Critical Care Medicine最新文献

{"title":"Association of Breathing Effort With Survival in Patients With Acute Respiratory Distress Syndrome.","authors":"Francisco José Parrilla-Gómez, Andrea Castellví-Font, Víctor Boutonnet, Andrés Parrilla-Gómez, Marta Antolín Terreros, Cristina Mestre Somoza, Marina Blanes Bravo, Paola Pratsobrerroca de la Rubia, Eva Martín-López, Santiago Marco, Olimpia Festa, Laurent J Brochard, Ewan C Goligher, Joan Ramon Masclans Enviz","doi":"10.1097/CCM.0000000000006797","DOIUrl":"10.1097/CCM.0000000000006797","url":null,"abstract":"<p><strong>Objectives: </strong>Invasive mechanical ventilation (IMV) is crucial for acute respiratory distress syndrome (ARDS) management, but mortality remains high. While spontaneous breathing is key to weaning, excessive respiratory effort may injure the lung and diaphragm. Most existing data on respiratory effort during IMV are based on brief periods of observation, potentially underestimating the burden of inappropriate efforts. This study aims to characterize the evolution of respiratory effort over time in ARDS patients and its relation to survival. We hypothesized that nonsurvivors would spend a greater proportion of time in the high-effort range during the active breathing phase compared with survivors.</p><p><strong>Design, setting, and patients: </strong>In this prospective cohort study, we continuously recorded airway pressure, flow, esophageal, and gastric pressures in ARDS patients on mechanical ventilation during 7 days after the onset of spontaneous breathing. We analyzed physiologic respiratory effort variables, focusing on the proportion of time spent within defined effort ranges, and compared these data between ICU survivors and nonsurvivors. Statistical analysis was conducted using variance weighted methods to account for variability in the number of respiratory cycles analyzed per patient. This study is registered at ClinicalTrials.gov under identifier NCT06490523.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>A total of 1,485,405 respiratory cycles were analyzed from 26 ARDS patients (19 survivors, seven nonsurvivors). Nonsurvivors spent significantly more time in high effort (12% vs. 3%; p = 0.006). In contrast, survivors spent more time in the moderate-effort range (50% vs. 5%; p < 0.001). The time spend with high dynamic transpulmonary driving pressure (> 25 cm H 2 O) was also significantly different between groups (32% survivors vs. 74% nonsurvivors; p = 0.001).</p><p><strong>Conclusions: </strong>Patients who die of ARDS are more likely to be exposed to high respiratory effort for prolonged periods of time compared with survivors.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1982-e1994"},"PeriodicalIF":6.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12490343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774848","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":"Hyperoxia and End-Organ Complications Among Cardiogenic Shock Patients Supported by Venoarterial Extracorporeal Membrane Oxygenation.","authors":"Jeffrey Wang, Apoorva Gangavelli, Joseph E Tonna, J Trent Magruder, Akram M Zaaqoq, Suraj Yalamuri, P Elliott Miller, Jacob C Jentzer","doi":"10.1097/CCM.0000000000006810","DOIUrl":"10.1097/CCM.0000000000006810","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate whether severe hyperoxia predisposes to end-organ complications and whether these complications contribute to in-hospital mortality among cardiogenic shock (CS) patients supported in venoarterial extracorporeal membrane oxygenation (VA-ECMO).</p><p><strong>Design: </strong>Adult patients with CS from the Extracorporeal Life Support Organization Registry between 2010 and 2023 were categorized into normoxia (Pa o2 60-150 mm Hg), mild hyperoxia (Pa o2 151-300 mm Hg), and severe hyperoxia (Pa o2 > 300 mm Hg) based on their Pa o2 at 24 hours. The primary outcome was in-hospital mortality. End-organ complications were analyzed using multivariate logistic regression models, and causal mediation analysis was performed to estimate the direct and indirect effects of hyperoxia on mortality.</p><p><strong>Setting: </strong>Multicenter, multinational prospective cohort study.</p><p><strong>Patients: </strong>Adults with CS supported on VA-ECMO.</p><p><strong>Interventions: </strong>Partial pressure of oxygen at 24 hours after VA-ECMO cannulation.</p><p><strong>Measurements/main results: </strong>A total of 10,541 patients were included (normoxia: 48.4%, mild hyperoxia: 30.0%, severe hyperoxia: 21.5%). There was higher in-hospital mortality in patients with severe hyperoxia (71.7%, adjusted OR [aOR]: 2.17; 95% CI, 1.19-2.50) and mild hyperoxia (63.8%, aOR: 1.34; 95% CI, 1.19-1.50) compared normoxia (52.7%; referent group). Severe hyperoxia was associated with more end-organ complications, which incrementally predicted higher mortality (aOR: 1.42; 95% CI, 1.25-1.61). Mediation analysis demonstrated that hyperoxia primary exerted a direct effect on mortality (86%), with contributions from neurologic (3.1%), hepatic (3.9%), renal (3.5%), and bleeding (2.3%) complications.</p><p><strong>Conclusions: </strong>Severe hyperoxia in patients with CS receiving VA-ECMO is associated with increased mortality and more end-organ complications. However, most of the effect of severe hyperoxia on mortality occurs via direct effects, independent of end-organ complications. These findings highlight the potential direct toxicity of hyperoxia and underscore the need for strategies to optimize oxygen delivery in this critically ill population.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e2043-e2053"},"PeriodicalIF":6.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788468","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":"Effect of Comprehensive Medication Management on Mortality in Critically Ill Patients.","authors":"Andrea Sikora, Wanyi Min, John W Devlin, Mengxuan Hu, David J Murphy, Brian Murray, Bokai Zhao, Ye Shen, Xianyan Chen, Susan E Smith, Sandra Rowe, Tianming Liu, Sheng Li","doi":"10.1097/CCM.0000000000006802","DOIUrl":"10.1097/CCM.0000000000006802","url":null,"abstract":"<p><strong>Objectives: </strong>Medication management in the ICU is causally linked to both treatment success and adverse drug events. The purpose of this evaluation was to explore the effect of comprehensive medication management (CMM) on mortality in critically ill patients.</p><p><strong>Design: </strong>Retrospective, observational, propensity-matched cohort study.</p><p><strong>Setting: </strong>Adult ICUs at the Oregon Health Sciences University.</p><p><strong>Patients: </strong>Consecutive adults admitted to an ICU greater than or equal to 24 hours between June 1, 2020, and June 7, 2023, with available pharmacist intervention data.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>CMM was measured by documented critical care pharmacist (CCP) medication interventions. Propensity score matching was performed to generate a balanced 1:1 matched cohort, and logistic regression was applied for estimating propensity scores. The primary outcome was the odds of hospital mortality. Hospital and ICU length of stay were also assessed. In a cohort of 10,441 ICU patients, the unadjusted mortality rate was 11% with a mean Acute Physiology and Chronic Health Evaluation II score of 9.54 ± 4.18 and Medication Regimen Complexity-ICU (MRC-ICU) score of 5.78 ± 4.09. Compared with CCP interventions less than 3, more CCP interventions was associated with a significantly reduced risk of mortality (estimate, -0.04; 95% CI, -0.06 to -0.03; p < 0.01) and shorter length of ICU stay (estimate, -2.77; 95% CI, -2.98 to -2.56; p < 0.01).</p><p><strong>Conclusions: </strong>The quantity of CCP-delivered CMM in the ICU is directly associated with reduced hospital mortality independent of patient characteristics and MRC.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1995-e2004"},"PeriodicalIF":6.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788458","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":"Machine Learning to Predict Individualized Treatment Effects of Sodium Bicarbonate for Patients With Out-of-Hospital Cardiac Arrest.","authors":"Chi-Hsin Chen, Cheng-Yi Fan, Yi-Chien Kuo, Chih-Hung Wang, Hung-Wen Chiu, Edward Pei-Chuan Huang","doi":"10.1097/CCM.0000000000006792","DOIUrl":"10.1097/CCM.0000000000006792","url":null,"abstract":"<p><strong>Objectives: </strong>Current evidence regarding the effect of sodium bicarbonate (SB) on patients with out-of-hospital cardiac arrest (OHCA) remains unclear. This study aimed to develop a machine-learning model to predict the individualized treatment effect (ITE) of SB use in OHCA patients.</p><p><strong>Design: </strong>An eXtreme Gradient Boosting-based causal forest model was developed using an 8-year retrospective OHCA database after propensity score matching (PSM) for age, serum potassium, pH, bicarbonate, and P co2 level.</p><p><strong>Setting: </strong>Multicenter study across three hospitals affiliated with the National Taiwan University Hospital system.</p><p><strong>Patients: </strong>Adult patients with nontraumatic OHCA.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The main outcome was any return of spontaneous circulation (ROSC) following resuscitation in the emergency department. Covariates included age, sex, witness status, bystander cardiopulmonary resuscitation, arrest location, response time, scene-to-hospital time, defibrillation using automatic external defibrillators, prehospital advanced airway type and epinephrine administration, initial cardiac rhythm, and laboratory data. The PSM cohort included 2368 patients. The ROSC rate was not different between the SB-treated and untreated groups. The predicted ITE ranged from a 24.7% absolute increase to a 28.3% absolute reduction in ROSC when SB was administered. The tertile of the predicted ITE significantly modified the effect of the original clinician treatment assignment on outcome ( p < 0.001), and it can discriminate patients who benefit from SB better than random allocation when assessed by the Qini curve and C-for-benefit (0.61). Factors associated with higher predicted benefit from SB administration included older age, poorer renal function, longer scene-to-hospital time, metabolic acidosis, and hyperkalemia.</p><p><strong>Conclusions: </strong>This study suggests the heterogeneous effects of SB on ROSC rates in patients with OHCA. The developed model may help identify specific subgroups more likely to benefit or be harmed by treatment. Further external validations and clinical trials are still needed to evaluate the model.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1874-e1885"},"PeriodicalIF":6.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834408","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":"Epinephrine Before Defibrillation in Children With Initially Shockable In-Hospital Cardiac Arrest.","authors":"Morgan B Swanson, Javier J Lasa, Paul S Chan, Ryan W Morgan, Robert M Sutton, Alexis A Topjian, Dianne L Atkins, Sarah E Haskell, Tia T Raymond, Saket Girotra","doi":"10.1097/CCM.0000000000006804","DOIUrl":"10.1097/CCM.0000000000006804","url":null,"abstract":"<p><strong>Objective: </strong>Assess prevalence of epinephrine before or during the same minute as defibrillation and association with clinical outcomes in pediatric in-hospital cardiac arrest (IHCA).</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>We used 2000-2020 data from the American Heart Association's Get With the Guidelines-Resuscitation Registry.</p><p><strong>Patients: </strong>Children (< 18 yr) with index IHCA with an initial shockable rhythm of ventricular fibrillation or pulseless ventricular tachycardia and at least one defibrillation attempt.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The primary exposure was epinephrine administration before or during the same minute as defibrillation. Study outcomes were survival to hospital discharge (primary outcome), return of spontaneous circulation (ROSC) for greater than or equal to 20 min, and survival with favorable neurologic outcome. Propensity-score matching was used for confounding adjustment. Among 492 pediatric IHCA index events with an initial shockable rhythm, median age was 7 years and 351 (71%) were in the ICU. Overall, 232 (47%) children received either epinephrine before defibrillation (29%) or during the same minute as defibrillation (18%). In unadjusted analyses, proportions of survival to hospital discharge (37.1% vs. 51.2%), ROSC (74.6% vs. 84.6%), and survival with favorable neurologic outcome (22.1% vs. 40.4%) were lower in the epinephrine before or during the same minute as defibrillation group. However, in adjusted analyses using propensity score matching with exact matching on time to defibrillation category, epinephrine before or during the same minute as defibrillation was not associated with hospital survival (odds ratio [OR] 0.84, 0.46-1.56), ROSC (OR 0.97, 0.48-1.96), or favorable neurologic outcome (OR 0.52, 0.27-1.00).</p><p><strong>Conclusions: </strong>Contrary to current guidelines, nearly 50% of pediatric IHCA due to an initial shockable rhythm receive epinephrine before, or during the same minute, as first defibrillation. Although survival outcomes were numerically lower in epinephrine before defibrillation group, the association was not statistically significant.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e2005-e2015"},"PeriodicalIF":6.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741437","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":"Association Between Patients' Admission to the ICU and Psychological Disorders in Their Families: A Retrospective Matched-Pair Cohort Study.","authors":"Kasumi Shirasaki, Hiroyuki Ohbe, Toru Hifumi, Masaki Okajima, Norio Otani, Hideo Yasunaga","doi":"10.1097/CCM.0000000000006793","DOIUrl":"10.1097/CCM.0000000000006793","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the impact of a family member's ICU admission on post-intensive care syndrome family (PICS-F).</p><p><strong>Design: </strong>Retrospective, cohort study using a matched-pair, cohort design and a large administrative database reflecting the entire Japanese population.</p><p><strong>Setting: </strong>The data were provided by DeSC Healthcare (Tokyo, Japan); the database comprised administrative claims data of 3.44 million insurance subscribers.</p><p><strong>Patients: </strong>The exposure group was defined as family members of ICU patients from April 1, 2014 to November 30, 2022. Then, families of ICU patients were randomly matched to individuals in the non-exposure group with an exposure to non-exposure ratio of 1:4; matching was performed by age (the same month and year of birth), sex, status of medical insurance, and relationship with the householder.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The primary outcome was the prevalence of psychological disorders associated with a diagnosis of PICS-F that needed medical care at least once within 6 months after the ICU admission date of the matched pair. Multivariable logistic regression analyses and subgroup analyses by relationship to the ICU patient (spouse, parent, or child) were performed.Of the eligible individuals, 35,652 family members of 27,748 ICU patients were matched with 142,463 individuals in the non-exposure group. The prevalence of psychological disorders associated with PICS-F within 6 months from the index date was significantly higher in the ICU patients' families than in the matched individuals (15.1% vs. 13.6%; adjusted odds ratio, 1.08; 95% CI, 1.02-1.15). Similar to the main analyses, ICU patients' spouses had a significantly higher prevalence of psychological disorders associated with PICS-F than matched individuals, but there were no significant differences in ICU patients' parents and children.</p><p><strong>Conclusions: </strong>Families of ICU patients, especially spouses, were more likely to seek medical care for psychological disorders associated with PICS-F within 6 months than individuals not exposed to a family member's ICU admission.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1963-e1972"},"PeriodicalIF":6.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741434","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":"Association of Medical Burden and Capacity Changes With Clinical Outcomes Among Patients Without COVID-19 During the Pandemic: A Multicenter Retrospective Cohort Study.","authors":"Masaaki Sakuraya, Tomoyuki Sugimoto, Kazuya Kikutani, Chikashi Takeda, Daisuke Kasugai, Hiromu Okano, Yoshitaka Aoki, Hiroki Shimada, Daisuke Kawakami, Akira Hirata, Takushi Santanda, Masaki Nakane, Junji Kumasawa, Toko Fukushima, Keisuke Ota, Naoki Moriyama, Masatoshi Uchida, Hiromasa Irie, Kenzo Ishii, Keisuke Mataichi, Junji Shiotsuka, Kensuke Sugimoto, Naoya Kobayashi, Reiki Kumashiro, Yukiko Koyama, Nobuaki Shime","doi":"10.1097/CCM.0000000000006785","DOIUrl":"10.1097/CCM.0000000000006785","url":null,"abstract":"<p><strong>Objectives: </strong>The spillover impact of the COVID-19 pandemic on patients without COVID-19 in ICUs should be assessed. We aimed to assess the association of ICUs' medical burden and capacity changes with clinical outcomes in such patients during the COVID-19 pandemic.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Twenty-three ICUs in Japan.</p><p><strong>Patients: </strong>Patients without COVID-19 in ICUs from January 2019 to February 2023.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>These ICUs completed a web-based questionnaire on medical burden and capacity limitations in November 2023, and they were classified as having a limited capacity if their scores exceeded the median; otherwise, they were categorized as having a maintained capacity. The primary outcome was the standardized mortality ratio (SMR), calculated with the Acute Physiology and Chronic Health Evaluation III-j model, compared with the pre-pandemic level. Using individual-level patient data, a generalized linear Poisson mixed-effects model including an offset-time term was employed to assess the association of capacity limitation, the number of patients with COVID-19, and ICU bed occupancy on the day of admission, with hazard ratios for in-hospital death. Nine and fourteen ICUs had a limited capacity (25,568 patients) and a maintained capacity (45,068 patients), respectively. SMRs increased in four epidemic waves in the ICUs with a limited capacity but in only one wave in those with a maintained capacity. After adjustment, capacity limitation (hazard ratio, 1.19; 95% CI, 1.01-1.41; p = 0.04) and the number of patients with severe COVID-19 (per five patients; hazard ratio, 1.09; 95% CI, 1.03-1.16; p = 0.002) were associated with in-hospital mortality, but ICU bed occupancy was not.</p><p><strong>Conclusions: </strong>SMRs increased more frequently in ICUs with a limited capacity during the pandemic. Our findings emphasize the need for proactive strategies to mitigate medical burden and capacity limitations for future preparedness.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e1918-e1929"},"PeriodicalIF":6.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144689092","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":"Nicholas M Mohr, Yiqi Tang, David F Gaieski, David G Buckler, Brendan Carr, Alexis Zebrowski","doi":"10.1097/CCM.0000000000006783","DOIUrl":"https://doi.org/10.1097/CCM.0000000000006783","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 10","pages":"e2114-e2115"},"PeriodicalIF":6.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238521","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":"Clinical Presentation, Laboratory Abnormalities, and Predictors of Outcome in 103 Patients With Acute Paraquat Poisoning: A Prospective Observational Study.","authors":"Alladi Mohan, Janjam Harikrishna, Bayyareddy Venkata Rami Reddy, Gottam Bindhu Madhavi, Lakshmanan Jeyaseelan, Kalpalatha K Guntupalli","doi":"10.1097/CCM.0000000000006807","DOIUrl":"10.1097/CCM.0000000000006807","url":null,"abstract":"<p><strong>Objectives: </strong>To study the clinical presentation and predictors of mortality in paraquat poisoning.</p><p><strong>Design: </strong>Prospective observational study.</p><p><strong>Setting: </strong>Tertiary care teaching hospital.</p><p><strong>Subjects: </strong>Patients presenting with paraquat poisoning.</p><p><strong>Interventions: </strong>We studied the clinical presentation, laboratory abnormalities, and predictors of mortality in 103 consecutive patients admitted to the medicine wards and medical ICU with acute paraquat self-poisoning from August 2023 to March 2024.</p><p><strong>Measurements and main results: </strong>The mean age of the patients was 29.5 ± 10.5 years, there were 73 males (70.8%). The most common presenting symptom was vomiting (93%) followed by throat pain (85%). Of the 103, 78 patients died (75.7%). On univariate analysis, significantly higher median (interquartile range) amount of poison consumed (45 mL [20-100 mL] vs. 10 mL [5-10 mL]; p < 0.001), serum creatinine (6 mg/dL [3.8-8.9 mg/dL] vs. 1.9 mg/dL [0.8-3.2 mg/dL]; p < 0.001), serum bilirubin (5.9 mg/dL [3.7-9.5 mg/dL] vs. 1.1 mg/dL [0.7-3.3 mg/dL]; p < 0.001), and Acute Physiology and Chronic Health Evaluation II score (15.5 [12-19] vs. 7 [3.5-11]; p < 0.001) and a significantly lower ratio of Pa o2 /F io2 at the time of admission (300 [150-400] vs. 420 [396-485]; p < 0.001) were evident in patients who died compared with survivors. An increasing trend in the mortality was observed with increasing International Program on Chemical Safety Poisoning Severity Score grade ( p = 0.001). On multivariable analysis, shortness of breath (odds ratio [OR], 0.008; p = 0.072), hepatic dysfunction (OR, 0.012; p = 0.048), duration of hospital stay (OR, 1.030; p = 0.023), and presence of infiltrates on chest radiograph/CT chest (OR, 0.003; p = 0.011) emerged as significant independent predictors of mortality.</p><p><strong>Conclusions: </strong>Paraquat is a lethal poison associated with a high mortality. Identification of predictors of mortality can facilitate early aggressive attempts at initiating appropriate treatment.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e2016-e2024"},"PeriodicalIF":6.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741435","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":"Rethinking Risk: How Body Mass Index Shapes the Impact of Frailty in Critical Care.","authors":"Snigdha Jain, Michaela R Anderson","doi":"10.1097/CCM.0000000000006820","DOIUrl":"10.1097/CCM.0000000000006820","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e2089-e2091"},"PeriodicalIF":6.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144793701","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}