christopher Wilcox, Winnie Liu, Shi Nang Feng, Patricia Brown, Bo Soo Kim, Daniel Brodie, Glenn J R Whitman, Sung-Min Cho","doi":"10.1097/CCM.0000000000006736","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006736","url":null,"abstract":"<p><strong>Objectives: </strong>Previous studies have shown that inaccurate peripheral oxygen saturation (SpO2) readings compared with arterial oxygen saturation (SaO2) may occur in extracorporeal membrane oxygenation (ECMO) patients. We hypothesized that a greater Spo2-Sao2 discrepancy in extracorporeal cardiopulmonary resuscitation (ECPR) patients is associated with higher mortality due to unrecognized hypoxemia.</p><p><strong>Design: </strong>Retrospective analysis.</p><p><strong>Setting: </strong>Data within the Extracorporeal Life Support Organization Registry from 496 ECMO centers (2018-2024).</p><p><strong>Patients: </strong>Patients 18 years old or older receiving ECPR (first-run only).</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Laboratory measurements including Spo2-Sao2 were measured at 24 hours of ECMO support. Acute brain injury (ABI) included hypoxic-ischemic brain injury, ischemic stroke, intracranial hemorrhage, and seizures. Based on an inflection point in cubic spline analysis, a Spo2-Sao2 threshold greater than or equal to 4% was used as a binary variable to assess its association with in-hospital mortality. Three thousand nine hundred seventy ECPR patients (median age, 57 yr; 71% male) were included. The median ECMO duration was 4 days (interquartile range, 2-7 d). There were 634 patients (16%) with Spo2-Sao2 greater than or equal to 4% and 3336 (84%) with Spo2-Sao2 less than 4%. Overall mortality was 60% (n = 2391). Patients with Spo2-Sao2 greater than or equal to 4% had higher mortality compared with patients with Spo2-Sao2 less than 4% (67%, n = 425 vs. 59%, n = 1966; p < 0.001). Patients with Spo2-Sao2 greater than or equal to 4% had higher serum lactate values than those with Spo2-Sao2 less than 4% (3.1 vs. 2.8 mmol/L; p = 0.0017). In multivariable logistic regression adjusted for preselected covariates, Spo2-Sao2 greater than or equal to 4% was associated with increased risk of mortality (adjusted odds ratio [aOR], 1.39; 95% CI, 1.13-1.71). Additional risk factors associated with higher mortality included ABI (aOR, 5.81; 95% CI, 4.70-7.20), hyperoxemia greater than or equal to 300 mm Hg (aOR, 1.93; 95% CI, 1.53-2.43), hyperoxemia 200-299 mm Hg (aOR, 1.76; 95% CI, 1.37-2.25), gastrointestinal hemorrhage (aOR, 1.69; 95% CI, 1.42-2.00), renal replacement therapy (aOR, 1.48; 95% CI, 1.03-2.11), hypoxemia less than 60 mm Hg (aOR, 1.45; 95% CI, 1.00-2.10), older age (aOR, 1.19; 95% CI, 1.13-1.26), and higher lactate (aOR, 1.17; 95% CI, 1.13-1.20). Race/ethnicity was not associated with higher mortality.</p><p><strong>Conclusions: </strong>Spo2-Sao2 greater than or equal to 4% in the first 24 hours after ECPR is associated with increased risk of mortality, potentially due to unrecognized hypoxemia, irrespective of race/ethnicity.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301306","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":"Epidemiology of Septic Shock Associated Acute Kidney Injury: A National Retrospective Cohort Study.","authors":"Asad E Patanwala, Brian L Erstad","doi":"10.1097/CCM.0000000000006735","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006735","url":null,"abstract":"<p><strong>Objectives: </strong>Septic shock is the most severe and final stage of sepsis. These patients may have a higher risk for sepsis-associated acute kidney injury (AKI). The purpose of this study is to determine the frequency of AKI, major adverse kidney events at 30 days (MAKE-30), and use of renal replacement therapy (RRT) in patients with septic shock. We also aim to determine the association between stage of AKI and in-hospital mortality.</p><p><strong>Design: </strong>Retrospective, multicenter, cohort study.</p><p><strong>Setting: </strong>This was conducted in 220 geographically diverse community and teaching hospitals across the United States.</p><p><strong>Patients: </strong>Adult patients were included if they had septic shock on hospital admission.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Measurements include stage 1, 2, and 3 AKI, RRT, and MAKE-30. Of the 21,803 patients included in the final cohort, 92.8% had AKI during hospital admission. Patients had a mean (sd) age of 66.0 years (15.1 yr), 48.6% were female, 29.5% had chronic kidney disease, and mean (sd) estimated glomerular filtration rate was 35.8 mL/min/1.73 m2 (24.3 mL/min/1.73 m2). The maximum stage of AKI during hospitalization was none (7.2%), stage 1 (22.9%), stage 2 (27.3%), or stage 3 (42.7%). The proportion of patients who received RRT was 6.4%. MAKE-30 occurred in 42.0% and 30.9% died. There was no significant association between stage 1 (odds ratio [OR], 1.12; 95% CI, 0.97-1.29; p = 0.109), but there was a significant association between stage 2 (OR, 1.25; 95% CI, 1.09-1.43; p = 0.001), and stage 3 AKI (OR, 1.66; 95% CI, 1.46-1.89; p < 0.001) and mortality.</p><p><strong>Conclusions: </strong>Among hospitalized patients with septic shock, most patients have AKI, and stage 3 AKI is associated with the highest risk of mortality.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282780","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":"Efficacy of Ramelteon, Suvorexant, and Lemborexant for Delirium Prevention in Hospitalized Patients: A Systematic Review and Meta-Analysis.","authors":"Helen Michaela de Oliveira, Mariano Gallo Ruelas, Fernanda Valeriano Zamora, Guilherme Oliveira de Paula, Pandora Eloa Oliveira Fonseca, Laura Luiz, Pablo Ramon Fruett da Costa","doi":"10.1097/CCM.0000000000006737","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006737","url":null,"abstract":"<p><strong>Objectives: </strong>Delirium is a prevalent complication among hospitalized patients, particularly in older adults and ICU populations, and it is associated with poor prognosis. Pharmacologic interventions targeting sleep-wake regulation and neurobiologic pathways, such as orexin receptor antagonists and melatonin receptor agonists, offer promising strategies for delirium prevention. Our objective was to evaluate the preventive efficacy of suvorexant, lemborexant, and ramelteon in reducing delirium prevalence and associated clinical outcomes.</p><p><strong>Data sources: </strong>We systematically searched PubMed, Embase, Cochrane Central Register of Controlled Trials, clinical trial registries, and gray literature databases through November 2024.</p><p><strong>Study selection: </strong>Randomized controlled trials or observational studies involving hospitalized adults assessing the use of suvorexant, lemborexant, or ramelteon for delirium prevention were included.</p><p><strong>Data extraction: </strong>Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane guidelines, two reviewers extracted data independently. Quality was assessed using the Grading of Recommendations Assessment, Development, and Evaluation; Risk of Bias in Randomized Studies; and Risk of Bias in Nonrandomized Studies-of Interventions tools. Random-effects meta-analysis pooled risk ratios (RRs) and median differences with 95% CIs.</p><p><strong>Data synthesis: </strong>Twenty-four studies involving 4489 patients were analyzed, of whom 1752 (39%) received one of the evaluated pharmacotherapies. Pooled analyses showed a significant reduction in delirium prevalence in both randomized trials (RR, 0.60; 95% CI, 0.38-0.97; low certainty) and observational studies (RR, 0.54; 95% CI, 0.43-0.68; low certainty). Exploratory analyses by individual agent did not identify credible subgroup effects (interaction p > 0.1), and medication-specific findings should be interpreted with caution. No significant effects were observed for ventilator days, mortality, or length of hospital or ICU stay (very low certainty).</p><p><strong>Conclusions: </strong>Sleep-wake regulating pharmacologic agents were associated with 40%-46% relative risk reductions in delirium prevalence, based on low-certainty evidence. Although these findings are promising, the absence of credible subgroup effects limits conclusions about the comparative efficacy of individual agents. Further, high-quality, prospective trials are needed to confirm these results and to clarify the role of specific pharmacologic strategies in delirium prevention.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282758","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":"Fifth Centile Versus 50th Centile Mean Blood Pressure Targets in Pediatric Septic Shock: A Randomized Controlled Trial.","authors":"Sachin Shah, Amita Kaul, Ganesh Shiwarkar, Rajesh Nare, Jayant Khandare","doi":"10.1097/CCM.0000000000006718","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006718","url":null,"abstract":"<p><strong>Objectives: </strong>Hypotension is common in septic children, mean blood pressure (MBP) guides vasoactive agent titration. However, the Surviving Sepsis Guidelines for children were unable to recommend whether to target the 5th or 50th MBP percentile for septic shock. We aim to compare two MBP targets (5th vs. 50th percentile) for titrating vasoactive agents in septic shock patients.</p><p><strong>Design: </strong>Single-center, open-label, randomized noninferiority trial.</p><p><strong>Setting: </strong>It was conducted in a tertiary care PICU in India from April 2021 to March 2024.</p><p><strong>Patients: </strong>Patients 1 month to 16 years old with septic shock unresponsive to fluids and requiring vasopressors.</p><p><strong>Interventions: </strong>Children with septic shock were randomly assigned to either the 5th or 50th percentile MBP group, with vasopressor treatment adjusted to maintain the target blood pressure (BP) for each group.</p><p><strong>Measurements and main results: </strong>The primary outcome was 28-day all-cause mortality. Secondary outcomes included PICU/hospital stay, duration of vasoactive use, vasopressor-related adverse events, need for continuous renal replacement therapy (CRRT), invasive ventilation, and prevalence of acute respiratory distress syndrome (ARDS). A total of 144 children were enrolled. At 28 days, mortality did not differ significantly between groups: 16.9% (12/71) in the 5th centile group vs. 23.2% (17/73) in the 50th centile group (p = 0.41; risk difference, 6.3; 95% CI, -6.9 to 19.2). Norepinephrine use was higher in the 50th centile group (85% vs. 67%; p = 0.04). Vasoactive duration was longer in the 50th centile group (30.4 ± 13.3 vs. 18.8 ± 10.8; p = 0.001). The Vasoactive-Inotropic Score was also higher (64.0 ± 35.7 vs. 45.2 ± 29.6; p = 0.001). ARDS prevalence was significantly higher in the 50th centile group (32.8% vs. 16.9%; p = 0.02). No significant differences were found in other secondary outcomes like length of stay, ventilation duration, need for CRRT, or adverse events.</p><p><strong>Conclusions: </strong>Targeting a lower MBP (5th vs. 50th centile) in septic shock showed no significant difference in 28-day mortality. This suggests a lower BP target may be safe, reducing vasoactive drug use and related side effects.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282781","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 Use of a Risk-Adjusted Mechanical Ventilation Digital Quality Measure Bundle in a Large Health System.","authors":"Christopher M Horvat, Jesse Klug, Ruoting Li, Jesse Raffa, Thomas Pollard, Leo Celi, McKenzie Plovock, Kimberly Emanuele, Michael Garver, Harry Hochheiser, Robert Clark, Rachel Sackrowitz, Derek Angus, Chenell Donadee, Aimee Boeltz","doi":"10.1097/CCM.0000000000006740","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006740","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the development, validation, and deployment of a risk-adjusted digital quality measure (dQM) bundle for spontaneous awakening trials (SATs), spontaneous breathing trials (SBTs), and low-tidal volume ventilation (LTVV) as part of a quality improvement (QI) program in a large health system.</p><p><strong>Design: </strong>Quasi-experimental before-after study.</p><p><strong>Setting: </strong>Thirty-seven ICUs across 14 hospitals in the United States.</p><p><strong>Patients: </strong>Mechanically ventilated patients older than 16 years.</p><p><strong>Interventions: </strong>An available, open-source, hospital mortality model, a new gradient-boosted ICU mortality model, and four new, heterogenous, stacked ensemble predicted duration of mechanical ventilation (DMV) models (one model predicting up to 14 d of ventilation [14-d DMV model] and three multiple classifier models predicting up to 6 d of ventilation) were created. A regularly refreshing dashboard displaying risk-adjusted information was coupled with audit and feedback sessions for ICU leadership beginning in September 2020.</p><p><strong>Measurements and main results: </strong>Risk model performance was evaluated, as appropriate, with C-statistics, mean se (MSE), concordance correlation coefficients (CCCs), and F1-scores. Across all ICUs, compliance with SBTs improved from 81 to 97%, LTVV 80 to 90%, and SATs 27 to 65%. Both hospital and ICU mortality models had robust performance, with C-statistics of 0.85 (95% CI, 0.84-0.85) and 0.94 (0.93-0.94), respectively. The 14-day DMV model MSE was 0.63 and CCC was 0.97, whereas the multiple classifier DMV models F1-scores ranged from 0.42 to 0.59. Unadjusted DMV was greater post-implementation (4.32 ± 3.99 d) vs. pre-implementation (3.76 ± 3.66 d). Actual vs. predicted ventilator days were stable pre-implementation vs. post-implementation when assessed with the multiple classifier models and decreased in the post-implementation period when assessed with the 14-day model. Risk-adjusted mortality remained stable.</p><p><strong>Conclusions: </strong>A dQM bundle proved useful for efficiently tracking process measures related to a ventilator management QI program in a large health system, although risk-adjusted information differed depending on model constructs. Future work should focus on developing and validating generalizable and interoperable dQM bundles.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282757","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":"Habitual Glucosamine Use and Risk of Sepsis: A 16-Year Follow-Up Study.","authors":"Shaokang Xu, Xiaoke Kong, Jian Shi, Yiting Tang, Bin Zhao, Fang Fang, Jiaqi Huang, Ben Lu","doi":"10.1097/CCM.0000000000006742","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006742","url":null,"abstract":"<p><strong>Objectives: </strong>Despite the well-documented anti-inflammatory and antioxidant properties of glucosamine, a supplement commonly used to relieve osteoarthritis and joint pain, its potential link with sepsis is yet to be elucidated. To evaluate the association between habitual glucosamine use and the risk of sepsis and 28-day mortality following sepsis in a large cohort.</p><p><strong>Design: </strong>A large-scale cohort study.</p><p><strong>Setting: </strong>This was a retrospective cohort study of prospectively collected data, including 437,133 participants of the U.K. Biobank.</p><p><strong>Patients: </strong>A total of 437,133 participants from the U.K. Biobank.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Information on glucosamine use was collected through touchscreen questionnaires at baseline. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs for the associations between habitual glucosamine use and risk of sepsis and 28-day mortality following sepsis. During a median follow-up of 13.6 years, 13,458 incident cases of sepsis and 2,555 deaths within 28 days post-sepsis were identified. In the multivariable-adjusted model, habitual glucosamine use was associated with a lower risk of sepsis (HR, 0.87; 95% CI, 0.83-0.92) and 28-day mortality following sepsis (HR, 0.79; 95% CI, 0.70-0.89). These associations were consistent across stratified and sensitivity analyses. Mediation analysis revealed that 1.2-7.0% of the association for sepsis and 2.8-5.4% of the association for 28-day mortality following sepsis were mediated through inflammatory biomarkers, including C-reactive protein and systemic immune-inflammation index (all p < 0.001).</p><p><strong>Conclusions: </strong>Our findings elucidated that habitual use of glucosamine was associated with lower risks of sepsis and post-sepsis mortality. The observed associations might be partially mediated through inflammatory pathways.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282782","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":"Lactate Values and Mortality in Patients With Cardiogenic Shock: Insights From the Altshock-2 Registry.","authors":"Matteo Pagnesi, Mauro Riccardi, Alice Sacco, Giovanna Viola, Fabrizio Oliva, Simone Frea, Martina Briani, Letizia Fausta Bertoldi, Maurizio Bertaina, Luciano Potena, Serafina Valente, Marco Marini, Gaetano Maria De Ferrari, Nicoletta D'Ettore, Astrid Cardinale, Rita Camporotondo, Matteo Rota, Guido Tavazzi, Nuccia Morici, Federico Pappalardo, Marco Metra","doi":"10.1097/CCM.0000000000006738","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006738","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to evaluate the prognostic role of baseline and 24-hour plasma lactates in patients with cardiogenic shock (CS).</p><p><strong>Design: </strong>Multicenter, observational, prospective Altshock-2 Registry (NCT04295252) enrolling patients with CS since March 2020.</p><p><strong>Setting: </strong>Multicenter Italian Registry (12 centers).</p><p><strong>Patients: </strong>Six hundred fifty-one consecutive patients with CS and available data on lactate values.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The association of baseline and 24-hour lactates with in-hospital mortality (primary endpoint) was evaluated. The optimal lactate cutoff points for predicting outcomes were identified in the overall cohort and among patients treated with mechanical circulatory support (MCS). Among the 651 included patients with CS, the mean age was 64 ± 14 years and 76% were male. On admission, patients with lactates less than 2.0, 2.1-4.0, and greater than 4.0 mmol/L were 248 (38.1%), 172 (26.4%), and 231 (35.5%), respectively. An improvement in lactate values at 24 hours was observed in 76.5% of patients. Baseline and 24-hour lactates were both independently associated with increased mortality (adjusted odds ratios for each 1-mmol/L increase: 1.08 [95% CI, 1.02-1.14] for baseline lactate; and 1.37 [95% CI, 1.15-1.63] for 24-hr lactate), but 24-hour lactates had a higher predictive accuracy than baseline lactates (area under the curve 0.702 vs. 0.648). The optimal baseline and 24-hour lactate cutoffs for predicting mortality were 3.2 mmol/L and 1.7 mmol/L, respectively, and varied in patients treated with MCS at different time points.</p><p><strong>Conclusions: </strong>Higher baseline and 24-hour lactates were both independently associated with increased in-hospital mortality in patients with CS, although the 24-hour value had a higher predictive accuracy. Optimal lactate cutoffs for predicting mortality varied between admission and 24 hours and according to the MCS strategies.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282783","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}