Critical Care Medicine最新文献

{"title":"Association Between Driving Pressure and Subsequent Development of Acute Kidney Injury in Acute Respiratory Distress Syndrome.","authors":"Ioannis Andrianopoulos, Panagiotis Kremmydas, Eleni Papoutsi, Eleni N Sertaridou, Kyriaki Parisi, Eleni A Vavouraki, Ilias I Siempos, Stelios Kokkoris","doi":"10.1097/CCM.0000000000006772","DOIUrl":"10.1097/CCM.0000000000006772","url":null,"abstract":"<p><strong>Objectives: </strong>Although preclinical evidence indicates that injurious mechanical ventilation may lead to acute kidney injury (AKI), relevant clinical evidence is limited. We aimed to investigate the association of driving pressure (a marker of injurious mechanical ventilation) with subsequent development of AKI in patients with acute respiratory distress syndrome (ARDS).</p><p><strong>Design: </strong>Secondary analysis of individual patient-level data from seven ARDS Network and Prevention and Early Treatment of Acute Lung Injury (PETAL) Network randomized controlled clinical trials.</p><p><strong>Setting: </strong>Adult ICUs participating in the ARDS Network and PETAL Network trials.</p><p><strong>Patients: </strong>After exclusion of patients with early AKI (i.e., those who met AKI criteria within the first 2 d following ARDS onset), we classified the study population into two groups: \"late AKI\" and \"no AKI.\" The \"late AKI\" group included patients who developed AKI more than 2 days but no longer than 7 days following ARDS onset.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Of 5367 patients with ARDS initially enrolled in trials, 2960 patients were included in the main analysis. Late AKI developed in 1000 patients (33.8%). After controlling for confounders, baseline driving pressure was independently associated with development of late AKI (each 1 sd increase in driving pressure was associated with a 35% increase in the odds of late AKI [odds ratio, 1.35; 95% CI, 1.15-1.58]). This result persisted in the sensitivity analysis, which did not exclude patients with early AKI, and in the sensitivity analysis, which included patients who developed AKI later than 7 days following ARDS onset. There was a threshold of driving pressure equal to 15 cm H 2 O for its association with development of late AKI.</p><p><strong>Conclusions: </strong>Driving pressure was associated with subsequent development of AKI in patients with ARDS suggesting that injurious mechanical ventilation may lead to AKI.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144539325","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 Encephalopathy Among Critically Ill Patients: Potential Implications for Daily Care.","authors":"Lavi Oud","doi":"10.1097/CCM.0000000000006650","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006650","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 7","pages":"e1518-e1519"},"PeriodicalIF":7.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144539329","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 Goal-Directed Therapy's Untimely Demise.","authors":"Angel O Coz-Yataco, Steven Q Simpson","doi":"10.1097/CCM.0000000000006652","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006652","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 7","pages":"e1522-e1523"},"PeriodicalIF":7.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144539330","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":"Protective Effect of Omega-3 in Sepsis.","authors":"Jiarong He, Yaqiong Liu","doi":"10.1097/CCM.0000000000006653","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006653","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 7","pages":"e1526"},"PeriodicalIF":7.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144539333","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":"Adjunctive Sedation with Dexmedetomidine for the Prevention of Severe Inflammation and Septic Encephalopathy: A Pilot Randomized Controlled Study.","authors":"Manuela Iten, Kaspar Bachmann, Stephan M Jakob, Denis Grandgirard, Stephen L Leib, Luca Cioccari","doi":"10.1097/CCM.0000000000006655","DOIUrl":"10.1097/CCM.0000000000006655","url":null,"abstract":"<p><strong>Objectives: </strong>Septic encephalopathy (SE) occurs in up to 50% of critically ill patients with sepsis and is associated with a high mortality and morbidity. The pathophysiology of SE is complex and involves increased levels of inflammatory mediators. Commonly used sedative drugs, such as propofol and midazolam, may worsen neuronal inflammation. Dexmedetomidine (DEX) has been shown to decrease the production of inflammatory mediators in experimental models of sepsis. The aim of this study was to investigate the effect of DEX on biomarkers associated with SE in critically ill patients with sepsis.</p><p><strong>Design: </strong>Pilot, open-label, randomized controlled clinical trial.</p><p><strong>Setting: </strong>Single-center University Hospital, Switzerland.</p><p><strong>Patients: </strong>Adult patients with sepsis admitted to the ICU, who required intubation and ongoing sedative medication between September 1, 2019, and June 30, 2022.</p><p><strong>Interventions: </strong>DEX-based sedation compared with propofol and/or midazolam-based sedation and serum S100-β level at 48 hr after randomization.</p><p><strong>Measurements and main results: </strong>The study included 70 participants with 34 (48.6%) randomized to the DEX group and 36 (51.4%) to the propofol/midazolam group. Median S100-β levels in the DEX group at 48 hr were 0.103 (interquartile range 0.052-0.194) ng/ml, and in the propofol/midazolam group 0.189 (0.086-0.368) ng/mL ( p = 0.064). Other biomarker showed no differences over time. In patients with a Glasgow Coma Scale less than or equal to 13, the median S100-β level in the DEX group was 0.13 ng/mL (0.06-0.18) compared to 0.91 ng/mL (0.43-0.96) in the propofol/midazolam group ( p = 0.033).</p><p><strong>Conclusions: </strong>DEX-based sedation compared to propofol/midazolam-based sedation did not show any significant difference in S100-β or any other markers of SE in critically ill patients with sepsis requiring mechanical ventilation. The finding of lower S100-β levels in DEX-sedated patients with GCS less than 13 warrants further investigation.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1377-e1388"},"PeriodicalIF":7.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12203981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751444","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":"Algorithmic Centralization of Sepsis Care Is Not a Promising Public Health Strategy.","authors":"David J Wallace","doi":"10.1097/CCM.0000000000006697","DOIUrl":"10.1097/CCM.0000000000006697","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1495-e1497"},"PeriodicalIF":7.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995936","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":"Impact of Emergency Department to ICU Transfer Delays on Patient Outcomes.","authors":"Zhiyi Zhang","doi":"10.1097/CCM.0000000000006647","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006647","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 7","pages":"e1504-e1505"},"PeriodicalIF":7.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144539332","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":"Tomoyoshi Tamura, Hiromichi Narumiya, Koichiro Homma, Motoaki Sano, Masaru Suzuki","doi":"10.1097/CCM.0000000000006695","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006695","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 7","pages":"e1516-e1517"},"PeriodicalIF":7.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144539340","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":"Potassium Levels and In-Hospital Cardiac Arrest: A Matched Case-Control Study.","authors":"Peter C Lind, Nikola Stankovic, Mathias J Holmberg, Lars W Andersen, Asger Granfeldt","doi":"10.1097/CCM.0000000000006713","DOIUrl":"10.1097/CCM.0000000000006713","url":null,"abstract":"<p><strong>Objectives: </strong>Hyperkalemia and hypokalemia are common in admitted patients and recognized as a reversible cause of cardiac arrest. How the risk of in-hospital cardiac arrest changes relative to the severity of hyperkalemia and hypokalemia remains uncertain. The objective of this study was to estimate the association between pre-cardiac arrest hyperkalemia and hypokalemia and in-hospital cardiac arrest and outcomes after in-hospital cardiac arrest.</p><p><strong>Design: </strong>Registry-based matched case-control study.</p><p><strong>Setting: </strong>Hospitalized patients in Denmark from 2017 to 2021.</p><p><strong>Patients: </strong>Cases were adults with in-hospital cardiac arrest identified through the Danish in-hospital cardiac arrest Registry. These were matched with controls on age, sex, and length and time of admission. The index time was defined for cases as their time of cardiac arrest. A corresponding index time was assigned to matched controls.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The exposure was potassium levels within 24 hours of the index time. Outcomes were in-hospital cardiac arrest and return of spontaneous circulation, 30-day survival, and 1-year survival in those with cardiac arrest. A total of 6,658 cases and 49,906 controls were included. Severe hyperkalemia (K + > 6.5) and hypokalemia (K + < 2.5) were associated with 2.03 (95% CI, 1.28-3.23) and 2.65 (95% CI, 1.61-4.38) times the odds of in-hospital cardiac arrest compared with normokalemia, respectively. Increasing severity of hyperkalemia was associated with decreased odds of return of spontaneous circulation, 30-day survival, and 1-year survival after in-hospital cardiac arrest. There was no clear association between hypokalemia and these outcomes.</p><p><strong>Conclusions: </strong>Hyperkalemia was associated with an increased risk of in-hospital cardiac arrest and with worse outcomes after cardiac arrest. Hypokalemia was associated with an increased risk of in-hospital cardiac arrest but was not associated with outcomes after cardiac arrest.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1426-e1436"},"PeriodicalIF":7.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093133","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":"Geographic Clusters in Sepsis Hospital Mortality and the Role of Targeted Regionalization.","authors":"Nicholas M Mohr, Yiqi Tang, David F Gaieski, David G Buckler, Brendan Carr, Alexis Zebrowski","doi":"10.1097/CCM.0000000000006678","DOIUrl":"10.1097/CCM.0000000000006678","url":null,"abstract":"<p><strong>Objectives: </strong>Sepsis is a severe condition associated with high mortality, and hospital performance is variable. The objective of this study was to develop geospatial sepsis clusters, identify sources of variation between clusters, and test the hypothesis that redistributing sepsis patients from low-performing hospitals to higher-performing hospitals within a cluster will improve sepsis outcomes.</p><p><strong>Design, setting, and patients: </strong>We conducted a cohort study of age-qualifying Medicare beneficiaries using administrative claims data from 2013 to 2015. We calculated risk-standardized mortality for hospitals then used a clustering algorithm to define geospatial cluster boundaries based on care-seeking and interhospital transfer patterns. Finally, we used simulation to model the effect of reallocating sepsis patients to higher-performing hospitals within the same cluster.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We included 1,125,308 patients, and they were grouped into 222 regional clusters. High-performing clusters were located largely in the Midwest, and they tended to be in less urban regions with smaller hospitals. In our simulation, the most impactful strategy was reassigning cases from the lowest-performing hospital in a cluster to the highest-performing hospital in the cluster, which was predicted to prevent 1705 deaths per year in the United States. This aggregate benefit was lower than the 5702 deaths predicted from reducing mortality by 1% absolute in hospitals in the lower half of the performance distribution.</p><p><strong>Conclusions: </strong>Geospatial clusters provide insight into regional approaches to system-based acute care. In a simulation study, targeted sepsis regionalization appears less effective than local performance improvement in reducing preventable sepsis deaths.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1365-e1376"},"PeriodicalIF":7.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12213171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978478","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}